Wisconsin Medicaid for the Elderly, Blind, or Disabled ...

Wisconsin Medicaid for the Elderly, Blind, or Disabled Application Packet F-10101 December 2021 Wisconsin department OF health services division of Medicaid services F-10101 (12/2021) Wisconsin Medicaid FOR THE ELDERLY, BLIND OR Disabled APPLICATION PACKET HOW TO APPLY This is an application for health care benefits for people who are 65 years of age or older, blind or have a disability. To apply for health care benefits, complete this application and return it to the following address or complete an application online at See below for more information about applying online. Mail or Fax Applications and/or Proof/Verification to: If you live in Milwaukee County: MDPU PO Box 05676 Milwaukee, WI 53205 Fax: 888-409-1979 If you do not live in Milwaukee County CDPU PO Box 5234 Janesville, WI 53547-5234 Fax: 855-293-1822 You can also upload any proof documents online at You will need to provide proof of some of your answers.

WISCONSIN DEPARTMENT OF HEALTH SERVICES Division of Medicaid Services F-10101 (12/2021) WISCONSIN MEDICAID FOR THE ELDERLY, BLIND OR DISABLED APPLICATION PACKET HOW TO APPLY This is an application for health care benefits for people who are 65 years of age or older, blind or have a disability.

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  Health, Services, Department, Medicaid, Division, Wisconsin, Wisconsin department of health services division of medicaid services, Wisconsin medicaid

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