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1.1 Introduction to Medicaid

1.1.1 Introduction

1.1.2 Subprograms of Medicaid

1.1.3 Financial Introduction Assets EBD Fiscal Group Disabled Minors Income

1.1.4 Health Care Choice

1.1.5 How to Apply

1.1.1 Introduction

Wisconsin Medicaid is a state/federal program that provides health coverage for Wisconsin residents who are elderly, blind, or disabled (EBD) or receive WWWMA . Medicaid is also known as Medical Assistance, MA, and Title 19.

1.1.2 Subprograms of Medicaid

There are different subprograms of Medicaid:



A person may fit into one (or more) of the above subprograms based on non-financial factors. A person is eligible if he or she meets all Medicaid non-financial and financial requirements.  Individuals who are not elderly, blind or disabled (EBD) may be eligible for BadgerCare Plus. See the BadgerCare Plus Handbook for more information.

1.1.3 Financial Introduction

See Section 39.4 Elderly, Blind, and Disabled Assets and Income Tables for EBD asset limits. See Section 25.7.2 Financial Tests for TB-related asset limits. See Section Disabled Minors to determine Medicaid eligibility for disabled minors that fail BadgerCare Plus financial tests. Assets

The EBD fiscal group’s assets must be within the appropriate categorically needy or medically needy asset limit before any member of that group can qualify for Medicaid. EBD fiscal groups who have assets in excess of the appropriate EBD asset limit are ineligible for Medicaid. EBD Fiscal Group

An EBD fiscal group includes the individual who is non financially eligible for Medicaid and anyone who lives with them, who is legally responsible for them. EBD fiscal test groups will always be a group of one or two. Spouses who live together are in each other’s fiscal group. This means that the income and assets of both spouses are counted when determining Medicaid eligibility for either or both spouses. The fiscal group size for this situation/living arrangement is two.


There are some exceptions to this concept. A blind or disabled minor living with their parents would be a one person fiscal group. Special instructions for deeming parental income and assets to the disabled minor are described in Section 24.1 SSI Related Medicaid Introduction.


Another exception to the fiscal group policy involves SSI recipients. If one spouse is applying for EBD Medicaid and the other spouse is an SSI recipient, the SSI recipient spouse is not included in the other spouse’s fiscal group. For this situation you would again have a one person fiscal group when determining the Medicaid eligibility of the non-SSI spouse.


An individual applying for Long Term Care Medicaid, including institutional, Home and Community-Based Waivers, Family, PACE, Partnership or IRIS would be a one person fiscal group. If the individual is married, refer to Section 18.1 Spousal Impoverishment Introduction for special instructions regarding spousal impoverishment procedures. Disabled Minors

A blind or disabled minor (or dependent 18 year old) can have their Medicaid eligibility determined according to special procedures when the disabled minor fails BadgerCare Plus eligibility test or when the parent chooses to decline BadgerCare Plus for their child and have their child receive EBD Medicaid if eligible. See Section 15.1.2 Special Financial Tests for Disabled Minors. Income

See Section 39.4 Elderly, Blind, and Disabled Assets and Income Tables for EBD income limits. See 39.5 FPL Table for all other Medicaid income limits. Chapters for each type of Medicaid explain how to determine the income that you compare to the income limits.


See Section 39.4.2 EBD Deductions and Allowances for TB-related income limits.

1.1.4 Health Care Choice

Once an individual has been determined eligible for Elderly, Blind, or Disabled Medicaid (EBD MA), he or she must be enrolled in EBD MA, even if they are also eligible for BadgerCare Plus (BadgerCare Plus), unless they have a change in circumstances that results in ineligibility for EBD MA. The only exception to this policy is pregnant women who are eligible for both EBD MA and BadgerCare Plus. In these instances, the pregnant woman will be enrolled in BadgerCare Plus.


If someone is pending for EBD MA or if they have an unmet deductible for EBD MA, the individual is not considered eligible for EBD MA and can enroll in BadgerCare Plus. Pending for EBD MA includes, but is not limited to, waiting for a disability determination from DDB or not eligible for Medicare. If an individual enrolled in EBD MA becomes ineligible for EBD MA for any reason, including going over the asset limit or failure to pay a MAPP premium, he or she can enroll in BadgerCare Plus if he or she is still eligible to do so.

1.1.5 How to Apply

The following application options are available for anyone who is applying for EBD Medicaid:


  1. ACCESS online application at https://

  2. Face-to-face Interview at the agency.

  3. Mail-in.

  4. Telephone interview.


Click here to view the directory of local IM agencies in Wisconsin or call Member Services at (800) 362-3002.




This page last updated in Release Number: 15-01

Release Date: 06/10/2015

Effective Date: 06/10/2015