Medicaid: Forms and Publications

This page includes links to Medicaid forms and publications. Selecting a link will take you to a page where you can choose to view a form or publication in your preferred language.

• Forms—Files for members to fill out
• Guides—Files that explain how Medicaid works
• Publications—Files you can use to share details about Medicaid
• Waiver documents—Information about waivers that give Wisconsin flexibility to design and improve our Medicaid programs.

If you’d like a printed version of a form or publication, make sure it’s available in print first. To do so, select the link you want, then check the “Other Location” column. If it says “None,” it’s not available in print. If it is available, you’ll see a link to fill out a request form.

Forms

Give these forms to Medicaid members (or potential members) if:

• They’re ready to apply for Medicaid.
  • Paper:
    • BadgerCare Plus/Medicaid Health Insurance Information, F-10115
    • Medicaid Disability Application, F-10112—Use this form if you need a disability determination.
    • Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application, F-10129—Use this form if you need to start your application process and set your application date.
    • Wisconsin Medicaid for the Elderly, Blind, or Disabled Application Packet, F-10101
    • Appoint, Change, or Remove an Authorized Representative: Person, F-10126A
    • Appoint, Change, or Remove an Authorized Representative: Organization, F-10126B
    • Paper—Medicaid Change Report, F-10137
    • Online using ACCESS

    Guides and handbooks

    Guides

    View these guides to learn more about Medicaid topics. These are helpful to give to Medicaid members:

    • Guide to Applying for Wisconsin’s Health, Nutrition, and Other Programs, P-16091
    • Medicaid and BadgerCare Plus Private Duty Nursing Guide, P-01122
    • Wisconsin Medicaid Purchase Plan (MAPP) Consumer Guide, P-00181
    • Wisconsin Medicaid SSI HMO Program Guide, P-12770

    Handbooks

    • ForwardHealth Enrollment and Benefits Handbook, P-00079—Each family who applies for a ForwardHealth plan gets a handbook in the mail.
    • Wisconsin Estate Recovery Program Handbook, P-13032

    Publications

    Brochures and flyers

    • BadgerCare Plus or Medicaid SSI HMO Ombuds, P-12002
    • Estate Recovery Transfer by Affidavit, P-13009
    • HealthCheck: Supporting Your Child’s Health, Brochure, P-01007
    • MyACCESS Mobile App Flyer, P-02309
    • Prenatal Care Coordination, P-01046

    Wallet cards

    • ACCESS/Marketplace Takeaway Card (50/pad, order by pad), P-00555
    • MyACCESS Mobile App Wallet Card, P-02308

    Fact sheets

    • Health Care for Migrant Workers, P-10053
    • Health Care for Wisconsin Immigrants, P-10164
    • Key Contacts, P-16108
    • Medicaid and BadgerCare Plus Emergency Services, P-10072
    • Medicaid—Enrollment Renewal Fact Sheet, P-10049
    • Medicaid—Patient Liability, P-10061
    • Medicaid Purchase Plan, P-10071
    • Medicare Savings Programs, P-10062
    • Non-Emergency Medical Transportation
    • Wisconsin Estate Recovery Program Policy Changes Effective August 1, 2014 Fact Sheet, P-00694 (PDF)
    • Wisconsin Medicaid and BadgerCare Plus Tuberculosis-Related Only Services, P-10022
    • Wisconsin Medicaid Divestment, P-10058
    • Wisconsin Medicaid—Home and Community-Based Services Waiver Programs, P-10059
    • Wisconsin Medicaid Spousal Impoverishment Protection, P-10063
    • Wisconsin Well Woman Medicaid, P-10065

    Poster

    Waiver documents

    • The BadgerCare Waiver provides benefits to certain childless, low-income adults.
    • The Section 1115 Postpartum Coverage Demonstration Waiver seeks to extend the length of postpartum coverage.