State of Wisconsin Department of Health Services

Release 24-03 December 18, 2024

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2.4 Valid Application

A valid application for Medicaid must include the applicant’s:

1. Name,
2. Address, and
3. Signature:
   1. In the Signature Section of the Medicaid application (F-10101),
   2. On the Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application (F-10129),
   3. In the Signature Section of the BadgerCare Plus Application Packet (F-10182),
   4. An electronic signature in ACCESS, or
   5. Telephonically.

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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