Medicaid Purchase Plan
You’re the Medicaid expert Wisconsin needs
Nobody knows Medicaid better than those who use it every day. That’s why we are forming a new group of people with current or past experience with Medicaid, and we want you to join! The Medicaid Member Experience Council (MMEC) will talk about how Medicaid is working, and how it can be improved. You can help build a better future for health care in Wisconsin by joining in and speaking up.
The Medicaid Purchase Plan (MAPP) offers Medicaid health care coverage to adults with disabilities who work or want to work. With MAPP, you can:
- Earn more income and have more assets than other Medicaid programs for people with disabilities.
- Save earnings in Independence Accounts, helping you reach personal and financial goals.
MAPP benefits are the same as those for other Medicaid members. If you are enrolled in MAPP, you may also be eligible to get long-term care services and supports through Family Care, Family Care Partnership, PACE (Program of All-Inclusive Care for the Elderly), IRIS (Include, Respect, I Self-Direct), or the Children’s Long-Term Support program.
Frequently asked questions
General program information
To qualify for MAPP, you must:
- Be at least 18 years old.
- Be a resident of Wisconsin.
- Be a U.S. citizen or qualifying immigrant.
- Be determined disabled by the Disability Determination Bureau.
- Have an adjusted family income of 250% of the federal poverty level (FPL) or less, based on your family size.
- Have individual assets of $15,000 or less.
- Countable assets include:
- Cash
- Checking and savings accounts
- Certificate of deposits
- Stocks and bonds
- Some life insurance policies
- Some annuities
- Some burial assets
- Countable assets don’t include:
- Your home or one car you own
- Achieving a Better Life Experience (ABLE) accounts
- Countable assets include:
- Meet the MAPP work requirement.
- Pay a monthly premium, if required.
MAPP is not a family health care plan. Any members of your family who are not eligible for MAPP may be able to get health coverage through BadgerCare Plus or another Wisconsin Medicaid program.
MAPP covers:
- Doctor visits
- Immunizations
- Hospital care
- Medical equipment
- Hearing services, including hearing aids
- Lab and X-ray services
- Transportation to Medicaid services
- Vision care, including eyeglasses
- Prescription drugs
- Family planning services and supplies
- Speech therapy
- Mental health services
- Dental services
You can apply for MAPP:
- Online using ACCESS (ACCESS in Spanish)
- By mail. Download the Wisconsin Medicaid for the Elderly, Blind, or Disabled Application Packet, F-10101.
- By phone or in person at your local agency.
Monthly premiums
A premium is a set amount of money we are required by state law to charge each month for your MAPP benefits if your gross monthly income is over a certain amount.
Your premium amount is determined by your gross monthly income. If your total gross monthly income is above 100% federal poverty level (FPL), you will have to pay a monthly premium to keep your MAPP benefits.
Premiums are based only on your income before taxes and other deductions—not the income of other people in your household.
If your gross monthly income is below 100% FPL, you will not have to pay a monthly premium.
After you pay your first premium (if you owe one), the rest are due by the 10th of each month. MAPP will send you a monthly statement with the amount due. You can pay:
- Online with a checking or savings account or a credit or debit card in ACCESS (ACCESS in Spanish) or the MyACCESS mobile app.
- By mailing a check or money order to:
Medicaid Purchase Plan Program
WI Dept of Health Services
PO Box 93187
Milwaukee, WI 53293-0187 - In person at your local agency with a check or money order.
You can also set up automatic ongoing monthly payments:
- Through Electronic Funds Transfer (EFT). Fill out the Member/Employer Electronic Funds Transfer for Medicaid Purchase Plan Premiums, F-13023 form.
- By wage withholding if offered by your employer. Work with your employer to fill out the Medicaid Purchase Plan Premium Employer Wage Withholding, F-13024 form to have the amount taken out of your paycheck.
Your MAPP benefits will end if you do not pay your premium by the 10th of each month. They will also end if your payment is returned or refused. If you participate in an adult long-term care program (Family Care, Family Care Partnership, IRIS, or PACE) and do not pay your MAPP premium, those benefits will also end.
You might be able to get your benefits back if:
- We process your late payment on or before the last day of the month your payment was due.
- You ask to start MAPP again the month after you lost your benefits, or later. You may have to pay a premium for the month you ask to restart.
If you can’t pay your premium due to a difficult situation, you may be able to stop paying for a short time. This is called a temporary waiver. Things to know about temporary waivers:
- You may ask for a temporary waiver to last for up to 12 months.
- You can ask for your waiver to backdate up to three months.
- You may ask for more than one temporary waiver as long as it does not exceed more than 12 months for the same difficult situation.
Examples of difficult situations include unexpected expenses related to work, an unexpected expense that may take a few months to pay off, or not being able to find childcare.
Learn more about the Medicaid Purchase Plan (MAPP) Hardship Waiver, P-03699 and find out if you qualify.
To ask for a temporary waiver, complete the Request for a Temporary Waiver of your Medicaid Purchase Plan Premium Because of a Difficult Situation, F-02603 form.
Work requirement
A work requirement means you have to engage in a work activity to get and keep your program benefits.
You have options to meet the MAPP work requirement. You can:
- Engage in a work activity at least once per month. This includes receiving wages from an employer, through self-employment, or by trading in-kind work for goods or services. "In-kind" work means you provide a service for someone in return for something of value, such as food, goods, or services.
- Enroll in the Health and Employment Counseling (HEC) pre-employment program if you are not currently employed but are looking for work.
If you have a health-related hardship and cannot work, you can apply for a temporary work exemption by filling out the Medicaid Purchase Plan Work Requirement Exemption, F-10127 form.
Volunteering does not meet the work requirement. You will still have to pay your premium while you are exempt from the work requirement if you owe one.
Independence Accounts
An Independence Account is a financial account. Once you are enrolled, you can save up to half of your job earnings in an Independence Account without it counting toward the $15,000 asset limit.
If you save more than half of your earnings over 12 months in this account, you will have to pay a penalty.
You can set up an Independence Account once you become a MAPP member, but not before.
All Independence Accounts must be registered with your agency. Do this by filling out the Medicaid Purchase Plan (MAPP) Independence Account Registration, F-10121 form.
When you enroll, you can register your retirement or pension accounts as Independence Accounts. The amounts already in these accounts before you enroll will count toward the $15,000 asset limit.
Deposits, interest, gains, or dividends added after a retirement or pension account becomes an Independence Account won't count toward the $15,000 limit. This is true as long as you are in MAPP.
Questions?
- Contact your local agency with eligibility questions.
- For help applying, contact your local Aging and Disability Resource Center (ADRC).
- Call Member Services at 800-362-3002 (voice) or 711 (TTY) for information on covered services or providers.