D2l2jhoszs7d12 cloudfront state WisconsinWisconsin Medicaid for the Elderly, Blind or Disabled 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by reading the Important Information section thoroughly. This will provide essential context about eligibility and required documentation.
  3. Fill in your personal information in Section I, including your name, date of birth, and Social Security Number. Ensure clarity by using blue or black ink.
  4. Proceed to Section II for contact information. Include a reliable phone number and email address for communication regarding your application.
  5. In Section III, provide your current address and any relevant details about your living situation, such as whether you reside in a nursing home.
  6. Complete Sections IV through VI by detailing any spouse information, disability status, and assets. Be thorough to avoid delays in processing.
  7. Review all sections carefully before submitting. Use the checklist on page 15 to ensure completeness.

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Wisconsins Family Care Program is a Medicaid long-term care program that provides a variety of services for older people, people with disabilities, and their families. This program offers self-directed support, which allows certain family members to be hired and paid as the personal care provider.
If youre age 65 or over, you likely are eligible for Medicarea federal health insurance program that covers a wide range of services to keep you healthy as you age. (While the minimum enrollment age is generally 65, the program also covers younger people with certain disabilities.)
If you recently lost (or will soon lose) Medicaid, you may be able to sign up for Medicare or change your current Medicare coverage. Dont wait. If you qualify, youll have a limited time to sign up or make changes.
While Medicare is the primary payer for medical needs, Medicaid can cover costs that Medicare coverage does not. When you visit a provider that takes both Medicare and Medicaid, Medicare pays first for the cost of your care. Medicaid pays second, covering copays and other costs not covered.
People who have both Medicare and full Medicaid coverage are dually eligible. Medicare pays first when youre a dual eligible and you get Medicare-covered services. Medicaid pays last, after Medicare and any other health insurance you have.

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Medicaid is the secondary payer and helps to cover leftover out-of-pocket costs like copays and premiums. It may also help pay for services that Medicare doesnt fully cover, including long-term care and personal care services.

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