Medicaid Applications and Forms

Medicaid, BadgerCare Plus 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.

Fair Hearing Voluntary Withdrawal DHA-17 (PDF 11 KB) — To withdraw your Fair Hearing request.

BadgerCare Plus Application Packet F-10182

Wisconsin Circuit Courts Transfer by Affidavit ($50,000 and under) PR-1831

ACCESS.wi.gov — Apply Online

Last Revised: May 11, 2015