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Medicaid : Legal Action of Wisconsin
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There are different types of Medicaid for different groups of people. In order to qualify you must fit into one of these groups. Some people belong to more than one.

1. AFDC-Medicaid 
This is for children under age 18 and their caretaker relatives who would have qualified for AFDC under rules existing prior to July 16, 1996.

2. AFDC-Related Medicaid
This is for children under age 19, their parents or caretakers, if their income is higher than the AFDC limits, but below the AFDC-related income limits.  See RULES FOR SPECIAL GROUPS for special rules on Medicaid eligiblilty for an 18 year old.

3. Healthy Start-OBRA Kids
This is for children under age 19, whose family income is below 100% of the federal poverty level.

4. SSI & SSI-Related Medicaid
This is for people who are age 65 or older, blind or permanently disabled.  Every person who receives SSI will get Medicaid without having to apply separately.

5. BadgerCare

BadgerCare Eligibility
In July 1999, a new Medicaid program called BadgerCare became available to Wisconsin residents.  BadgerCare provides health insurance coverage to children under age 19 and parents residing with their children, who have incomes below 185% of the federal poverty level.  If you are found eligible for BadgerCare, you can be on the program until your income is over 200% of poverty.

Premiums
If your income is over 150% of the federal poverty level, you will be required to pay a monthly premium of not more than 3% of your income.   Premiums will be collected through a payroll deduction or electronic fund transfer from a bank account or you can pay directly. If you fail to pay the premium, you will be terminated from BadgerCare and will not be allowed to reapply for six months, unless you have a good reason for not paying the premium.

Access to other Insurance

  • If you can get family health insurance through your job you cannot get BadgerCare if your employer pays at least 80% of the premium.
  • If you had the opportunity to get family health insurance within 18 months before your application for BadgerCare, where the employer would have paid at least 80% of the premium, and you did not sign up, you will be ineligible for BadgerCare.  With some exceptions, you will be ineligible for 18 months, starting with the first day of the month that you could have been covered by your employer's policy.
  • If you have health insurance through your job or had health insurance for your family in the three months before you apply (unless the reason you lost the insurance was not due to your fault) you are not eligible for BadgerCare.  This rules applies even if your employer doesn't pay your health insurance premium.  However, if your employer doesn't pay at least 80% of your family's health insurance premium you can drop your insurance, wait 3 months and then apply for Badger Care.
  • The state may pay for health insurance for your family through your job if:
    • your employer pays between 60% and 80% of the premium;
    • your family did not have health insurance through a job in the previous six months; and
    • it costs less to buy an employer's plan than to pay for BadgerCare.
Note: If the state pays for health insurance through your job, and that plans covers fewer services than the Medicaid program, then Medicaid will pay for services which are not covered by your employer's plan.
 
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