Form F-10122 Medicaid Purchase Plan (Mapp) Member / Premium Information - Wisconsin

What Is Form F-10122?

This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the Form F-10122?
A: Form F-10122 is the Medicaid Purchase Plan (Mapp) Member/Premium Information form.

Q: What is the Medicaid Purchase Plan (Mapp)?
A: The Medicaid Purchase Plan (Mapp) is a program in Wisconsin that allows individuals who have a disability to work and still receive Medicaid benefits.

Q: What information does the Form F-10122 gather?
A: The Form F-10122 gathers member and premium information for the Medicaid Purchase Plan (Mapp).

Q: Who is eligible for the Medicaid Purchase Plan (Mapp)?
A: Individuals in Wisconsin who have a disability and meet certain income and asset requirements are eligible for the Medicaid Purchase Plan (Mapp).

Q: What is the purpose of the Medicaid Purchase Plan (Mapp)?
A: The Medicaid Purchase Plan (Mapp) allows individuals with disabilities to work and retain their Medicaid benefits by paying a monthly premium based on their income.

Q: How often do I need to fill out the Form F-10122?
A: The Form F-10122 needs to be completed annually to determine your eligibility and premium for the Medicaid Purchase Plan (Mapp).

Q: What documents do I need to submit with the Form F-10122?
A: You may need to submit documents such as proof of income, disability, and residency along with the Form F-10122.