BadgerCare Plus, explained
BadgerCare Plus is Wisconsin's Medicaid program for low-income adults, kids, and pregnant residents. It's free or near-free, year-round enrollment, and serves about 1 in 6 Wisconsinites. Here's what to know.
Who qualifies (2026)
- Adults 19–64: household income up to 100% of FPL (~$15,960/yr single, $21,640 for 2-person). Wisconsin did NOT expand Medicaid; adults 101-138% FPL go to the ACA Marketplace instead.
- Children under 19: up to 300% FPL. Children continuously eligible for 12 months once enrolled.
- Pregnant residents: up to 306% FPL. Coverage continues for 12 months postpartum.
The Wisconsin coverage gap
Wisconsin is one of 10 states that didn't expand Medicaid under the ACA. A §1115 waiver from CMS lets WI cover childless adults up to 100% FPL — but adults between 101% and 138% FPL fall into a gap that other states fill with expansion Medicaid. Those adults go to HealthCare.gov (the Marketplace) and usually get a $0 monthly premium with subsidies.
What it covers
BadgerCare Plus is comprehensive — doctor visits, hospital, prescriptions, lab work, mental health, maternity, dental (limited adult), and preventive care. Most members get coverage through one of about a dozen HMO partners (BCBS WI, MercyCare, Children's Community, Group Health Cooperative, MHS Health, Network Health, Quartz, Trilogy, Children's First, etc.). DHS auto-assigns an HMO if you don't pick one within 30 days, but you can switch within that window.
Costs
- Adults: Generally no premium and only nominal copays ($1–$3 per service). Free for those at the lowest income tiers.
- Kids over 200% FPL: Sliding-scale monthly premium ($10–$98 per child).
- Pregnant women: No premium during pregnancy and 12 months postpartum.
How to apply
- 1Online at ACCESS — fastest. Set up an account at access.wisconsin.gov, complete the application, upload documents.
- 2By phone — call your local Income Maintenance agency or the statewide line at 1-800-362-3002. TTY: 711.
- 3In person at your county or tribal Income Maintenance Consortium office.
- 4Paper — download Form F-16001 and mail or drop it off.
After you apply
DHS has 30 days to make a decision (45 if disability is involved). If approved, you get a ForwardHealth member ID card and you pick (or are assigned) an HMO within 30 days. If denied, you have 45 days to request a fair hearing — see our appeals helper for the letter template.
Already on BadgerCare? Things to know
- Annual renewal.WI tries to renew you automatically (“ex parte”) using state data. If they can't, you'll get a packet by mail. Return it. Watch your ACCESS inbox.
- Lost coverage in the unwinding? WI disenrolled 394,000+ people from BadgerCare 2023-2024 — most were procedural terminations. See our unwinding helper for next steps.
- Income changed? You have 10 days to report changes. If your income went up substantially, you may need to switch to the Marketplace.
Want to see what you qualify for?
Our 3-minute screener checks every WI Medicaid program at once.
Start the screener