Medicaid Forms and Publications

Click the number (e.g., F-10115) of a form or publication to go to a page where you will be able to choose a language in which to view that form or publication.

Note: Some materials are available as paper versions and can be ordered by completing an online request form. Before requesting a paper version of a form or publication, review the appropriate forms or publications list to ensure it is available as a paper version. If the entry in the column "Other Location" reads "None," paper versions are not available. All other entry types will provide ordering instructions.

Forms

  • Applications
    • Paper
      • Medicaid—Disability Application, F-10112. (Use this form to if you need a disability determination.)
      • Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application, F-10129. (Use this form to start your application process and to set your application date.)
      • Wisconsin Medicaid for the Elderly, Blind, or Disabled Application Packet, F-10101
    • Online—access.wi.gov
  • BadgerCare Plus/Medicaid Health Insurance Information, F-10115
  • Change Report
  • Fair Hearings
    • Fair Hearing Voluntary Withdrawal, DHA-17 (PDF, 11 KB)
    • Request for Fair Hearing, DHA-28 (PDF, 70 KB)
  • Medicaid/BadgerCare Plus/FoodShare Wisconsin Authorization of Representative, F-10126. (Use this form to designate someone to apply for Medicaid for you.)
  • Statement of Identity for Children Under 18 Years of Age, F-10154
  • Wisconsin Circuit Courts Transfer by Affidavit ($50,000 and under), PR-1831 (PDF, 158 KB)

Guides/Handbooks

Guides
  • Guide to Applying for Wisconsin's Health, Nutrition, and Other Programs, P-16091
  • A Guide to Obtaining Augmentative Communication Devices and Accessories Through Wisconsin Medicaid and BadgerCare Plus, P-11065 (PDF, 73 KB)
  • Private Duty Nursing: A Guide for Wisconsin Medicaid and BadgerCare Plus Members and Their Families, P-01122
  • Wisconsin Medicaid SSI HMO Choice Booklet, P-12770A
  • Wisconsin Medicaid SSI HMO Program Guide, P-12770
Handbooks
  • ForwardHealth Enrollment and Benefits Handbook, P-00079. (A handbook is mailed to each family who applies for a ForwardHealth plan.)
  • Wisconsin Estate Recovery Program Handbook, P-13032

Publications

Brochures
  • BadgerCare Plus or Medicaid SSI HMO Ombuds Brochure, P-12002
  • HealthCheck Brochure, P-01007
  • Prenatal Care Coordination Brochure, P-01046
  • Wisconsin Estate Recovery Program Transfers by Affidavit, P-13009
Fact Sheets
  • ACCESS: Apply for Benefits Card, P-00874
  • ACCESS/Marketplace Take Away Card, P-00555
  • Applying for Medicaid Disability, P-10048
  • BadgerCare Plus and Medicaid Plans—Medical Support Liability, P-10064
  • Community Waivers Plan, P-10059
  • Health Care for Wisconsin Immigrants, P-10164
  • Health Care For Migrant Workers, P-10053
  • Key Contacts, P-16108
  • Medicaid for the Elderly, Blind, or Disabled Divestment, P-10058
  • Medicare Savings Programs, P-10062
  • Non-Emergency Medical Transportation
  • Wisconsin Estate Recovery Program: Policy Changes Effective August 1, 2014 Fact Sheet, P-00694 (PDF,  218 KB)
  • Wisconsin Legal Services Programs, P-10096 (PDF,  211 KB)
  • Wisconsin Medicaid/BadgerCare Plus Deductible Plans, P-10052
  • Wisconsin Medicaid and BadgerCare Plus—Emergency Services, P-10072
  • Wisconsin Medicaid—Enrollment Renewal, P-10049
  • Wisconsin Medicaid—Patient Liability, P-10061
  • Wisconsin Medicaid—Purchase Plan, P-10071
  • Wisconsin Medicaid—Spousal Impoverishment Protection, P-10063
  • Wisconsin Medicaid and BadgerCare Plus Tuberculosis (TB) Only Related Services, P-10022
  • Wisconsin Well Woman Medicaid, P-10065
Last Revised: August 2, 2016