|
State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
| Group Size | Annual FPL | 100% FPL | 120% FPL | 133% FPL | 135% FPL | 150% FPL | 156% FPL | 160% FPL | 185% FPL | 191% FPL | 200% FPL | 201% FPL | 240% FPL | 250% FPL | 300% FPL | 306% FPL | 30% of 200% FPL |
| 1 | $13,590 | $1,132.50 | $1,359.00 |
$1,506.23 |
$1,528.88 |
$1,698.75 |
$1,766.70 |
$1,812.00 |
$2,095.13 |
$2,163.08 |
$2,265.00 |
$2,276.33 |
$2,718.00 |
$2,831.25 |
$3,397.50 |
$3,465.45 |
|
| 2 | $18,310 | $1,525.83 | $1,831.00 |
$2,029.35 |
$2,059.87 |
$2,288.75 |
$2,380.29 |
$2,441.33 |
$2,822.79 |
$2,914.34 |
$3,051.66 |
$3,066.92 |
$3,661.99 |
$3,814.58 |
$4,577.49 |
$4,669.04 |
$915.50 |
| 3 | $23,030 | $1,919.17 | $2,303.00 |
$2,552.50 |
$2,590.88 |
$2,878.76 |
$2,993.91 |
$3,070.67 |
$3,550.46 |
$3,665.61 |
$3,838.34 |
$3,857.53 |
$4,606.01 |
$4,797.93 |
$5,757.51 |
$5,872.66 |
|
| 4 | $27,750 | $2,312.50 | $2,775.00 |
$3,075.63 |
$3,121.88 |
$3,468.75 |
$3,607.50 |
$3,700.00 |
$4,278.13 |
$4,416.88 |
$4,625.00 |
$4,648.13 |
$5,550.00 |
$5,781.25 |
$6,937.50 |
$7,076.25 |
|
| 5 | $32,470 | $2,705.83 | $3,247.00 |
$3,598.75 |
$3,652.87 |
$4,058.75 |
$4,221.09 |
$4,329.33 |
$5,005.79 |
$5,168.14 |
$5,411.66 |
$5,438.72 |
$6,493.99 |
$6,764.58 |
$8,117.49 |
$8,279.84 |
|
| 6 | $37,190 | $3,099.17 | $3,719.00 |
$4,121.90 |
$4,183.88 |
$4,648.76 |
$4,834.71 |
$4,958.67 |
$5,733.46 |
$5,919.41 |
$6,198.34 |
$6,229.33 |
$7,438.01 |
$7,747.93 |
$9,297.51 |
$9,483.46 |
|
| 7 | $41,910 | $3,492.50 | $4,191.00 |
$4,645.03 |
$4,714.88 |
$5,238.75 |
$5,448.30 |
$5,588.00 |
$6,461.13 |
$6,670.68 |
$6,985.00 |
$7,019.93 |
$8,382.00 |
$8,731.25 |
$10,477.50 |
$10,687.05 |
|
| 8 | $46,630 | $3,885.83 | $4,663.00 |
$5,168.15 |
$5,245.87 |
$5,828.75 |
$6,061.89 |
$6,217.33 |
$7,188.79 |
$7,421.94 |
$7,771.66 |
$7,810.52 |
$9,325.99 |
$9,714.58 |
$11,657.49 |
$11,890.64 |
|
| 9 | $51,350 | $4,279.17 | $5,135.00 |
$5,691.30 |
$5,776.88 |
$6,418.76 |
$6,675.51 |
$6,846.67 |
$7,916.46 |
$8,173.21 |
$8,558.34 |
$8,601.13 |
$10,270.01 |
$10,697.93 |
$12,837.51 |
$13,094.26 |
|
| 10 | $56,070 | $4,672.50 | $5,607.00 |
$6,214.43 |
$6,307.88 |
$7,008.75 |
$7,289.10 |
$7,476.00 |
$8,644.13 |
$8,924.48 |
$9,345.00 |
$9,391.73 |
$11,214.00 |
$11,681.25 |
$14,017.50 |
$14,297.85 |
|
| 11 | $60,790 | $5,065.83 | $6,079.00 |
$6,737.55 |
$6,838.87 |
$7,598.75 |
$7,902.69 |
$8,105.33 |
$9,371.79 |
$9,675.74 |
$10,131.66 |
$10,182.32 |
$12,157.99 |
$12,664.58 |
$15,197.49 |
$15,501.44 |
|
| 12 | $65,510 | $5,459.17 | $6,551.00 |
$7,260.70 |
$7,369.88 |
$8,188.76 |
$8,516.31 |
$8,734.67 |
$10,099.46 |
$10,427.01 |
$10,918.34 |
$10,972.93 |
$13,102.01 |
$13,647.93 |
$16,377.51 |
$16,705.06 |
|
| 13 | $70,230 | $5,852.50 | $7,023.00 |
$7,783.83 |
$7,900.88 |
$8,778.75 |
$9,129.90 |
$9,364.00 |
$10,827.13 |
$11,178.28 |
$11,705.00 |
$11,763.53 |
$14,046.00 |
$14,631.25 |
$17,557.50 |
$17,908.65 |
|
| 14 | $74,950 | $6,245.83 | $7,495.00 |
$8,306.95 |
$8,431.87 |
$9,368.75 |
$9,743.49 |
$9,993.33 |
$11,554.79 |
$11,929.54 |
$12,491.66 |
$12,554.12 |
$14,989.99 |
$15,614.58 |
$18,737.49 |
$19,112.24 |
|
| 15 | $79,670 | $6,639.17 | $7,967.00 |
$8,830.10 |
$8,962.88 |
$9,958.76 |
$10,357.11 |
$10,622.67 |
$12,282.46 |
$12,680.81 |
$13,278.34 |
$13,344.73 |
$15,934.01 |
$16,597.93 |
$19,917.51 |
$20,315.86 |
|
| 16 | $84,390 | $7,032.50 | $8,439.00 |
$9,353.23 |
$9,493.88 |
$10,548.75 |
$10,970.70 |
$11,252.00 |
$13,010.13 |
$13,432.08 |
$14,065.00 |
$14,135.33 |
$16,878.00 |
$17,581.25 |
$21,097.50 |
$21,519.45 |
|
| 17 | $89,110 | $7,425.83 | $8,911.00 |
$9,876.35 |
$10,024.87 |
$11,138.75 |
$11,584.29 |
$11,881.33 |
$13,737.79 |
$14,183.34 |
$14,851.66 |
$14,925.92 |
$17,821.99 |
$18,564.58 |
$22,277.49 |
$22,723.04 |
|
| 18 | $93,830 | $7,819.17 | $9,383.00 |
$10,399.50 |
$10,555.88 |
$11,728.76 |
$12,197.91 |
$12,510.67 |
$14,465.46 |
$14,934.61 |
$15,638.34 |
$15,716.53 |
$18,766.01 |
$19,547.93 |
$23,457.51 |
$23,926.66 |
|
| 19 | $98,550 | $8,212.50 | $9,855.00 |
$10,922.63 |
$11,086.88 |
$12,318.75 |
$12,811.50 |
$13,140.00 |
$15,193.13 |
$15,685.88 |
$16,425.00 |
$16,507.13 |
$19,710.00 |
$20,531.25 |
$24,637.50 |
$25,130.25 |
|
| 20 | $103,270 | $8,605.83 | $10,327.00 |
$11,445.75 |
$11,617.87 |
$12,908.75 |
$13,425.09 |
$13,769.33 |
$15,920.79 |
$16,437.14 |
$17,211.66 |
$17,297.72 |
$20,653.99 |
$21,514.58 |
$25,817.49 |
$26,333.84 |
|
| 21 | $107,990 | $8,999.17 | $10,799.00 |
$11,968.90 |
$12,148.88 |
$13,498.76 |
$14,038.71 |
$14,398.67 |
$16,648.46 |
$17,188.41 |
$17,998.34 |
$18,088.33 |
$21,598.01 |
$22,497.93 |
$26,997.51 |
$27,537.46 |
|
| 22 | $112,710 | $9,392.50 | $11,271.00 |
$12,492.03 |
$12,679.88 |
$14,088.75 |
$14,652.30 |
$15,028.00 |
$17,376.13 |
$17,939.68 |
$18,785.00 |
$18,878.93 |
$22,542.00 |
$23,481.25 |
$28,177.50 |
$28,741.05 |
|
| 23 | $117,430 | $9,785.83 | $11,743.00 |
$13,015.15 |
$13,210.87 |
$14,678.75 |
$15,265.89 |
$15,657.33 |
$18,103.79 |
$18,690.94 |
$19,571.66 |
$19,669.52 |
$23,485.99 |
$24,464.58 |
$29,357.49 |
$29,944.64 |
|
| 24 | $122,150 | $10,179.17 | $12,215.00 | $13,538.30 | $13,741.88 | $15,268.76 | $15,879.51 | $16,286.67 | $18,831.46 | $19,442.21 | $20,358.34 | $20,460.13 | $24,430.01 | $25,447.93 | $30,537.51 | $31,148.26 | |
| each additional person | $4,720 | $393.33 | $472.00 | $523.13 | $531.00 | $590.00 | $613.59 | $629.33 | $727.66 | $751.26 | $786.66 | $790.59 | $943.99 | $983.33 | $1,179.99 | $1,203.59 | |
| QMB BC+ Extensions trigger limit BC+ Adults limit MAPP premium limit | SLMB | BC+ adult premium limit | QI-1 (SLMB+) | MAGI/BC+ Limit for kids 6-18 subject to access / backdate / EE | SeniorCare tier one limit | BC+ EE for kids ages 1-5 | MAGI/BC+ limit for kids 1-5 subject to access / backdate / EE | QDWI & lower SI Inc Alloc BC+ kids premiums BC+ adults limit | MAGI/BC+ kids premiums | SeniorCare tier three limit | MAPP | BC+ pregnant women kids limit | MAGI/BC+ pregnant women kids limit | excess shelter allowance |
| Annual figures for SeniorCare | $21,744.00 | $27,180.00 | $32,616.00 | |||||||
| $29,296.00 | $36, 620.00 | $43,944.00 |
This page last updated in Release Number: 22-01
Release Date: 04/04/2022
Effective Date: 04/04/2022
The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 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-10030