Site Map

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Applications

• BadgerCare Plus Application Packet, HCF 101082 (725 KB)
• Hmong, HCF 10182H (PDF, 201 KB)
• Spanish, HCF 10182S (PDF, 752 KB)
• Medicaid Disability Application, HCF 10112 (PDF, 263 KB)

• Medicaid, BadgerCare and Family Planning Waiver Registration, HCF 10129 (PDF, 10 KB)
  • Hmong, HCF 10129H (PDF, 75 KB)
  • Russian, HCF 10129R (PDF, 102 KB)
  • Spanish, HCF 10129S (PDF, 74 KB)
• Medicaid / FoodShare Wisconsin Authorization of Representative, HCF 10126 (PDF, 9 KB)
  • Hmong, HCF 10126H (PDF, 57 KB)
  • Russian, HCF 10126R (PDF, 104 KB)
  • Spanish, HCF 10126S (PDF, 60 KB)
• ACCESS — Apply Online

• Wisconsin Medicaid Elderly/Blind/Disabled Application and Review, HCF 10101  (PDF, 782 KB)
  • Hmong, HCF10101H (PDF, 801 KB)
  • Russian, HCF 10101R (PDF, 1.10 MB)
  • Spanish, HCF 10101S (PDF, 790 KB)

Brochures

• For Teens: Birth Control for Wisconsin Teens, PHC 10160 (5/07)
  • Spanish
• Clozapine and Clozaril^®, PDE 3192 (7/04)
• Eligibility and Benefits Booklet, PHC 10025 (PDF, 202 KB) (01/08)
• A Guide to Obtaining Augmentative Communication Devices and Accessories Through Wisconsin Medicaid, PHC 11065 (4/06)
• For Teens: Health Care for Pregnant Teens, PHC 10161 (5/07)
  • Spanish
• HealthCheck, PHC 1007 (12/05)
  • Hmong
  • Spanish
• Ombuds Brochure, PHC 12002 (02/08)
• Medicaid Therapy Services for Children, PHC 1794 (6/05)
• Prenatal Care Coordination, PHC 1046 (6/99)
  • Hmong
  • Spanish
• Private Duty Nursing, POH 1122, (4/99)
• The Wisconsin BadgerCare Plus HMO Program Guide, PHC 12020 (02/08)
  • Hmong
  • Russian
  • Spanish
• Wisconsin BadgerCare Plus Choice Booklet, PHC 12020A (02/08)
  • Hmong
  • Russian
  • Spanish
• Wisconsin Medicaid SSI HMO Program Guide, PHC 12770 (02/08)
  • Hmong
  • Russian
  • Spanish
• Medicaid SSI HMO Choice Booklet, PHC 12770A (02/08)
  • Hmong
  • Russian
  • Spanish
• Medicaid SSI HMO Choice Booklet — Southwest Counties, PHC 12770B (02/08)
  • Hmong
  • Russian
  • Spanish
• Wisconsin Medicaid and BadgerCare Citizenship and Identity, PHC 10162 (10/06)
• Wisconsin Medicaid Estate Recovery Program, PHC 13032 (8/04)
  • Spanish
• Wisconsin Medicaid — Health care coverage for you or someone you know, PHC 10163 (10/06)
  • Hmong
  • Spanish

Contacts

• Medicare Part D contact information
• Recipient Services and other telephone numbers.
• Wisconsin Medicaid Eligibility Outstation Locations and contact information.
• Wisconsin Medicaid Certifying Agencies County/Tribal Social or Human Services Departments.
• Wisconsin Medicaid Certifying Tribal Agencies.
• Social Security Offices in Wisconsin.
• Social Security Administration Web Site.
• Wisconsin Medicaid Managed Care Programs, State-contracted HMOs.
• Wisconsin Medicaid Special Managed Care Programs.
• Division of Supportive Living, Bureau of Quality Assurance (BQA) - Regional Offices.
• Katie Beckett Program Consultants.
• Directory of used medical equipment.

Fact Sheets

• ACCESS — Am I Eligible, PHC 16105 (2/07) (PDF, 47 KB)
• ACCESS — Apply For Benefits, PHC 16107 (2/07) (PDF, 49 KB)
• ACCESS — Check My Benefits, PHC 16106 (2/07) (PDF, 47 KB)
• Alien Eligibility, PHC 10055 (9/01)
  • Hmong
  • Russian (PDF, 77 KB)
• Applying for Medicaid Disability, PHC 10048 (12/06)
• Community Waivers Program, PHC 10059 (1/07)
  • Spanish
• Contact Us — Wallet Card, PHC 16108 (4/07)
• Divestment, PHC 10058 (7/07)
• Emergency Medicaid, PHC 10072 (10/06)
  • Hmong
  • Russian
  • Spanish
• Guide to Applying for Wisconsin Health and Nutrition Programs, PHC 16091 (01/08) (PDF, 173 KB)
• Hmong (PDF, 190 KB)
• Spanish (PDF, 206 KB)
• Health Insurance Premium Payment (HIPP) Program, PHC 10095 (5/05)
• Medicaid Deductible, PHC 10052 (9/06)
  • Spanish
• Medicaid Eligibility Review, PHC 10049 (2/05)
• Medicaid for Migrant Workers, PHC 10053 (7/06)
  • Hmong
  • Russian
  • Spanish
• Medicaid Purchase Plan, PHC 10071 (5/02)
  • Hmong
  • Russian
  • Spanish
• Medical Support Liability, PHC 10064 (2/02) 
• Medicare Premium Assistance, PHC 10062 (5/05)
• Proving Citizenship and Identity For Wisconsin Medicaid/BadgerCare/Family Planning Waiver Program, PHC 10159 (9/06)
  • Hmong
  • Spanish
• Spousal Impoverishment, PHC 10063 (7/07)
• Tuberculosis (TB)-Related Medicaid, PHC 10022 (1/06)
• Hmong
• Russian
• Spanish
• Wisconsin Legal Services Programs, PHC 10096 (5/07) (PDF, 38 KB)
• Wisconsin Medicaid — Patient Liability, PHC 10061 (5/07)
  • Spanish
• Wisconsin Well Woman Medicaid, PHC 10065 (9/06)
  • Hmong
  • Russian
  • Spanish

Federal Poverty Level Guidelines

• Federal Poverty Level Guidelines (FPL)

Forms

• Medicaid Disability Application, HCF 10112 (PDF, 263 KB)
• Authorization to Disclose Information to Disability Determination Bureau, HCF 14014 (PDF, 168)
• Medicaid / FoodShare Wisconsin Authorization of Representative, HCF 10126 (PDF, 9 KB)
  • Hmong (PDF, 57 KB)
  • Russian (PDF, 104 KB)
  • Spanish (PDF, 60 KB)
• Medicaid Change Form, HCF 10137 (PDF, 75 KB)
  • Hmong (PDF, 14 KB)
  • Russian (PDF, 80 KB)
  • Spanish (PDF, 14 KB)
• Medicaid Health Insurance Information, HCF 10115 (PDF, 249 KB)
• Request For Fair Hearing, DHA-28 (PDF, 50 KB)

Privacy Notices

• Notice of Privacy Practices, HCF 13040 (English, Hmong, Laotian [PDF, 368KB], Russian, Spanish)
• Wisconsin Medicaid Privacy Notices
  • HIPAA Privacy Authorization for Use or Disclosure, HCF 13145 (PDF, 94 KB)
  • HIPAA Privacy Revocation of Authorization, HCF 13146 (PDF, 91 KB)
  • HIPAA Privacy Restriction Request, HCF 13147 (PDF, 84 KB)
  • HIPAA Privacy Access Request, HCF 13148 (PDF, 90 KB)
  • HIPAA Privacy Accounting Request, HCF 13149 (PDF, 83 KB)
  • HIPAA Privacy Alternate Communication Request, HCF 13150 (PDF, 88 KB)
  • HIPAA Privacy Amendment Request, HCF 13151 (PDF, 84 KB)
  • HIPAA Privacy Complaint, HCF 13152 (PDF, 87 KB)

Medicare Part D Information

Consumer Alert

• Medicare Beneficiaries Urged to be on the Look-out for Phone Scams — March 7, 2006, CMS (PDF, 68 KB)

Resources

• Medicare Part D FAQs
• Contact Information

Letters

• Medicare Part D Letter Second Notice — 12/16/05
• Medicare Part D Letter — 11/21/05
• SeniorCare Creditable Coverage Letter — 11/8/05

Fact Sheets

• More Time to Fill the Prescriptions You Need — February 2006, CMS Pub No. 11193 (PDF, 414 KB)
• SeniorCare and Medicare Part D, PHC 10074 — 08/06

Related Programs

• BadgerCare Plus

• Caretaker Supplement

• Family Care Information

• FoodShare

• Health Insurance Risk Sharing Plan (HIRSP)

• Medicaid Purchase Plan Information

• SeniorCare

• Supplemental Security Income (SSI)

Translations

Hmong Translations

Applications

• ACCESS — Apply Online
• BadgerCare Plus Application Packet, HCF 101082H (201 KB)
• Daim Ntawv Thov Kev Pab Thiab Soj Ntsuam Rau Viv Xis Kas Xees Medicaid Mes Dis Khes Rau Cov Laus / Dig Muag / IB CE Tsis Meej Xeeb (PDF, 801 KB), HCF 10101H, (Wisconsin Medicaid Elderly/Blind/Disabled Application and Review)
• Medicaid, BadgerCare and Family Planning Waiver Registration (PDF, 75 KB), HCF 10129H
• Tus Tau Kev Tso Cai Sawv Cev Hauv Medicaid (PDF, 57 KB), HCF 10126 

Brochures

• HealthCheck Yog Dab tsi?, PHC 1007H, Rev. 12/05
• Cev xeebtub lawm lo? Yuav kom me nyuam ntsib kev noj qab nyob zoo, yuav tau nug seb Prenatal Care Coordination yog dab tsi, POH 1046H, 7/98
• Phau Ntawv Qhia Txog Wisconsin BadgerCare Plus HMO Program Guide, PHC 12020H, 02/08 (The Wisconsin BadgerCare Plus HMO Program Guide)
• Phau Ntawv Qhia Txog BadgerCare Plus, PHC 12020AH, 02/08 (Wisconsin BadgerCare Plus Choice Booklet)
• Phau Ntawv Qhia Txog, PHC 12770H, 02/08 (Wisconsin Medicaid SSI HMO Program Guide)
• Phau Ntawv Qhiav Txog, PHC 12770AH, 02/08 (Medicaid SSI HMO Choice Booklet)
• Phau Ntawv Qhia Txog, PHC 12770BH, 02/08 (Medicaid SSI HMO Choice Booklet — Southwest Counties)
• Wisconsin Medicaid — Kev pab cuam them nqi kho mob rau koj los sis ib tug koj paub, PHC 10163H, 10/06 (Health care coverage for you or someone you know)

Fact Sheets

• Alien Muaj Feem Tau, PHC 10055, 9/01 (Alien Eligibility) 
• Emergency Medicaid PHC 10072H, 2/06
• Kev Yuav Mes Dis Khes, PHC 10071, 5/02 (Medicaid Purchase Plan)
• Lus Qhia Mus Thov Wisconsin Cov Kev Pab Cuam Rau Kev Mob Nkeeg Thiab Kev Noj Haus, PHC 16091, 01/08 (PDF, 190 KB) (Guide to Applying for Wisconsin Health and Nutrition Programs)
• Medicaid Rau Cov Neeg Caum Hauj Lwm Ua Raws Caij Nyoog, PHC 10053, Rev. 07/06 (Migrant Workers)
• Muab Ntaub Ntawv Pov Thawj Ua Pej Xeem Thiab Qhia Txog Tus Kheej Rau Wisconsin Medicaid/BadgerCare/Family Planning Waiver Program, PHC 10159H, 09/06 (Proving Citizenship and Identity)
• Tuberculosis-(TB) Related Medicaid, PHC 10022H, 02/06
• Wisconsin Well Woman Medicaid, PHC 10065H, 09/06

Forms

• Tus Tau Kev Tso Cai Sawv Cev Hauv Medicaid (PDF, 57 KB), HCF 10126, 1/03 (Medicaid Authorization of Representative)

Privacy Notices

• Daim Ntawv Qhia Txog Kev Siv Moj Kab Sim Nraim, PHC 13040H, 3/03 (Notice of Privacy Practices)

Laotian Translations

• Privacy Notice, HCF 13040L — (PDF 368 KB)

Russian Translations

Applications

• ACCESS — Apply Online
• ПРОГРАММА «мЕДИКЕЙД» ДЛЯ ПРЕСТАРЕЛЫХ / сЛЕПЫХ / НЕТРУДОСПОСОБНЫХ ЗАЯВЛЕНИЕ И ОБЗОР (PDF, 1.10 MB), HCF 10101R,  (Wisconsin Medicaid Elderly/Blind/Disabled Application and Review)
• РАЗРЕШЕНИЕ НА ПРЕДСТАВЛЕНИЕ ИНТЕРЕСОВ ПРОСИТЕЛЯ В ПРОГРАММЕ MEDICIAD (PDF, 104 KB), HCF 10126R, 1/03 (Medicaid Authorization of Representative)
• Medicaid, BadgerCare and Family Planning Waiver Registration (PDF, 102 KB), HCF 10129R, 1/03

Fact Sheets

• (PDF, 77 KB), PHC 10055, 9/01 (Alien Eligibility)
• Программа Emergency Medicaid PHC 10072R, 2/06
• План покупки Medicaid, PHC 10071R, 5/02 (Medicaid Purchase Plan)
• Программа Medicaid для сезонных рабочих, PHC 10053R, Rev. 7/06 (Migrant Workers)
• Обслуживание по программе Medicaid при лечении туберкулеза (TB-Related Medicaid), PHC 10022R, 2/06
• WI Well Woman Программа «Medicaid для здоровой женщины в штате Висконсин», PHC 10065R, 09/06 (Wisconsin Well Woman Medicaid)

Forms

• РАЗРЕШЕНИЕ НА ПРЕДСТАВЛЕНИЕ ИНТЕРЕСОВ ПРОСИТЕЛЯ В ПРОГРАММЕ MEDICIAD (PDF, 104 KB), 10126R, 01/03 (Medicaid Authorization of Representative)

Privacy Notices

• Уведомление о правилах обращения с личной информацией, HCF 13040R, 03/03 (Notice of Privacy Practices)

Spanish Translations

Application

• BadgerCare Plus Application Packet, HCF 101082S (752 KB)
• Medicaid, BadgerCare and Family Planning Waiver Registration (PDF, 74 KB), HCF 10129S, 1/03
• ACCESS — Apply Online
• SOLICITUD Y REVISIÓN PARA EL PROGRAMA MEDICAID PARA ANCIANOS, CIEGOS E InCAPACITADOS DE WISCONSIN (PDF, 790 KB), HCF 10101S, 2/03 (Wisconsin Medicaid Elderly/Blind/Disabled Application and Review)
• AUTORIZACIÓN DE MEDICAID PARA REPRESENTANTES (PDF, 60 KB), HCF 10126S, 1/05 (Medicaid Authorization of Respresentative)

Brochures

• Control de la Natalidad para Adolescentes en Wisconsin, PHC 10160 (05/07) (For teens: Birth Control for Wisconsin Teens)
• Cuidado de Salud para Adolescentes Embarazadas, PHC 10161S (05/07) (For teens: Health Care for Pregnant Teens)
• ¿Qué es HealthCheck?, PHC 1007S, Rev. 12/05
• Embarazada? Para tener un niño saludable pregunte sobre Coordinación del Cuidado Prenatal, (Prenatal Care Coordination) POH 1046S, 1/98
• Guía para el HMO BadgerCare Plus de Wisconsin, PHC 12020S, 02/08 (The Wisconsin BadgerCare Plus HMO Program Guide)
• BadgerCare Plus Folleto de Selección, PHC 12020AS, 02/08 (Wisconsin BadgerCare Plus Choice Booklet)
• Guía para el HMO Medicaid SSI de Wisconsin, PHC 12770S, 02/08 (Wisconsin Medicaid SSI HMO Program Guide)
• HMO Medicaid SSI Folleto de Selección, PHC 12770AS, 02/08 (Medicaid SSI HMO Choice Booklet)
• Wisconsin HMO Medicaid SSI Folleto de Selección Condados del Suroeste, PHC 12770BS, 02/08 (Medicaid SSI HMO Choice Booklet — Southwest Counties)
• Programa de recuperación del patrimonio de Medicaid de Wisconsin, PHC 13032S, Rev. 8/04 (Estate Recovery Program)
• Medicaid de Wisconsin — Cobertura de cuidado médico para usted o para alguien que usted conozca, PHC 10163S, 10/06 (Health care coverage for you or someone you know)

Fact Sheets

• Community Waivers Program, PHC 10059S (1/07)
• Emergency Medicaid, PHC 10072S (2/06)
• Guia Para Solicitar Los Programas De Salud Y Nutricion De Wisconsin, PHC 16091, 01/08 (PDF, 206 KB) (Guide to Applying for Wisconsin Health and Nutrition Programs)
• Medicaid Deductible, PHC 10052S, 9/06
• Medicaid Para Adolescentes, PHC 10057, Rev. 11/03 (Medicaid for Teens)
• Medicaid Para Trabajadores Migrantes, PHC 10053S, Rev. 7/06 (Migrant Workers)
• Plan de compras de Medicaid, PHC 10071S, 5/02 (Medicaid Purchase Plan)
• Prueba de Ciudadania Y de Identidad para Wisconsin Medicaid /BadgerCare/Family Planning Waiver Program de Wisconsin, PHC 10159S (09/06) (Proving Citizenship and Identity)
• Medicaid Relacionado con Tuberculosis (TB), PHC 10022S, 2/06
• Medicaid para el Cuidado de Salud de la Mujer en Wisconsin, PHC 10065S, 09/06 (Wisconsin Well Woman Medicaid)
• Responsabilidad Del Paciente, PHC 10061S (Patient Liability), 05/07

Forms

• AUTORIZACIÓN DE MEDICAID PARA REPRESENTANTES (PDF, 60 KB), HCF 10126S, 01/03 (Medicaid Authorization of Representative)

Privacy Notices

• Notificación sobre prácticas de privacidad, HCF 13040S, 03/03 (Notice of Privacy Practices)

Updates

• Abortions covered by Wisconsin Medicaid and BadgerCare, January 2006
• Notice to Medicaid and BadgerCare Recipients and SeniorCare Participants regarding Brand Medically Necessary Drugs, September 1, 2004
• 100 Days Supply for Prescription Drugs- July 15, 2004
• Medicaid Recipient Update, September 2003
• Letter to parents of children with autism who receive intensive in-home services, June 17, 2003
• Your home care provider is required to supply some disposable medical supplies used for your care, December 2002
• Medicaid Recipient Update, March 2000
• Important Changes to the Medicaid Estate Recovery Program, March 2000
• Copayments and Other Information, October 1997

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Wisconsin Department of Health and Family Services
Protecting and promoting the health and safety of the people of Wisconsin