To see if you may be able to get SeniorCare or to check your benefits, go to access.wi.gov. At this time, you cannot apply for SeniorCare on ACCESS.
Application — F-10076 (PDF, 152KB) — To apply for SeniorCare Prescription Drug Assistance
Authorization of Representative — F-10080 (PDF, 32KB) — Designate someone to apply for SeniorCare for you.
Fair Hearing Request (exit DHS) - To request a hearing if you don't agree with a decision about your benefits.
Fair Hearing Voluntary Withdrawal — DHA 17, (PDF 10KB) *(exit DHS) — If you want to withdraw your request for a hearing.
SeniorCare Member Handbook — P-10079 — To learn more about your SeniorCare Prescription Drug benefits.
Additional Information about SeniorCare can be found at dhs.wisconsin.gov/seniorcare.
Agency Directory - To find the telephone number and address of your local agency.
Income Limits - To find current income limits.
Legal Services (PDF, 189KB) - To find the name and telephone number of who in your area can provide you with legal help. You may also go to:
Legal Action of Wisconsin, Inc. web site at http://www.legalaction.org/ *(exit DHS),
The Wisconsin Judicare, Inc. web site at www.judicare.org/ *(exit DHS), or
SeniorLaw web site at badgerlaw.net/Home/PublicWeb/SrLAW *(exit DHS).
Disability Rights of Wisconsin — Disability Rights Wisconsin is a private non profit organization which helps people across Wisconsin gain access to services and opportunity through its advocacy and legal expertise.*(exit DHS)