Medicaid is a program that provides health coverage to some low-income Wisconsin residents. Medicaid covers families with children and pregnant women, medically needy individuals, the elderly, and people with disabilities, if state and federal guidelines are met. Legal residents who are not U.S. citizens may be eligible for Medicaid however, questions concerning immigration status and eligibility should be directed to the Wisconsin Department of Health and Family Services.
- For certain categories of people, eligibility for Medicaid is based on the amount of your household income.
In Wisconsin you may be eligible for Medicaid if you are an infant, a child, pregnant, the parent of a dependent child, elderly, or disabled and your family income meets the Medicaid income standards.
Income eligibility levels for these categories are described below. Your assets and some expenses also may be taken into account, so you should contact the Wisconsin Department of Health and Family Services for more information.
Low income persons eligible for Medicaid in Wisconsin*
Category Income eligibility (as percent of federal poverty level)
Infant — 185% (monthly income of about $2,559 for family of 3)
Child 1-19 — 185%
Pregnant woman — 185%
Working — 192%
Non-Working — 185%
Individual — 83%
Couple – 61%
* Eligibility information was compiled State Health Facts Online, the Henry J. Kaiser Family Foundation and may have changed since this guide was published. Contact your state Medicaid program for the most up to date information and for other eligibility requirements that may apply.
To get an idea of how your income compares to the federal poverty level*, use the federal poverty guideline issued by the U.S. Department of Health and Human Services for the year 2006:
Size of Family Unit — Poverty Guideline (annual income)
1 $ 9,800
-For larger families add $3,400 for each additional person.
-So, for example, using this guideline, 185% of the federal poverty level for a family of 3 would be an annual income of $30,710, or a monthly income of $2,559.
*Contact your state Medicaid program for the most up to date information and for other eligibility requirements that may apply.
- Parents who receive benefits under TANF (also called Wisconsin Works) should also know that when you get a job and your TANF benefits end, you generally can stay on Medicaid for a 12-month transitional period.
In addition, your children may qualify for Medicaid if your family’s income meets certain income standards.
- Poor elderly or disabled people who get Supplemental Security Income (SSI) benefits are automatically eligible for Medicaid.
Disabled individuals should know that if your income earned from a job increases so that you no longer qualify for SSI, you may be able to continue your Medicaid coverage at least for a limited time.
- People who have high medical expenses may also qualify for Medicaid. You may qualify as medically needy if you are a child, parent or a dependent child, pregnant, elderly, or disabled and have high medical expenses that, when subtracted from your income, would make you eligible for Medicaid coverage. For example, people who have to pay a lot for prescription drugs, nursing home care, or other long term care services sometimes qualify as medically needy if they don’t have health insurance that covers these services.
- Retired or disabled people who have low incomes and are enrolled in Medicare may also qualify for help from Medicaid. Even though your income may be too high to qualify for Medicaid insurance coverage, there may be other ways Medicaid can help you.
If your household income is below the poverty level, Medicaid will pay your Medicare monthly premium and your Medicare deductibles and coinsurance. This is called the Qualified Medicare Beneficiary (QMB) program.
If your household income is above 100% but below 120% of the poverty level, Medicaid will pay for your monthly Medicare premiums only. This is called the Specified Low-Income Medicare Beneficiary (SLMB) program.
- If you are a child, parent of dependent child, pregnant, elderly or disabled and you have very high medical expenses you may be able to qualify for Medicaid if your income minus your medical expenses is at or below the medically needy income level.
- There may be other ways that Medicaid can help. To find out if you or other members of your family qualify for Medicaid, contact the Wisconsin Department of Health and Family Services.
To obtain the locations and telephone numbers of Department of Health and Family Services offices near you, call (800) 362-3002.