Medicaid Purchase Plan
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DHS is closely monitoring the current federal government shutdown. Our goal is to keep the public informed, especially our Medicaid members who receive vital health care and services. Even though the federal government has shutdown, Medicaid and BadgerCare Plus members still have coverage to get the care and services they need. We will share information as it becomes available. For updates, visit the Medicaid News page.
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.
Your initial (first) MAPP premium can be paid online in ACCESS (ACCESS in Spanish) or the MyACCESS mobile app or by mailing a check or money order.
You make your initial premium payment and one-time payments the following ways:
- Online in ACCESS (ACCESS in Spanish) or the MyACCESS mobile app with a:
- Checking account or savings account
- Credit card or debit card
- By mailing a check or money order to:
Medicaid Purchase Plan Program
WI Dept of Health Services
PO Box 93187
Milwaukee, WI 53293-0187
After the initial premium payment, you can set up recurring monthly deductions one of the following ways:
- Online with ACCESS AutoPay in ACCESS (ACCESS in Spanish) with a:
- Checking account or savings account
- Credit card or debit card
- Through Electronic Funds Transfer (EFT). Fill out the Member/Employer Electronic Funds Transfer for Medicaid Purchase Plan Premiums, F-13023 to pay from a:
- Checking account
- Savings account
- With 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.
To avoid processing delays, MAPP premiums should be paid online or by mail. If you go to a local agency with a premium payment, the agency staff will help you pay online or assist you in mailing your check or money order.
In very limited circumstances, in-person premiums can be accepted for processing by a local agency.
For this to happen, all of the following must be met:
- You are unable to pay your premium online
- Your benefits will end before the payment can be processed by mail
- You have a specific and immediate medical need where a delay or a stop in benefits will result in:
- Not being able to get a prescription
- Not being able to attend a medical appointment
- Loss of long-term care services
Premium payments are due by the 10th of each month. If you do not pay your MAPP premium by the end of the next month, you will be disenrolled. For example, if your premium payment was due February 10, you will have until March 30 to pay the past due amount before you are disenrolled. This allows you to keep your benefits while managing financial challenges or payment delays.
If you do not pay your premium or do not have an approved temporary waiver of your premium, your MAPP benefits will end. We will send you a letter telling you this is going to happen.
If you lose your MAPP benefits after not paying a premium, you can reenroll in MAPP in the future. You will not need to pay the unpaid premium, but you will need to pay any new premiums for you to re-enroll.
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, you could be disenrolled from your long-term care program as well. If you stop being enrolled in MAPP and are enrolled in different full-benefit Medicaid health care coverage instead, your monthly cost for your long-term care services could increase.
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.
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.
ACCESS AutoPay
ACCESS AutoPay allows you to set up an automatic, ongoing monthly payments from a:
- Credit card
- Debit card
- Checking account
- Savings account
It is available through ACCESS (ACCESS in Spanish) or the MyACCESS mobile app. You can set up ACCESS AutoPay after you have paid your initial premium and if you don't owe any past due or current premiums.
Benefits of ACCESS AutoPay Monthly premiums will be automatically deducted on the third day of each month. This includes weekends and holidays, so you don’t need to worry about delays due to non-business days. This helps ensure timely payments and reduces the risk of benefit loss due to missed payments.
Benefits of ACCESS AutoPay
- It’s a convenient and reliable way to pay ongoing premiums.
- Helps you pay your premium on time each month.
- Avoids mail or processing delays.
Log in to ACCESS (ACCESS in Spanish) or the MyACCESS mobile app. To enroll, you need to select the link titled Set Up AutoPay located on the Premiums Homepage next to your current balance.
If the AutoPay link is not available, you may not be able to set up AutoPay yet. You cannot have any outstanding premiums due. All benefit months including the current month must be fully paid.
After you are enrolled, instead of getting a monthly premium statement, you will get a Recurring Payment Reminder for ACCESS AutoPay.
- You will be disenrolled from ACCESS AutoPay if a payment comes back as “unpaid” because we were unable to process your payment using the account information you provided. This could mean that you didn’t have enough money in the account or that the account was closed. In this case, you will need to pay your future premiums using another payment method.
- You will be disenrolled from ACCESS AutoPay if you no longer owe a MAPP premium or if you are no longer enrolled in MAPP.
- You can also voluntarily choose to end ACCESS AutoPay in ACCESS (ACCESS in Spanish) or the MyACCESS mobile app.
No. There is no service fee or additional charges for paying your monthly premium with ACCESS AutoPay.
You can call Member Services at 800-362-3002 for questions about or issues with:
- ACCESS
- MyACCESS
- ACCESS AutoPay
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 and enrollment 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.