Wisconsin BadgerCare Plus 2026: Who Qualifies and Apply

BadgerCare Plus pays for health care; it isn't cash or a grant, and it costs nothing to apply. Our Wisconsin Medicaid income limits guide has every income line by family size.

BadgerCare Plus at a Glance (November 2026)

BadgerCare Plus is full coverage Medicaid for Wisconsinites ages 0 to 64, and DHS says there's no open enrollment period: you can apply any day. According to the DHS income guidelines data and program pages Grantsights read on November 13, 2026:

Sources: DHS BadgerCare Plus page, income guidelines, Apply for Benefits page and member handbook P-00079, checked November 13, 2026.

Why Wisconsin Isn't a Coverage Gap State

Wisconsin covers adults up to 100% of poverty, and Marketplace premium tax credits start at 100%, according to the HealthCare.gov Medicaid expansion page (opens in a new tab). That means a low-income adult usually has somewhere to go: BadgerCare Plus below the line, a subsidized Marketplace plan above it. In states that neither expanded nor cover adults to 100%, HealthCare.gov says people under 100% fall into a gap.

What Wisconsin gives up is money and reach. DHS's August 2025 summary says that if Wisconsin expanded to 138% of poverty, the federal share for those adults would rise from about 60 cents to 90 cents on the dollar. The same summary says the 2025 federal law adds barriers that make expansion "fiscally and operationally unfeasible," including six-month renewals that would apply to an expansion population.

Grantsights analysis of the 2026 chart shows the practical split for one adult: earn $1,330 a month or less and BadgerCare Plus is the better route; earn more and the Marketplace is where to look. A worker whose hours swing month to month should report income changes promptly so DHS can move them between the two.

Who Qualifies for BadgerCare Plus in 2026

DHS's income chart sets 3 main lines for February 1, 2026 to January 31, 2027:

• Adults (100% of poverty): parents, caretakers and adults without children, $1,330 a month for one, $2,276.67 for three and $2,750 for four.
• Pregnant people and children (306% of poverty): $4,069.80 a month for one and $8,415 for four. Count each expected baby in a pregnant person's household.
• Children's premium threshold (201% of poverty): children 1 through 18 in families above $5,527.50 a month for four pay a premium, but the handbook says a child keeps coverage even if the family can't pay.

Seniors, people with disabilities and nursing home residents use separate Medicaid programs with their own income and asset rules. People who work and have a disability may use the Medicaid Purchase Plan (MAPP).

Noncitizen change, October 1, 2026. DMS Operations Memo 26-29 says adult noncitizens with these statuses lost eligibility for BadgerCare Plus and most Medicaid programs that day: conditional entrants, refugees and special immigrants, asylees, people paroled for at least a year, people granted withholding of removal, VAWA self-petitioners, foreign-born members of a Tribal Nation, trafficking victims and their families, and Amerasians. Lawfully residing children and pregnant people keep their coverage options, and emergency services remain. The national Medicaid income limits guide shows how Wisconsin's adult line compares with neighbors such as Minnesota and Iowa.

What BadgerCare Plus Covers and Copays

DHS's BadgerCare Plus page lists doctor visits, prescriptions, urgent and emergency care, lab tests, pregnancy and family planning, mental health and assisted living, and the member handbook adds dental, vision with eyeglasses and rides to appointments. Most adult services carry small copays, per the member handbook's Appendix B:

Source: Wisconsin DHS member handbook P-00079 (opens in a new tab), Appendix B, checked November 13, 2026.

Monthly copay limits. Federal law caps copays and premiums at 5% of household income, and the handbook's 2026 table sets a monthly limit for one person of $0 under 50% of poverty and $26 between 50% and 100%. A one-person household with income under $665 a month pays no copays at all. Children under 19, pregnant people, American Indian and Alaska Native members and young adults who aged out of out-of-home care pay none. Providers must try to collect a copay but can't refuse care if you can't pay.

BadgerCare Plus HMOs

BadgerCare Plus is a mandatory HMO program for most members, with a 3-month window to switch plans, and everyone eligible in the same household joins the same HMO, per the BadgerCare Plus Eligibility Handbook (section 38.4). Which HMOs you can pick depends on where you live; the HMO Enrollment Specialist at 800-291-2002 gives unbiased counseling and takes your choice.

How the timing works:

• Start date: if your eligibility is set before the 10th of the month, HMO enrollment starts the 1st of the next month; on the 10th or later, it starts the 1st of the month after that. Until then, you can see any BadgerCare Plus-certified provider.
• Changing plans: you get a three-month open enrollment period from your first HMO start date to switch freely, then a nine-month lock-in. After the lock-in ends, you can change at any time, which restarts the cycle.
• Who can't join: people in a long-term care managed care organization, nursing home residents and people with both BadgerCare Plus and Medicare.

If your doctor isn't in your assigned HMO, call during the first three months, not after.

How to Apply for BadgerCare Plus, Step by Step

DHS offers 4 routes and calls ACCESS the fastest and easiest. One ACCESS application can also cover FoodShare and other programs.

Step 1: Choose a route

Source: Wisconsin DHS Apply for Benefits page, revised June 25, 2026, checked November 13, 2026.

ForwardHealth Member Services (800-362-3002) can tell you which agency serves your county.

Step 2: Have information ready

DHS asks for details on each person applying, and for BadgerCare Plus, information about any health insurance available through an employer. The DHS guide P-16091 lists the full set.

Step 3: Expect a decision within 30 days

The handbook says you have the right to a decision within 30 days of the day your agency gets your application. You can ask for a fair hearing if it isn't acted on in that time. After approval, a ForwardHealth card comes in the mail.

Step 4: Ask about back coverage

Per Eligibility Handbook section 25.8.2, most BadgerCare Plus eligibility can be backdated up to three months before the application month, and adults without children under 100% of poverty are eligible for backdating. DHS's August 2025 summary says that starting January 1, 2027, new enrollees can get back coverage for only 2 months before they apply, so anyone with bills from this fall should apply before the new year.

For example, one applicant in Eau Claire, a 52-year-old living alone who earns $1,200 a month from part-time retail work, is under the $1,330 adult line. At about 90% of poverty, her copay limit would be $26 a month, and her pay already clears the $580 income test in the 2027 work rule (an illustration built from Wisconsin DHS's 2026 figures, not a real case).

Wisconsin's 2027 Work Requirement

DHS mailed letters in August 2026 to members who may be affected. The rule, from the 2025 federal budget law, covers BadgerCare Plus members who are 19 to 64, not pregnant, not disabled and without a dependent child under 19 living with them at least 40% of the time.

When it starts, per DHS's work requirement page:

• New applicants, January 1, 2027: you must meet the rule in the month before you apply; a January 2027 applicant needs a qualifying December 2026.
• Most current members, March 2027: checked at your next scheduled renewal, looking for one qualifying month since you were last approved, which is usually the last 12 months.

How to meet it in a month: 80 hours of work, volunteering or work program participation; at least half-time school; any combination adding to 80 hours; or at least $580 in household income. DHS says paid, in-kind and unpaid work such as internships can count, and unemployment compensation counts toward the $580 because it's income.

Exemptions DHS lists include being enrolled in a Medicaid program other than BadgerCare Plus, being under 19 or over 64, being a parent or guardian of a child under 19 who lives with you at least 40% of the time, and being pregnant or within 12 months after a pregnancy. DHS's exemptions page and fact sheets P-03809 through P-03809J cover medical and other exemptions.

What happens if you don't meet it: applications are denied and current members lose coverage at renewal with advance notice. You can reapply at any time. DHS warns that someone denied for not meeting the rule can't get Marketplace premium tax credits, under the same federal law.

DHS says it checks the rule when you apply and then once a year at renewal, so you don't have to prove it every month.

What Wisconsin DHS Doesn't Tell You

Grantsights read the DHS pages, the November 2026 handbook and the eligibility handbook together and found 6 points that are easy to miss:

1. A $580 month is enough. For current members, one qualifying month since the last approval meets the rule, so a single good month of seasonal work can carry a renewal.
2. The parent exemption depends on 40% custody. A parent whose child lives with them less than 40% of the time is treated as having no dependent child at home.
3. Marketplace help disappears if you're denied for the work rule. DHS says those adults can't get premium tax credits, so don't count on the Marketplace as a backup.
4. Back coverage is still three months, but not for long. The eligibility handbook still prints three months; DHS's own summary says two months from January 1, 2027.
5. The HMO window is three months. After that, a nine-month lock-in applies.
6. Children keep coverage even if a premium goes unpaid. The handbook says so plainly, so don't drop a child's coverage over a premium bill.

Common Mistakes and Red Flags

A common mistake is missing the yearly renewal notice. DHS checks household, income, assets and insurance every year, and a renewal that isn't returned ends coverage.

Other ways Wisconsinites lose or miss coverage:

• Not reporting a new child or custody change, which can create a work rule exemption.
• Underestimating how much a single month matters for new 2027 applicants, who are judged on the month before they apply.
• Turning down the Marketplace after earning slightly over $1,330 a month, when tax credits may make a plan cheap.
• Waiting more than 45 days to ask for a hearing.

Red flags: DHS warns that scammers try to steal identities from benefit recipients. After you apply, use only ACCESS and the MyACCESS app to manage benefits, avoid sharing personal details with unknown callers, and hang up and call your agency or Member Services at 800-362-3002 if you're unsure who's calling.

Fair Hearings: 45 Days From the Action

For health care, a fair hearing request must be made no later than 45 days after the date of the action, according to the DHS member handbook (P-00079, November 2026). Use the Request for Fair Hearing form linked from DHS's apply page; requests go to the Division of Hearings and Appeals.

• Keep benefits during the appeal by asking before your benefits change; if you lose, the handbook warns you may have to repay some benefits in programs like FoodShare.
• Talk to your agency first if you like. An agency conference can fix a mistake quickly, but it doesn't extend the 45-day deadline.
• Bring help. You can bring witnesses, your own lawyer or another advisor; you'll get written notice at least 10 days before the hearing.

Other Help in Wisconsin

BadgerCare Plus households often qualify for FoodShare, energy help and other programs through the same ACCESS account:

• Food: our Wisconsin SNAP benefits guide covers FoodShare applications, and the Wisconsin food stamps guide lists income limits.
• Heating: the Wisconsin LIHEAP guide explains heating and electric bill help in Wisconsin.
• Lost a job: the Wisconsin unemployment benefits guide explains weekly claims, and those payments count toward the work rule's $580 income test.

Wisconsinites checking for other benefits can use Grantsights' free eligibility checker, which points to official programs. Only Wisconsin DHS and its county and Tribal agencies can approve BadgerCare Plus.

FAQ: Wisconsin BadgerCare Plus

How do I apply for BadgerCare Plus?

On ACCESS, through your county or Tribal agency by phone or in person, or by mailing a paper application.

What is the income limit for BadgerCare Plus in 2026?

$1,330 a month for one adult and $2,750 for four; pregnant people and children qualify up to 306% of poverty.

Did Wisconsin expand Medicaid?

No; adults are covered to 100% of poverty under Wisconsin's own rules instead of 138%.

When does the BadgerCare work requirement start?

January 1, 2027, for new applicants and March 2027 renewals for most current members.

How long does BadgerCare take to decide an application?

30 days from the day your agency gets it.

Can I change my BadgerCare HMO?

Yes, in the first three months of HMO enrollment, then after a nine-month lock-in.

How long do I have to ask for a BadgerCare fair hearing?

45 days after the date of the action.

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Sources

1. Wisconsin DHS: BadgerCare Plus (opens in a new tab), revised August 31, 2026
2. Wisconsin DHS: BadgerCare Plus Income Guidelines (opens in a new tab), revised July 10, 2026
3. Wisconsin DHS: ForwardHealth, Apply for Benefits (opens in a new tab), revised June 25, 2026
4. Wisconsin DHS: Medicaid, New Federal Work Requirement (opens in a new tab), revised November 2, 2026
5. Wisconsin DHS: Information About Your Enrollment and Benefits, P-00079 (opens in a new tab), November 2026
6. BadgerCare Plus Eligibility Handbook 25.8: Begin Dates (opens in a new tab)
7. BadgerCare Plus Eligibility Handbook 38.4: HMO Enrollment (opens in a new tab), Release 26-03, August 12, 2026
8. Wisconsin DHS: DMS Operations Memo 26-29, non-citizen eligibility changes (opens in a new tab), August 14, 2026
9. Wisconsin DHS: Impact of the federal budget reconciliation bill, August 2025 (opens in a new tab)
10. HealthCare.gov: Marketplace savings start at 100% of poverty (opens in a new tab)