The Medicaid Income Limit is the most important criteria for deciding whether you qualify for Medicaid in your state. In this post, we are going to explain in detail the Wisconsin Medicaid Income Limits for 2021. Wisconsin’s Medicaid program is called BadgerCare Plus.
Based on this information, you will be able to determine whether your income qualifies you for Wisconsin Medicaid or not.
However, before we get into details about the income limit, we will first explain the Medicaid program in Wisconsin and how it works.
Next, we will discuss who is eligible for Medicaid, including how eligibility works for various categories, including Children, Pregnant Women, and Adults.
What is Medicaid?
Medicaid is a federal and state health insurance program for people with a low income.
It provides free or low-cost health coverage to millions of Americans, including families and children, pregnant women, the elderly, and people with disabilities.
The Children’s Health Insurance Program (CHIP) offers health coverage to children in families with incomes too high to qualify for Medicaid, but who can’t afford private coverage.
How Many People are on Medicaid?
According to the Centers for Medicare & Medicaid Services, as of November 2020, here are the number of people enrolled in Medicaid and Chip in the entire United States:
- 78,521,263 individuals were enrolled in Medicaid and CHIP
- 72,204,587 individuals were enrolled in Medicaid
- 6,695,834 individuals were enrolled in CHIP
Wisconsin Medicaid
The Wisconsin Medicaid program provides medical coverage to low-income individuals and families.
As of 2020, the program, along with the Children’s Health Insurance Program (CHIP) covered 1.2 million people.
This includes 556,000 children as shown by the image below.
In Wisconsin, the Wisconsin Department of Health Services’ Division of Medicaid Services (DMS) administers the state’s Medicaid Programs.
Who Can Get Medicaid in Wisconsin?
You should apply for Medicaid if your income is low and you match one of the descriptions below:
- You think you are pregnant
- The parent or caretaker of a child and/or teenager under the age of 19.
- You are a child or teenager age 18 or under.
- An adult age 65 or older.
- You are legally blind.
- Living with a disability or disabled.
- You are in need of nursing home care.
Wisconsin Medicaid Income Limit
The WisconsinMedicaid Income Limit is calculated as a percentage of the Federal Poverty Line.
To qualify, you must meet the Wisconsin Medicaid Income limits listed below.
Here is the Federal Poverty Level (FPL) for 2021.
| 2021 Federal Poverty Levels for the 48 Contiguous States & D.C. | |||
| Household Size | Poverty Guideline for 48 states & DC | Alaska | Hawaii |
| 1 | $12,880 | $16,090 | $14,820 |
| 2 | $17,420 | $21,770 | $20,040 |
| 3 | $21,960 | $27,450 | $25,260 |
| 4 | $26,500 | $33,130 | $30,480 |
| 5 | $31,040 | $38,810 | $35,700 |
| 6 | $35,580 | $44,490 | $40,920 |
| 7 | $40,120 | $50,170 | $46,140 |
| 8 | $44,660 | $55,850 | $51,360 |
| Over 8 people | add $4,540 for each additional person | $5,680 | $5,220 |
Additionally, to be eligible for Medicaid, you cannot make more than the income guidelines outlined below:
- Children up to age 1 with family income up to 301 percent of FPL
- Any child age 1-5 with a family income up to 186 percent of FPL
- Children ages 6- 18 with family income up to 151 percent of FPL
- CHIP for children with family income up to 301 percent of FPL
- Pregnant women with family income up to 301 percent of FPL
- Parents of minor children with family income up to 95 percent of FPL
- Individuals who are elderly, blind, and disabled with family income up to 83% of the FPL
Wisconsin Medicaid Income Limit Charts
The Wisconsin Medicaid eligibility income limit charts are divided by groups.
For example, the first chart is focused on income limits for children who qualify for Medicaid.
Similarly, the second chart below focuses on the Medicaid income limits for adults in Wisconsin who qualify for Medicaid.
Wisconsin Medicaid Income Limit for Children
Below is the income limit for children by age category. Find the age category your child falls into and you will see the income limit by household size.
| Wisconsin Medicaid Income Limit – Children | ||||||
| Children Medicaid Ages 0-1 | Children Medicaid Ages 1-5 | Children Medicaid Ages 6-18 | Children Separate CHIP | |||
| % FPL | 100% | 301% | 186% | 151% | 301% | |
|
Household Size
|
1 | $12,880 | $38,769 | $23,957 | $19,449 | $38,769 |
| 2 | $17,420 | $52,434 | $32,401 | $26,304 | $52,434 | |
| 3 | $21,960 | $66,100 | $40,846 | $33,160 | $66,100 | |
| 4 | $26,500 | $79,765 | $49,290 | $40,015 | $79,765 | |
| 5 | $31,040 | $93,430 | $57,734 | $46,870 | $93,430 | |
| 6 | $35,580 | $107,096 | $66,179 | $53,726 | $107,096 | |
| 7 | $40,120 | $120,761 | $74,623 | $60,581 | $120,761 | |
| 8 | $44,660 | $134,427 | $83,068 | $67,437 | $134,427 | |
Next is the income limit for adults by category. Find the category you fall into and you will see the income limit by household size.
Wisconsin has not expanded Medicaid to include adults without dependents.
Therefore, adults without dependents do not qualify for Medicaid in Wisconsin.
For an update on the Medicaid expansion debate and timeline in Wisconsin, see our Wisconsin Medicaid Expansion update below.
Wisconsin Medicaid Income Limit for Adults
| Wisconsin Medicaid Income Limit – Adults | ||||||
| Pregnant Women Medicaid | Adults (Medicaid) Parent/ Caretaker | Seniors & People w/ Disabilities (Medicaid) | Adults (Medicaid) Expansion to Adults | |||
| % FPL | 100% | 301% | 95% | 83% | 95%* | |
|
Household Size
|
1 | $12,880 | $38,769 | $12,236 | $10,690 | $12,236 |
| 2 | $17,420 | $52,434 | $16,549 | $14,459 | $16,549 | |
| 3 | $21,960 | $66,100 | $20,862 | $18,227 | $20,862 | |
| 4 | $26,500 | $79,765 | $25,175 | $21,995 | $25,175 | |
| 5 | $31,040 | $93,430 | $29,488 | $25,763 | $29,488 | |
| 6 | $35,580 | $107,096 | $33,801 | $29,531 | $33,801 | |
| 7 | $40,120 | $120,761 | $38,114 | $33,300 | $38,114 | |
| 8 | $44,660 | $134,427 | $42,427 | $37,068 | $42,427 | |
The state of Wisconsin has not expanded Medicaid under the ACA.
However, the state has a section 1115 demonstration, which provides Medicaid coverage to some additional low-income adults.
In some cases, coverage:
- Includes limitations on eligibility and benefits
- Is not offered to all residents of the state
- Includes an enrollment cap
How to Read the Wisconsin Medicaid Income Limits Charts Above
You cannot have an income higher than the Federal Poverty Level percentage described for your group to be eligible for Medicaid.
Similarly, when you identify the income group that applies to you, the income limit you see refers to the maximum level of income you can earn to qualify for benefits.
For example, if you are pregnant, to qualify for Medicaid, you cannot have an income higher than 301% of the Federal Poverty Level – which for a family of two is $52,434 as shown in the chart above.
How to Apply for Wisconsin Medicaid
There are 3 ways you can apply for Medicaid in Wisconsin.
Option 1 – Apply online
You can apply online through the ACCESS Wisconsin Portal – as shown in the image below.
If you have an account, you can log in or create your ACCESS Wisconsin Account. Click here to be taken to the website.
Option 2 – Apply Income Maintenance or Tribal Agency Office Near You
You can apply in person at the Wisconsin Income Maintenance or Tribal Agency office near you. Click here to locate a DHS office.
Option 3 – Download Application
You can download an application, complete it, and mail it to your county Income Maintenance or Tribal Agency office or submit it in person.
Wisconsin Medicaid Phone Number
Here’s how to contact the Wisconsin Medicaid Agency:
For General Questions About Medicaid, call Wisconsin Medicaid Member Services at 800-362-3002.
This number is for members, member advocates, and those interested in applying for Medicaid in Wisconsin.
Wisconsin Medicaid Expansion Update
While Wisconsin has not opted to expand Medicaid under the ACA, there is no coverage gap in the state.
That is because the state’s Medicaid program does cover all legally present residents with incomes under the poverty level.
Wisconsin is the only non-Medicaid-expansion state that does not have a coverage gap.
That is because all low-income residents either have access to Medicaid or subsidies to help them purchase private coverage in the exchange.
As of May 2020, there were 175,893 non-disabled adults without minor children who had coverage under Wisconsin Medicaid.
This was an increase of nearly 23,000 from March 2020, when the COVID-19 pandemic began, highlighting the importance of Medicaid in covering people who lost their health coverage and their incomes amid the pandemic.
Wisconsin Medicaid Income Limits Summary
We hope this post on Wisconsin Medicaid Income Limits was helpful to you.
If you have any questions about Medicaid in the state of Wisconsin, you can ask us in the comments section below.
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Be sure to check out our other articles about Medicaid.
Income limits for Florida Medicaid
Wyoming Medicaid Income Limits