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Medicaid : Legal Action of Wisconsin
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MEDICAID DEDUCTIBLE

What happens if my income is over the
Medicaid income limits?
If you have income that is higher than the Medicaid income limits, you may qualify by meeting a Medicaid "deductible." The Medicaid deductible is the difference between your income and the Medicaid income limit. The Medicaid deductible period is calculated every six months. Once you meet your deductible you may qualify for Medicaid for the rest of the six months.

Which Medicaid groups have a deductible?
The Medicaid groups that have a deductible program are AFDC-Medicaid, AFDC-Related Medicaid for children (not for caretaker relatives), Healthy Start for children under age six and pregnant women and SSI related Medicaid for persons over age 65 or disabled. There is no deductible in the OBRA Kids or BadgerCare programs.

Example: You apply for Medicaid for yourself and your 15-year-old daughter. The only income in your household is the $950 you earn each month from your job. You and your daughter are over-income for all of the Medicaid categories. Your daughter will only be eligible for AFDC-related Medicaid if she meets a deductible. 
 

Her deductible is calculated as follows:
Gross family income
$950
Earned income deduction
-$90
Net income 
$860
AFDC-related income for two
-$591
Income over Medicaid limit
$269
Medicaid deductible for six-month period: $269×6 = $1614

If your family incurs $1,614 in medical bills, your daughter will qualify for Medicaid for the rest of the six months. Because there is no deductible program for parents who are not disabled, you will not be eligible for Medicaid at this time. You may however, be eligible for BadgerCare.  Your daughter will have a choice of getting Medicaid with a deductible or BadgerCare.  

What kind of medical bills can I use to
meet my deductible?
Medical bills you have incurred within 3 months prior to your month of application, whether paid or not, can be used to meet your deductible. Old bills, regardless of the date, can be used to meet your deductible, as long as you still owe them. Medical bills used to meet a previous deductible or bills paid by the Medicaid program cannot be used to meet your current deductible. Medical bills of your spouse or minor children can be used to meet your deductible.

What happens if my income changes?
If you have a Medicaid deductible and your income changes significantly, contact your worker and a new deductible amount may be calculated.

Can I pay my deductible up front?
You can pay your deductible for six months up front and get a Medicaid card right away without waiting to get medical bills. Ask your caseworker how you can do this.

 
 
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