How to Apply for Medicaid in Wisconsin
Health care is expensive. Medicaid is a benefit that provides Americans with the opportunity to obtain low-cost, sometimes free, medication and professional medical care on an annual basis. You may be familiar with the program, but do you know how to apply for Medicaid in Wisconsin?
Many households have the impression that the Medicaid application procedure is burdensome or are confused about how to apply, the list of requirements, and what type of Medicaid plan is applicable to them. Our experienced attorney at Gage-Michaels Law Firm can provide you with the appropriate assistance and direction you need in determining how to apply for Wisconsin Medicaid.
If you want to discover how Gage-Michaels Law Firm can assist you in smoothly navigating the Medicaid application process long term care in Wisconsin, reach out to us today!
Why do I need a Medicaid Lawyer in Wisconsin?
Even if you are the type of person who enjoys accomplishing things on your own, hiring an experienced Medicaid attorney in Wisconsin to help you with your Medicaid application can be your best course of action. Applying for Medicaid can be a complicated process, especially if you are unfamiliar with the program. There are numerous factors that can disqualify you from receiving benefits. And any mistakes may delay your approval and cost you money.
Here are a few of the reasons why Gage-Michaels Law Firm recommends hiring a lawyer to help you with your Medicaid application.
- We can assist you in gathering the necessary documentation to demonstrate your need for long-term care services, as well as correctly preparing and managing your application process.
- We can help you structure your assets to allow eligibility while retaining more value.
- We can guide you in developing a spend-down strategy that will get you qualified sooner and leave more resources for your loved ones.
- We can aid you in identifying any factors that may result in a penalty and, more importantly, assist you in avoiding or reducing any penalties.
Applying in Wisconsin requires strategic Medicaid planning and timing. Gage-Michaels Law Firm can provide you with the legal representation necessary to ensure you meet all the requirements, understand how the application process works, the factors the government takes into account, and how to make the process as simple as possible.
All it takes is a missing document or an error on your application to receive a denial. And the longer you wait, the more difficult it is on your family financially. Applying for Medicaid in Wisconsin can be done smoothly with a Medicaid lawyer on your side. So what are you waiting for? Contact us today!
What is Wisconsin Medicaid?
Medicaid in the state of Wisconsin is a health insurance program for low-income individuals, families, and the elderly that is funded jointly by the federal government and the state. Residents who do not have insurance, senior citizens, and those with disabilities who are eligible for the program are provided assistance in getting the necessary insurance coverage in order to receive appropriate medical treatment.
Wisconsin’s Medicaid program is managed by the Wisconsin Department of Health Services, which includes the ForwardHealth Medicaid plan, BadgerCare+, and Wisconsin Well Woman Medicaid.
Requirements for Wisconsin Medicaid Application
circumstances of your home all play a role in determining which type of Medicaid program you are eligible for. Because the state provides a variety of options, it is crucial that you do your research and seek legal advice from a Medicaid lawyer in Wisconsin. This will help you determine which type of plan best suits your needs and those of your family before submitting an application.
BadgerCare+ is Wisconsin’s Medicaid program for people who are NOT elderly, blind, or disabled. To be eligible, families and individuals must:
- Be residing in Wisconsin
- Be a United States citizen or a qualified immigrant
- Possess or have requested a social security number
- Meet the income requirements of the program
ForwardHealth Medicaid Plan
The ForwardHealth Medicaid Plan covers elderly, blind, and disabled individuals. To qualify for this program, you must:
- Be blind, disabled, or age 65 or older
- Have a household income that meets the monthly program limit
- Be a citizen of the United States or a legal immigrant
If you meet these criteria, you might also be qualified for the Community Waiver or Family Care program, which helps aged, blind, or disabled persons get the care they need to live in their own homes. The Medicare Savings Program, which enables Medicaid to cover all or a portion of your monthly Medicare Part A or Part B premiums, may also be available to you.
Well Woman Medicaid
Women who have been diagnosed with breast cancer or cervical cancer and require treatment are eligible for full Medicaid coverage under Wisconsin’s Well Woman Medicaid program. In order to qualify for this program, you must:
- Participate in the Wisconsin Well Woman program through a local Well Woman coordinating organization
- Have been screened by the Wisconsin Well Woman Program for breast or cervical cancer
- Be under 65 years old
- Be residing in Wisconsin
- Be a United States citizen or an eligible immigrant
- Possess or request a social security number
- Have cervical or breast cancer diagnosis or require treatment for a precancerous disease of the cervix
Other Wisconsin Medicaid Services
Medicaid Purchase Plan
If you are disabled and working, but your adjusted family income is less than 250% of the federal poverty line, and your countable assets are less than the required amount, you can enroll in the Medicaid Purchase Plan. This plan allows you to obtain Medicaid insurance at a reduced cost. And the amount of a premium you will pay is determined by your income.
Tuberculosis Only Related Services Program
If you have tuberculosis and are ineligible for other Wisconsin Medicaid programs, you may be eligible for the Tuberculosis Only Related Services Program. This program covers some of the costs of tuberculosis treatment, including
- Laboratory tests and x-rays
- Prescription drugs
- Physician services
- Services required as a result of treatment side effects
- Services aimed at encouraging treatment program completion
To qualify, you must meet the monthly gross income requirement for a one-person household in Wisconsin.
Emergency Services Program
If your immigration or citizenship status prevents you from receiving Medicaid or BadgerCare+, you may still be eligible for Wisconsin’s Emergency Services Program. To be eligible, you must:
- Be 65 years old or older
- Be disabled or blind
- Be under the age of 19
- Be pregnant
- Have children that are under the age of 19 in your household
You must also satisfy any additional program conditions, such as income restrictions. Only emergency medical services are covered by the Emergency Services Program. As soon as you begin treatment, the service starts, and it lasts until your situation is no longer regarded as an emergency.
You can apply for services if you’re pregnant one month before the due date. The Emergency Services Program aids in covering delivery and emergency scenario costs. Prenatal and postnatal care are not included.
Medicaid Deductible Plus Plan
If you are denied Medicaid or BadgerCare+ services because your household income exceeds the limit, you may still be eligible for the Medicaid Deductible Plus Plan. This plan calculates a deductible based on your excess income, and once that deductible is met, your Medicaid or BadgerCare+ benefits kick in.
How to Apply for Medicaid in Wisconsin?
Obtaining coverage begins with determining where and how to apply for Medicaid in Wisconsin that is most advantageous to you or your loved ones. Learning about the options for where to sign up for Medicaid can help you decide how you want to submit your Medicaid form.
You can submit an application in person, over the phone, online, or via mail or fax.
How to Apply for Medicaid Online
Applying for Medicaid health care coverage online is frequently the quickest and most convenient way for petitioners to request benefits. Many petitioners choose the online Medicaid application because it is the simplest way to submit the completed form and can be accessed from any computer with internet access.
To apply, go to the ACCESS website. When using ACCESS, you can apply for multiple programs at the same time.
How to Apply for Medicaid by Phone
Another option is to apply for Medicaid benefits over the phone. After obtaining the phone number of the county or tribal agency that serves your area, you can call and submit a Medicaid application verbally. The most important aspect of applying for Medicaid over the phone is having all of the required documentation and information ready ahead of time.
How to Apply for Medicaid by Mail / Fax
You can also apply for Medicaid in Wisconsin through the mail or fax. You can complete a Medicaid application form and mail it or fax it to the provided address. Any required proof or supporting documentation establishing Medicaid eligibility must also be included with the mailed or faxed application.
Fill out, print, and send in a paper application for each program to which you are applying.
- BadgerCare Plus Application Packet (F-10182)
- Wisconsin Medicaid for the Elderly, Blind, or Disabled Application Packet (F-10101)
If you live in Milwaukee County, mail or fax your application to
Milwaukee Document Processing Unit (MDPU)
PO Box 05676 Milwaukee, WI 53205
Fax number: 1-888-409-1978
If you don’t live in Milwaukee County, mail or fax your application to
Central Document Processing Unit (CDPU)
PO Box 5234 Janesville, WI 53547
Fax number: 1-855-293-1822
How to Apply for Medicaid In-person
The final way to apply for Medicaid is in person by visiting your local county or tribal agency during their office hours. Many applicants, particularly new petitioners who may require assistance during the process, prefer to sign up in person. In-person applications for Wisconsin Medicaid will allow you to take your time and have your questions and concerns addressed by trained professionals.
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Information Required on the Medicaid Application Form in Wisconsin
This is the information that should be readily available for each individual who is applying for Wisconsin Medicaid:
- Date of birth
- Complete address
- Social Security number
- Marital status
- U.S. citizenship or immigration status
- Full legal names of people living in your home and how they are related
- Latest income tax return
- Job information, including employer’s name, address, and phone number
- Other income (for example, Social Security or Unemployment Compensation)
- Health insurance policies
- Offered health coverage options
What if Your Wisconsin Medicaid Application is Denied?
Once your Medicaid application in Wisconsin is submitted, a decision will be made within 30 days from the date your application is received by the agency.
If you received notification that your Medicaid application has been denied, you have the right to file an appeal. If your Medicaid application was rejected in error, if it was not processed within the 30-day period, or if you disagree with the decision, you can request a fair hearing.
If you decide to request a hearing, you should follow the deadlines and instructions indicated in your Medicaid denial letter. You can also seek legal advice and assistance from a Medicaid attorney in Wisconsin to help you navigate the appeal process.
Call our Competent Medicaid Attorney in Green Bay, Wisconsin, Now!
As you get older, receiving quality care becomes an increasingly important factor.
Before you file your Wisconsin Medicaid application, consult with a Green Bay Medicaid attorney to review your assets, income, and overall status. This will help you determine where you may be vulnerable. You may be able to protect some assets before applying, and it is critical that you understand your rights and legal options for doing so. Failure to follow legal procedures may result in a violation of government regulations, which you do not want to risk when attempting to obtain government healthcare coverage.
Consult Gage-Michaels Law Firm today to discuss your Wisconsin Medicaid application. Our law firm has assisted countless individuals and families in applying for Medicaid, protecting assets, and complying with all laws in order to gain access to Wisconsin quality health care. For more detailed information on how to apply for Medicaid in Wisconsin, call us today and schedule a personalized case evaluation!
What is the Denial Notice?
If your state Medicaid agency declined your application for Medicaid, you have the option to appeal the rejection. Your state agency will handle the appeal, but it must adhere to federal Medicaid appeal regulations. You might be refused Medicaid if you had too much money or assets, or if your state Medicaid agency did not believe you were handicapped if you applied based on disability. When a state Medicaid agency denies a request for assistance, a formal denial notice must be sent.
When Will You Receive the Notice of Refusal?
States are required to adhere to federal timeframes for Medicaid application determinations. States have the following timeframe to issue you a notice of denial:
- If you are applying for Medicaid based on a disability, you must do it within 90 days of your application date.
- If you apply for Medicaid on another basis, you must do it within 45 days after the application date.
Within such timeframes, you should get a written notification of the decision.
How Can You Appeal If Your Medicaid Application is Denied?
Some states require Medicaid beneficiaries to submit their appeal petitions in writing, while others do not. To discover your state’s rules, read your notice carefully. Even if you are not required to file a written notice, you should nonetheless do so. You can draft a straightforward appeal letter.
If possible, submit your request in person at your state Medicaid agency’s local office and have it postmarked to show that it was received by the deadline. You want to avoid establishing that your appeal was submitted on time or justify a late appeal.
Medicaid Appeal Proceedings
Once your appeal is scheduled for a hearing, you must attend (in person or by phone, depending on the state’s regulations) or risk having your appeal dismissed. If your appeal is denied due to your absence from the hearing, you must demonstrate “good cause” (a reasonable reason for missing the hearing) to have the hearing reopened.
It might be tough to establish that you have a good cause. It is insufficient to argue that you forgot the date or lost the notification. Your state Medicaid agency will provide you with information regarding the hearing procedure. In certain areas, the state Medicaid agency conducts hearings, but other states have independent hearings agencies or utilize the court system.
After proper notice, hearings must be held at a reasonable time, day, and location. One or more hearing officers (judges) may conduct hearings, so long as they are impartial and are not directly involved in the initial decision to reject your benefits. Hearing officers can work for the state’s Medicaid agency even if the hearing is at a separate agency.
Getting Ready for the Hearing
Before the hearing, federal Medicaid regulations require states to grant Medicaid applicants access to their files and all the documents upon which the agency relied in denying your Medicaid coverage.
It might be beneficial to write down the points you wish to make to the judge or hearing officer so that you do not forget them during the hearing. In addition, you have the opportunity to present your witnesses at the hearing and to question any of the agency’s witnesses.
You may choose to retain legal representation. You can call your local legal aid agency to determine if they assist clients in Medicaid appeals, or you can reach out to our seasoned Green Bay Medicaid denial and appeal process lawyer. Additionally, federal Medicaid regulations let you utilize a family member, friend, or any other representative of your choosing to assist you with your appeal, or you can represent yourself.
If your Medicaid application was denied because the state Medicaid agency believed you were not disabled, the hearing officer may decide to order you to undergo a second medical exam. If the hearing officer orders you to have a medical examination, you will lose your appeal. The state will pay for any medical checkups or testing that it requests.
After the Hearing
You will get written notification of the decision made by the hearing officer. If you lose your hearing, the notification will include the appeals process. Depending on the state’s particular procedures, at your next appeal, you may not get another chance to testify and bring witnesses (at what’s known as an evidentiary hearing).
You may instead be confined to submitting written arguments about the evidence presented during the initial appeal hearing. Check your refusal letter carefully to determine the state’s appeal procedures.
Retroactive Application of Medicaid Coverage
If you win your appeal and qualify for Medicaid, the state Medicaid agency will retroactively apply your coverage to the day you became eligible. In most cases, this will be the date you submitted your Medicaid application. Keep track of all medical expenses incurred after the date of your Medicaid application so that you can report them to the state Medicaid agency when you become eligible for benefits.
How Can You Avoid Medicaid Appeals?
People from all walks of life may qualify for Medicaid assistance, but certain individuals are more likely to benefit from the advice of our Green Bay Medicaid denial and appeal process lawyer. For example:
- Adults who may require long-term care may incur substantial expenses. Planning for long-term care can help minimize or at least reduce these expenditures by assuring Medicaid eligibility when it is required.
- Families of those with special needs face difficulties in preserving assets while maintaining eligibility for government benefits for their loved ones. The use of estate planning mechanisms, such as various forms of trusts, can help achieve these objectives.
There is no one-size-fits-all answer, and the possibilities are state-specific. Therefore, it is essential to discuss your circumstances with our seasoned Medicaid appeal process lawyer.
How Can Our Green Bay Medicaid Denial and Appeal Process Lawyer Help?
If you are concerned about your Medicaid eligibility, you should seek legal counsel. Our knowledgeable Green Bay Medicaid denial and appeal process lawyer can prevent you from squandering down your assets excessively, advise you on how to manage your funds to maintain eligibility, and complete the application on your behalf.
There is a built-in appeals procedure that involves administrative hearings and judicial actions to protect the rights of vulnerable seniors whose Medicaid applications are originally refused. We have extensive knowledge of elder law and can defend your rights if your application is rejected.
Pre- and post-retirement clients receive our individualized legal services, including Medicaid preparation for those worried about the expense of nursing facility care. Call us now to find out how Gage-Michaels Law Firm might assist you in obtaining the services you deserve.
Schedule an Appointment With Our Green Bay Skilled Medicaid Appeal Process Lawyer
Our skilled Medicaid appeal process lawyer at Gage-Michaels Law Firm can assist you with the Medicaid application process. Our seasoned practitioners keep ahead of legislative changes that may influence your eligibility, and we are unafraid to challenge an unjust refusal.
Suppose you are just beginning the Medicaid application process or believe you or a loved one may require Medicaid in the future. In that case, we can also assist you with the preparation and the application procedure. Call us immediately, whether you live in Green Bay or anywhere else in Wisconsin, to find out how our Medicaid denial and appeal process lawyer can assist you with your Medicaid appeal.