Medicaid and Other Programs


Medical Assistance

Medical Assistance, or Medicaid, is a joint federal/state program designed to provide health care to low-income persons. The program is funded by state dollars (42%) matched by the federal government (58%). Federal funds are authorized by Title XIX of the Social Security Act. Medicaid reimburses Wisconsin hospitals much less than the actual cost of providing services to beneficiaries--approximately 65% of the actual cost of inpatient services, 50% of the cost of outpatient services. WHA works with the Governor, the Legislature, and the Department of Health and Family Services on hospital payment issues that are included in the state budget.


The Balanced Budget Act of 1997 established the State Childrens Health Insurance Program (SCHIP). BadgerCare is Wisconsins innovative program, which was developed using the national SCHIP dollars. BadgerCare is intended to fill gaps between Medicaid and private health insurance without supplanting or "crowding out" private insurance. BadgerCare extends health care coverage to low-income families with children through a Medicaid expansion under Titles XIX and XXI.

HIRSP  (The HIRSP Program sunsetted on December 31, 2013.)

The Wisconsin Health Insurance Risk Sharing Plan (HIRSP) offers health insurance to Wisconsin residents who, due to their medical conditions, are unable to find adequate health insurance coverage in the private market. This program is subsidized through contributions from health care providers and health maintenance organizations.


SeniorCare, created in 2001 Wisconsin Act 16 (the 2001-03 biennial budget act), provides assistance to individuals that are 65 years of age or older with the purchase of prescription drugs. The program began September 1, 2002. Benefits are funded with a combination of general purpose revenue (GPR), federal medical assistance (MA) matching funds, and rebate revenue received from pharmaceutical manufacturers. Administrative costs are funded with revenue from payment of a $20 annual enrollment fee, which is required of all SeniorCare participants. Additionally, SeniorCare costs are partially offset by cost-sharing requirements for participants, discounted prices absorbed by pharmacies and payments from third parties that are also liable for participants' prescription drug costs. SeniorCare is administered by the Department of Health and Family Services (DHFS).

WHA Contact:

Brian Potter

Senior Vice President, Finance/Chief Operating Officer