Wisconsin Medicaid Eligibility Requirements

This page provides general guidelines for the Wisconsin Medicaid eligibility requirements. This is an assistance program that provides medical coverage for low-income people of all ages. The department that handles the Medicaid program is Wisconsin Department of Health Services. If you have questions or issues about the Medicaid application or the eligibility requirements, contact the Wisconsin Medicaid office.


Wisconsin Medicaid Overview

The Medicaid program is a federal and state funded program that serves needy individuals and families who meet financial and other eligibility requirements and certain other individuals who lack adequate resources to pay for medical care.


Wisconsin Medicaid Eligibility Requirements - Non Income

The enrollee must be a U.S. citizen or legal alien and a resident of Wisconsin.


Documents Needed For Wisconsin Medicaid Application

  • Proof of U.S. citizenship, or legal immigration status
  • Proof of identity
  • Proof of income and/or assets
  • Proof of medical expenses
  • Proof of pregnancy (If you are pregnant)
  • If acting on behalf of applicant, documentation of Power of Attorney

Wisconsin Medicaid Benefits

Benefits include but are not limited to hospital care (inpatient and outpatient), nursing home care, physician services, laboratory and x-ray services, immunizations and other early and periodic screening, diagnostic, and treatment (EPSDT) services for children, family planning services, health center (FQHC) and rural health clinic (RHC) services, nurse midwife and nurse practitioner services.


Wisconsin Medicaid & CHIP Eligibility Levels

Below is the modified adjusted gross income (MAGI) eligibility levels for Wisconsin Medicaid and Children's Health Insurance Program (CHIP).

Eligibility Levels - By Percentage Of Federal Poverty Level (FPL)

Medicaid Expansion Medicaid Children Separate CHIP Pregnant Women Parents Other Adults
No
Age 0-1: 301%
Age 1-5: 186%
Age 6-18: 151%
 301% (1-18) Medicaid: 301%
CHIP: N/A		 95% 95%

Eligibility Levels - Individual By Monthly Income

Medicaid Expansion Medicaid Children Separate CHIP Pregnant Women Parents Other Adults
No
Age 0-1: $2,927
Age 1-5: $1,809
Age 6-18: $1,468
 $2,927 (1-18) Medicaid: N/A
CHIP: N/A		 $924 $924

Eligibility Levels - Family Of Two By Monthly Income

Medicaid Expansion Medicaid Children Separate CHIP Pregnant Women Parents Other Adults
No
Age 0-1: $3,946
Age 1-5: $2,438
Age 6-18: $1,979
 $3,946 (1-18) Medicaid: $3,946
CHIP: N/A		 $1,245 $1,245

Eligibility Levels - Family Of Three By Monthly Income

Medicaid Expansion Medicaid Children Separate CHIP Pregnant Women Parents Other Adults
No
Age 0-1: $4,964
Age 1-5: $3,067
Age 6-18: $2,490
 $4,964 (1-18) Medicaid: $4,964
CHIP: N/A		 $1,5678 $1,567

Eligibility Levels - Family Of Four By Monthly Income

Medicaid Expansion Medicaid Children Separate CHIP Pregnant Women Parents Other Adults
No
Age 0-1: $5,982
Age 1-5: $3,697
Age 6-18: $3,001
 $5,982 (1-18) Medicaid: $5,982
CHIP: N/A		 $1,888 $1,888

Medicaid Eligibility

State Medicaid Office

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