Introduction to Medicaid 

These are some common questions that parents ask: How do I join a Medicaid-HMO? Before you can join a Medicaid-HMO you need to be eligible for a program called Medicaid. You may also have heard this program called Medical Assistance, MA, or Title 19. Medicaid is a health insurance program run by the State of Wisconsin for low-income persons. If you are eligible, you can get a medical card from your state Department of Health and Family Services. This is the card you take to a doctor or hospital to get medical care.

Are there different types of Medicaid? 
Yes. There are different types of Medicaid for different groups of people. In order to qualify, you must fit within one of these groups. Some people fit into more than one group.  

1. AFDC-Medicaid and AFDC-Related Medicaid

This is for children under age 19 and their parents 
(or other relatives who care for them). 
 
2. Healthy Start

This is for pregnant women and children under age 6, whose family income is below 185% of the federal poverty level. 
 
3. OBRA Kids

This is for children between the ages of 6 and 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. However, Social Security Disability recipients are required to apply for Medicaid through the county. 
 
5. BadgerCare

Eligibility - In July 1999, a new Medicaid program called BadgerCare will be available to Wisconsin residents. BadgerCare will provide health insurance coverage to children under age 19 and parents living 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 the federal poverty level. 

Premiums - If your income is over 150% of the federal poverty level, you will have to pay a monthly premium of not more than 3% of your income. Premiums will be collected through a payroll deduction or other automated system or you can pay it 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 family 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 your fault), you are not eligible for BadgerCare.  This rule 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 BadgerCare. 

• 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.