Get Wi F-10081a 2019-2025

The WI F-10081A form is designed for pregnant women seeking temporary enrollment in BadgerCare Plus through Express Enrollment. This guide provides detailed instructions on how to complete the form accurately and efficiently online.

Follow the steps to complete the WI F-10081A form online.

1. Press the ‘Get Form’ button to obtain the form and access it in the online editor.
2. Provide applicant information, including residency status in Wisconsin. If the applicant is a resident, proceed to Line 1.
3. In Line 1, enter the applicant's full name, birth date, and phone number.
4. Complete Line 2 by entering the applicant's address and county of residence. If needed, a different mailing address can be specified.
5. In Line 3, indicate if the applicant is currently receiving Wisconsin Medicaid or BadgerCare Plus. If yes, move to Section IV.
6. For Line 4, determine whether the applicant has previously received BadgerCare Plus for the current pregnancy. If yes, proceed to Section IV.
7. In Line 5, confirm if the applicant is a U.S. citizen or lawfully present in the U.S. If no, proceed to Section IV.
8. In Section II, Line 6, provide information regarding the pregnancy, including the number of babies and expected delivery date.
9. In Section III, answer income information questions starting from Line 7, which requires household size details.
10. Record total monthly earned income in Line 8 and total unearned income in Line 9.
11. Calculate total monthly income by adding amounts from Lines 8 and 9, and enter this in Line 10.
12. On Line 11, compare total monthly income against the federal poverty level thresholds to determine eligibility.
13. In Section IV, determine eligibility based on the information provided. Follow instructions for eligible or non-eligible applicants.
14. For eligible applicants, complete Line 13 by ensuring the applicant reads, checks the box, signs, and dates the application.
15. Finally, save changes, download a copy of the application, print it, or share it as needed.

Complete the WI F-10081A form online to ensure timely access to BadgerCare Plus benefits.