ABC's : Your Healthy Family : Legal Action of Wisconsin
Legal Action of Wisconsin Inc. - created by BAM!
Introduction to Medicaid
there different types of 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.
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.
to other Insurance
and AFDC-Related Medicaid
is for children under age 19 and their parents
other relatives who care for them).
is for pregnant women and children under age 6, whose family income is
below 185% of the federal poverty level.
is for children between the ages of 6 and 19, whose family income is below
100% of the federal poverty level.
& SSI-Related Medicaid
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.
- 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.
- 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.
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
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
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.
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.