• General Information
  • Introduction
  • Provider Certification
  • Eligibility Criteria
  • Applications
    • Introduction
    • Obtaining Forms
  • Eligibility Verification
  • Duration of Benefits
    • Introduction
    • Extensions
  • Applying for Full-Benefit Medicaid
  • Covered Services
  • Claims
• Appendix
  • Appendix 1 — Instructions for Completing the Presumptive Eligibility for Pregnant Women Application
  • Appendix 2 — Sample Presumptive Eligibility for Pregnant Women Application
• PDF

General Information

Applying for Full-Benefit Medicaid

Since the PE for Pregnant Women Benefit is a limited benefit that is also temporary, pregnant women should apply for full-benefit Medicaid while receiving services through the PE for Pregnant Women Benefit. Providers should remind women that, despite their receiving Forward cards, applying for Wisconsin Medicaid is necessary to receive full Medicaid benefits, including inpatient delivery.

Presumptive eligibility providers may assist women with completing the Medicaid application at the same time PE determination takes place. The following may be requested electronically from the DHFS Web site by completing an electronic order form (DMT 25A):

• Medicaid, BadgerCare, and Family Planning Waiver Registration Application, HCF 10129 (fillable PDF, 67 KB).
• Wisconsin Family Medicaid, BadgerCare, and Family Planning Waiver Program Application, HCF 10100 (PDF, 261 KB), and completion instructions. This form is now obsolete and has been replaced with the BadgerCare Plus Application Packet, HCF 10182 (PDF, 725 KB).

These forms, in addition to the Medicaid/FoodShare Wisconsin Authorization of Representative form, HCF 10126 (PDF, 9 KB) may be downloaded from the Recipient section of the Medicaid Web site. All of these forms may also be requested by faxing or mailing a request to the DHCF Forms/Publications Manager.

After completing the application, the recipient should be referred to a county/tribal social or human services agency or Medicaid outstation site where the woman can apply for full-benefit Medicaid. A list of county/tribal social or human service agencies and Medicaid outstation sites is available on the Recipient section of the Medicaid Web site.

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