ForwardHealth: BadgerCare Plus and Medicaid Emergency Services

Emergency Services is a program for people who have a medical emergency but can’t get Medicaid or BadgerCare Plus because of their:

• Citizenship status.
• Immigration status.

The program may pay for medical emergencies if you:

• Are 18 years or younger, or 65 years or older.
• Are blind or disabled.
• Are pregnant.
• Are 18-25 years and in foster care or out-of-home care when you turned 18.
• Have children under age 19 in your home. 

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What services are covered

The Emergency Services program will only pay for medical emergencies. A medical emergency is a health problem that could cause you serious harm if you don’t get medical care right away. This doesn’t include care for chronic, or long-lasting, conditions.

If the problem is not considered an emergency, you will have to pay for your medical care.

You don’t need to have a Social Security number to use the program. In addition, your family’s information will not be shared with the United States Citizenship and Immigration Services.

Example of services covered

Sara had a heart attack. She received treatment at the hospital. This was a medical emergency. Sara applied and was covered by BadgerCare Plus Emergency Services. Weeks later, she went for a routine checkup. This was not a medical emergency. Emergency Services did not cover it.

Who can apply

To apply for Emergency Services, you must have an immigration status that stopped you from getting BadgerCare Plus or Medicaid. You also must:

• Live in Wisconsin.
• Be one of the following:
  • Age 18 years or younger.
  • Age 65 years or older.
  • Age 18-25 and in foster care or out-of-home care when you turned 18.
  • A parent or caregiver of a child younger than age 19 who lives with you.
  • Pregnant.
• Have a monthly income at or below the following (see the table below):
  • For newborns through age 1, up to 306% of the federal poverty level (FPL).
  • For children ages 1-5, up to 191% of the federal poverty level.
  • For children ages 6-18, up to 156% of the federal poverty level.
  • For youth aged 18-25 in out-of-home care when they turned 18, any percent of the federal poverty level.
  • For pregnant women, up to 306% of the federal poverty level.
  • For parents and caretakers, up to 100% of the federal poverty level.

Income requirements

Using the table below, find your family size. Then find your income. You and your children may qualify if your income is less than the dollar amount in the correct column.

For example: If you’re a single parent with two children ages 2 and 5, you’re a family of three. Your children are in the 1-5-year age group. That means if your income is less than $4,109.69 each month (the 191% FPL column), your children are eligible.

If your income is less than $2,151.67 (100% FPL column) each month, you are eligible.

How to apply

You must apply for the Emergency Services benefit through your local county or tribal agency. Your agency will ask you for the dates of your emergency. Your doctor can help you get this information.

You can apply in one of these ways:

• Online—Use the ACCESS website.
• Phone—Call your local county or tribal agency during their office hours.
• Mail—Fill out and mail an application. To get an application, or if you have questions, call ForwardHealth Member Services at 800-362-3002 between 8 a.m.–6 p.m., Monday through Friday.
• In person—Go to your local county or tribal agency during their office hours.

You can get a Certification of Emergency for Non-U.S. Citizens, F-01162 from the doctor who treated. This form states that you received care for a medical emergency. You can include this form with your application, but it is not required.

When to apply

Your Emergency Services benefits begin the first day you get medical care for the emergency. They end when your condition is no longer considered an emergency. You must apply for benefits within three months of the first day of emergency care.

If you’re pregnant, you may be able to join the BadgerCare Plus Prenatal Plan. This program covers routine doctor visits. It also covers hospital care related to pregnancy and labor and delivery.

If you’re not able to get benefits through the BadgerCare Plus Prenatal Plan, Emergency Services may cover your labor and delivery costs. You can apply up to one month before your due date. If you qualify, your coverage will last 60 days past the end of your pregnancy. It also stays in effect through the end of the month of the 60th day.

This means, if you have your baby on March 3, the 60 days ends on May 2. Your coverage lasts until May 31 (the end of May).

Your rights

You have the right to a fair hearing. If you disagree with a decision made about benefits, you can share why. A hearing officer will listen to you and your agency to find out if the decision was right or wrong. You don’t have to go alone. You can bring a friend, family member, or attorney to the hearing.

To ask for a hearing, use a letter or a Request for Fair Hearing form. Fax your letter or the form to 608-264-9885. You can mail your letter or form to:

Division of Hearings and Appeals
PO Box 7875
Madison, WI 53707-7875

You also can get free legal help. To learn more, call Legal Action of Wisconsin at 888-278-0633 or Wisconsin Judicare Inc. at 800-472-1638.

Need more help?

• Call ForwardHealth Member Services at 800-362-3002. You can call any time Monday through Friday, from 8 a.m.—6 p.m.
• Contact your local county or tribal agency.
• Learn more about BadgerCare Plus Prenatal Services.
• View or print our brochure, Wisconsin Medicaid and BadgerCare Plus – Emergency Services, P-10072.
• Visit our ForwardHealth program resources page.