State of Wisconsin Department of Health Services

Release 24-02 August 22, 2024

View History

25.4 Valid Application

A valid applicationA request for BadgerCare Plus coverage. The request must be on the Department's application or registration form and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. for BadgerCare Plus must include the applicant’s:

• Name
• Address
• Signature in the Rights and Responsibilities section of one of the following forms:
  • Wisconsin Medicaid for the Elderly, Blind, or Disabled Application Packet (F-10101)
  • Wisconsin Medicaid, BadgerCare Plus and Family Planning Services Registration Application (F-10129)
  • BadgerCare Plus Application Packet (F-10182)
  • BadgerCare Plus Supplement to FoodShare Wisconsin Application (F-10138)
  • Application for Health Coverage & Health Paying Costs
  • Application for Health Coverage & Help Paying Costs from the FFMFederally-Facilitated Marketplace (also known as the Marketplace or the Exchange). Applications for BadgerCare Plus or Medicaid may be filed with the Federally-Facilitated Marketplace, run by the U.S. Department of Health and Human Services. The Marketplace will assess their applicants as potentially eligible for the State’s Medicaid or CHIP programs, and, if found potentially eligible, will transfer individual accounts to the income maintenance agency for a full determination. Individuals who apply at income maintenance agencies or ACCESS and are found ineligible for Medicaid or CHIP will be sent to the Marketplace.
  • Telephonic signature in CWW
  • Electronic signature in ACCESS
  • Electronic signature in an account transfer from the FFM

This page last updated in Release Number: 17-04
Release Date: 12/13/2017
Effective Date: 12/13/2017

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The information concerning the BadgerCare Plus program provided in this handbook release is published in accordance with: Titles XI, XIX and XXI of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapter 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2 and 101 through 109 of the Wisconsin Administrative Code.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10171