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Medicaid, BadgerCare and Family Planning Waiver Registration Application, F-10129 — Use this form to start your application process and to set your application date. You can also do this online at
access.wi.gov.
Wisconsin Medicaid for the Elderly, Blind and Disabled Application/Renewal, F-10101 — Use this form to apply. You can also apply online at
access.wi.gov.
Medicaid Disability Application, F-10112 — Use this form to if you need a disability
determination.
Medicaid / FoodShare Wisconsin Authorization of Representative, F-10126 — Designate someone to apply for Medicaid for
you.
Medicaid Change Form, F-10137 — To report changes. You can also report changes online at
access.wi.gov.
Medicaid Health Insurance Information, F-10115
Request For Fair
Hearing, DHA-28 (PDF, 50 KB) — To request a Fair Hearing. (Leaving DHS)
Fair Hearing Voluntary
Withdrawal, DHA-17 (PDF, 11KB) — To withdraw your Fair Hearing request. (Leaving DHS)
BadgerCare Plus Application Packet, F- 10182
Wisconsin Circuit Courts Transfer by Affidavit
($50,000 and under) (Leaving DHS) PR-1831
ACCESS.wi.gov — Apply Online
Last Revised:
February 21, 2013
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