Medicaid is a joint, federal and state program that covers healthcare and long-term supports for children and adults with disabilities. Children in foster care, pregnant women, people with low income, and older adults may also be eligible for Medicaid. Medicaid is part of ForwardHealth and is managed by the Department of Health Services.

Medicaid Has Many Names 

In Wisconsin, Medicaid is also known as: Medical Assistance (MA), BadgerCare Plus, Title 19, SSI-Related Medicaid and Katie Beckett.  

Medicaid may be important for your child, or whole family, if you:

• • • do not have access to affordable private insurance,
    • can’t afford the additional out-of-pocket costs of private insurance or,
    • need services not covered by a private insurance plan.

Important Medicaid Benefits!

Families who have children with special health care needs often don’t realize that Medicaid covers many important services and supplies. With a medical provider’s prescription, a child’s Medicaid (ForwardHealth) card will pay for diapers for children ages 4 and older, transportation (or mileage reimbursement) to medical and therapy appointments, and some over-the-counter medications.

Through Medicaid’s HealthCheck Other Services (www.dhs.wisconsin.gov/publications/p02413-0419.pdf) treatments like residential mental health services, orthodontia and many other services deemed “medically necessary” can be covered.  

Doorways into Medicaid

There are several ways to be eligible for Wisconsin Medicaid. Any of these entry points give access to the same Medicaid coverage.

• • • Income A child whose family meets the low-income requirements may qualify for BadgerCare Plus. Children in a household whose income is less than 306% of the Federal Poverty Limit (FPL) and single adults over the age of 18, whose income is under 100% FPL, may qualify. To learn more, go to dhs.wisconsin.gov/badgercareplus.
    • Disability: A child with “marked and severe” physical or mental health limitations, but whose family income is too high for BadgerCare Plus, may qualify through the Katie Beckett Program. To learn more about Katie Beckett visit dhs.wisconsin.gov/kbp, or see: What is the Katie Beckett Program? For questions about eligibility for Katie Beckett Medicaid, contact an eligibility specialist by calling (888) 786-3246, or emailing DHSKatieBeckett@dhs.wisconsin.gov
    • Disability and Income: A child who meets both the disability and income requirements may be eligible for Supplemental Security Income (SSI). SSI provides a monthly check. In addition, the child qualifies for Medicaid. For information visit the Social Security Administration’s disability site ssa.gov/family or read our SSI and Children with Disabilities Fact Sheet.

Medicaid Funded Long-Term Support Programs:

There are additional programs connected to Medicaid that can provide support at home for children with special health care needs or disabilities. These programs are referred to as Medicaid waiver programs. This includes the Children’s Long-Term Support Program and county-based mental health programs, like Coordinated Service Teams.  

At age 18, Medicaid waiver programs that serve adults with disabilities include Family Care and IRIS.

What if My Child Qualifies for More than One Medicaid Program?

A child may qualify for Medicaid through several “doorways.” This can be very helpful, especially if your family’s income changes over the year. For example, a child may be eligible through SSI and Katie Beckett. Having Katie Beckett as a “backup” to keep your child’s FowardHealth card is a way to ensure their coverage does not lapse.  

Can My Child Have Both Private Insurance and Wisconsin Medicaid?

Yes. Families who have private insurance may wonder if applying for, and maintaining Medicaid coverage for, their child is helpful.

While a private health plan or HMO covers many important health services and therapies, a child with a disability or chronic health condition may need medically related services, equipment and supplies not covered by private insurance plans.

Also, your private insurance coverage might change from year-to-year, so having Medicaid for a child with higher medical needs helps to keep these needs and prescriptions fully covered and maintains the continuity of care.

Some of the Benefits of Having both Private Insurance and Medicaid

• • • Medicaid can be used to pay co-pays, deductibles, or other out-of-pocket expenses from private insurance.
    • Medicaid can cover additional therapy visits if there are annual limits on your private health plan.
    • Medicaid can cover supplies, like diapers and other incontinence supplies, or special formulas that are not typically covered by most health plans.
    • Medicaid covers prescription medications that may not be covered by private plans.  
    • Medicaid’s HealthCheck “Other Services” benefit can be used to cover the cost of many over-the-counter medications. See “What is HealthCheck Other Services.”
    • Medicaid can help cover the costs for transportation to appointments, whether in town or hundreds of miles away—A benefit most private insurers do not offer. See “Medicaid and Non-Emergency Medical Transportation.”

Who can Help with Medicaid Denials?

Start by reviewing the Family Voices fact sheet, Medicaid: Appealing a Denial.  If you need additional help with appealing a denial from Wisconsin Medicaid, contact ABC for Health at (608)261-6939.  They are a public interest law firm that offers support to families who have medical financing concerns.

INFORMATION AND RESOURCES

Wisconsin Wayfinder: Children’s Resource Network, 877-WiscWay (877-947-2929): Wisconsin Wayfinder offers families one name and phone number to find services for children with special health care needs. Wayfinder connects you to a resource guide at one of the five Children’s Resource Centers in your area.