How to Complete and Submit the Wisconsin Medicaid Application Form (F-10101)

Wisconsin’s Medicaid application form F-10101 is the packet to use if you are 65 or older, legally blind, or have a qualifying disability and want to apply for Medicaid coverage, including long-term care. You can download it free from the Department of Health Services website or pick up a paper copy at your local income maintenance agency, then submit it online through ACCESS, by mail, by fax, in person, or by phone.¹ Once the state receives a complete application, it has 30 calendar days to issue a decision.²

Is F-10101 the Right Form for You

Wisconsin publishes two Medicaid application packets, and sending in the wrong one slows your case down because the agency has to redirect it.

Use F-10101 if you are 65 or older, legally blind, or have a qualifying disability. This packet collects the detailed asset and resource information that elderly, blind, and disabled (EBD) Medicaid programs require, including information needed to screen you for long-term care, nursing home coverage, and home- and community-based waiver programs like Family Care, IRIS, and PACE.¹

Use F-10182 instead if you’re applying for BadgerCare Plus — the program for low-income adults under 65, children, and pregnant women — and none of the EBD categories apply to you.³ If you apply online at access.wi.gov, the system routes you to the right questions automatically, so you don’t have to pick a form number yourself.⁴

Income and Asset Limits That Shape Your Application

Before you fill anything out, check the limits. EBD Medicaid differs from BadgerCare Plus in one important way: it imposes a strict asset test on top of income rules. For an individual, countable assets cannot exceed $2,000. For a married couple when both spouses apply, the limit is $3,000.⁵

Countable assets include bank accounts, certificates of deposit, stocks, bonds, and life insurance policies with cash value. Your home, one vehicle, and certain personal belongings are generally exempt. The application asks you to list each account and asset by type, institution, and balance, so having those statements in front of you before you start is essential.

Spousal Impoverishment Protections

If one spouse needs nursing home care and the other stays in the community, federal law prevents the community spouse from being left destitute. For 2026, the community spouse can keep between $50,000 and $162,660 in countable assets, depending on the couple’s total resources. If combined countable assets exceed $325,320, the community spouse keeps $162,660. If combined assets fall between $100,000 and $325,320, the community spouse keeps half. If combined assets are $100,000 or less, the community spouse keeps $50,000.⁶ The F-10101 asks for financial information about both spouses so the agency can run this calculation.

What to Gather Before You Fill Out the Form

Stopping midway to track down a bank statement is the most common reason applications stall or come back incomplete. Pull these together first:

Social Security numbers and dates of birth for everyone in the household. Wisconsin verifies this electronically through the Social Security Administration.⁷
Proof of income for every household member who works, including employer names, pay frequency, and recent pay stubs showing monthly gross income.
Other income sources: Social Security benefits, pensions, child support, self-employment earnings, rental income, and any other money coming in.
Asset documentation: current statements for every bank account, certificate of deposit, brokerage account, savings bond, life insurance policy with cash value, and any real property other than your primary home.
Health insurance details for any current coverage, including Medicare cards and employer-sponsored plans. The state needs this to coordinate who pays first.
Monthly housing costs — rent or mortgage, property taxes, utilities — which feed into deductions for certain programs.
A list of everyone living in the home, even people not applying, because household size affects where you fall against the limits.

Report amounts that match your pay stubs and bank statements. The agency cross-checks what you write against electronic data sources, and anything that doesn’t line up triggers a verification request that delays the decision.

Filling Out and Submitting F-10101

Write legibly if you’re completing the paper packet, and answer every question. Leave nothing blank — if something doesn’t apply, write “N/A” so the agency knows you didn’t skip it. Sign and date the form; an unsigned application isn’t considered filed. The packet includes a rights and responsibilities section you must read and acknowledge.

Wisconsin accepts the completed form through four channels.

Online Through ACCESS

The ACCESS portal at access.wi.gov is the Department of Health Services’ recommended method and is measurably faster than paper.⁴ It’s a full online application rather than a PDF upload — click “Apply now,” answer each screen, and continue until you reach the confirmation page with your tracking number. That timestamp becomes your official filing date.

By Mail or Fax

Where you send the paper form depends on where you live:⁸

Outside Milwaukee County: Central Document Processing Unit (CDPU), PO Box 5234, Janesville, WI 53547-5234. Fax: 855-293-1822.
Milwaukee County: Milwaukee Document Processing Unit (MDPU), PO Box 05676, Milwaukee, WI 53205. Fax: 888-409-1979.

Original documents mailed to a processing unit are not returned, so send copies of anything you want to keep.⁹

In Person

Your local income maintenance agency accepts hand-delivered applications during business hours. Wisconsin groups counties into eleven regional consortia, and you can look up your consortium and local office through the Department of Health Services website.¹⁰ Walking in is useful if you want help completing the form — agency staff can assist on the spot.

By Phone

You can also apply over the phone by calling your regional consortium. A representative enters your answers directly into the state database during the call. For general questions, call Member Services at 800-362-3002, Monday through Friday, 8 a.m. to 6 p.m.¹¹

What Happens After You File

Wisconsin must process your application and issue a decision within 30 calendar days of receiving it. If the 30th day falls on a weekend or holiday, the deadline moves to the next business day.²

That clock can stretch when the agency asks for more proof. If it needs additional documentation — pay stubs, bank statements, proof of citizenship, verification of a disability — it mails a Request for Verification spelling out exactly what to provide. You get at least 20 calendar days from the date the request is mailed to respond.¹² The agency cannot deny your application for missing verification until both the 20-day response window and the 30-day processing period have run, whichever is later. Still, respond as fast as you can.

EBD applicants may also have a brief interview with a caseworker to clarify complicated financial situations, especially around asset ownership and spousal resources. This is a verification conversation, not a new hurdle. The caseworker is confirming what you already reported.

When the review is finished, the state mails a Notice of Decision — or posts it to your ACCESS account — telling you whether you were approved, which program you’re enrolled in, and the effective date of coverage.

Retroactive Coverage

Wisconsin Medicaid can cover medical bills you incurred up to three months before the month you applied, as long as you met all eligibility requirements during that earlier period. If you had qualifying medical expenses in those months, mention this on the form so the agency evaluates them as part of your case.

Divestment and Estate Recovery: Pay Attention If You Need Long-Term Care

Two rules apply to EBD applicants seeking nursing home or long-term community care that don’t come into play for most BadgerCare Plus applicants. If either could affect you, consider talking with an elder law attorney before you file.

Divestment Penalties

The state reviews your financial transactions for the 60 months before your application date, known as the look-back period. If you gave away assets, sold property below fair market value, or transferred resources during that window to reduce your countable wealth, the state imposes a penalty period during which you are ineligible for long-term care benefits. The penalty equals the value of the transferred assets divided by Wisconsin’s average daily nursing home rate, which is $352.06 as of January 1, 2026.¹³ A $35,206 gift would create a 100-day penalty.

Some transfers don’t trigger a penalty. Transferring assets to a spouse, to a blind or disabled child, or returning the asset to the applicant can eliminate or reduce the penalty. Transfers to a caregiver child who lived in the home and provided care for at least two years before you entered a nursing home are also exempt.

Estate Recovery

After a Medicaid member dies, the state may seek repayment from the member’s estate for certain benefits it paid. Nursing home residents of any age may have costs recovered for all Medicaid-funded benefits received during their stay. Community residents aged 55 or older may face recovery for specific services, including skilled nursing, home health aide care, personal care services, and participation in waiver programs such as Family Care, IRIS, and PACE.¹⁴

Recovery does not happen while a surviving spouse, a child under 21, or a blind or disabled child of any age is still alive. The state can file a lien on real property and delay collection until after those protected family members have died. You can request a hardship waiver if recovery would leave surviving family members without a place to live or cause undue financial hardship.¹⁴

If Your Application Is Denied

The Notice of Decision includes instructions for requesting a fair hearing. You have 45 days from the date of the agency’s action to file your appeal.¹⁵ Submit the Request for Fair Hearing form (DHS-28), or a signed letter explaining why you disagree, to the Division of Hearings and Appeals.¹⁶ Include a copy of the denial notice with your request.

An administrative law judge reviews the case and decides whether the agency followed state and federal rules correctly. Keep copies of every document you submitted with your application and every piece of correspondence you received. That paperwork becomes your evidence. If you file your appeal before your benefits terminate and the termination date hasn’t passed yet, you can often keep receiving benefits while the hearing is pending.

Renewing Your Coverage Each Year

Enrollment is not permanent. Wisconsin checks your eligibility every year. The Department of Health Services assigns each member a renewal month and mails a prefilled renewal packet about a month beforehand. You can also find your renewal date by logging into ACCESS.¹⁷

Renewing through ACCESS is the fastest route: log in, look for the “Benefit Renewals Due For” alert, and follow the prompts. You can also return the paper packet by mail or renew by phone or in person. Miss the window and your benefits end. You can still submit renewal information within three months of the due date and have it treated as on time, but waiting longer than three months means starting a brand-new application from scratch.¹⁷

1
Wisconsin Department of Health Services. Wisconsin Medicaid for the Elderly, Blind or Disabled Application Packet
2
Wisconsin Department of Health Services. Medicaid Eligibility Handbook Release 25-04
3
Wisconsin Department of Health Services. BadgerCare Plus Application Packet
4
Wisconsin Department of Health Services. ForwardHealth: Apply for Benefits
5
Wisconsin Department of Health Services. Medicaid Eligibility Handbook – 39.4 Elderly, Blind, or Disabled Assets and Income Tables
6
Wisconsin Department of Health Services. Wisconsin Medicaid – Spousal Impoverishment Protection
7
Medicaid. MAGI-Based Eligibility Verification Plan
8
Wisconsin Department of Health Services. BadgerCare Plus and Other Medicaid Programs
9
Wisconsin Department of Health Services. Submitting Documents
10
Wisconsin Department of Health Services. Income Maintenance and Tribal Agency Contact Information
11
Wisconsin Department of Health Services. Medicaid: Contacts
12
Wisconsin Department of Health Services. Medicaid Eligibility Handbook – 20.7 When to Verify
13
Wisconsin Department of Health Services. Wisconsin Medicaid Divestment
14
Wisconsin Department of Health Services. Wisconsin Estate Recovery Program Handbook
15
Wisconsin Department of Health Services. Medicaid/BadgerCare Plus Fair Hearing Information
16
Wisconsin Department of Administration. Requesting a Hearing
17
Wisconsin Department of Health Services. ForwardHealth: Health Care Renewals