To see if you may be eligible or to apply, go to access.wi.gov.

Application, (HCF 10101) (English, Hmong, Spanish) (PDF, 268KB) — To apply for Medicaid or you can apply online at access.wi.gov.

Authorization of Representative (HCF 10126) (PDF, 453KB)  — Designate someone to apply for Medicaid for you.

Change Report (HCF 10137) (English, Hmong, Russian, Spanish) (PDF, 544KB) — Report changes to the local agency or you can report changes online at access.wi.gov.

Enrollment and Benefits handbook (PHC 10025) (English, Hmong, Spanish) (PDF, 136KB) — To learn more about your Medicaid benefits.

Fair Hearing Request — (DHA 28) (PDF, 100KB)

Fair Hearing Voluntary Withdrawal (DHA 17) (PDF, 10KB) — If you want to withdraw your request for a hearing.

Guide to Applying for Wisconsin's Health and Nutrition Programs, P-16091, (English, Hmong, Spanish) (PDF, 181KB)  

Statement of Identity, (HCF 10154), English, Hmong, Russian, Spanish), (PDF, 91KB) — To provide proof of identity for children under 18 years of age.

Additional Links

Agency Directory - To find the telephone number and address of your local agency.

Income Limits - To find current income limits.

Additional Information about Medicaid can be found at dhfs.wisconsin.gov/medicaid1/index.htm

Legal Services - To find the name and telephone number of who in your area can provide you with legal help.  You may also go to:

• Legal Action of Wisconsin, Inc. web site at badgerlaw.net/Home/PublicWeb/LAW, or

• The Wisconsin Judicare, Inc. web site at www.judicare.org/.