Medicaid Purchase Plan Wisconsin: How to Keep Medicaid While Working

The Problem the Medicaid Purchase Plan Solves

Adults with disabilities in Wisconsin face a trap: SSI provides Medicaid, but countable earned income can reduce the SSI cash payment to zero. The $1,690 monthly Substantial Gainful Activity figure is used in the adult disability standard, not as a simple post-entitlement SSI earnings cutoff. Many adults want to work but cannot afford to lose their health coverage — especially when they depend on medications, therapies, or medical equipment that private insurance may not cover.

Wisconsin's Medicaid Purchase Plan (MAPP) breaks this cycle. It allows working adults with disabilities to buy into Medicaid by paying a monthly premium when required, even when their earnings disqualify them from SSI.

Eligibility Requirements

To qualify for MAPP, an individual must:

• Be a Wisconsin resident aged 18 or older
• Be determined disabled by the Wisconsin Disability Determination Bureau
• Meet the MAPP work requirement through work activity or, if not employed, the Health and Employment Counseling pre-employment program
• Meet the asset limit

The income limit for MAPP is significantly higher than standard Medicaid, but it is not unlimited: adjusted family income must be at or below 250% of the federal poverty level, based on family size. Premiums are generally required when gross monthly income is above 100% of the federal poverty level and are based on gross monthly income.

The asset limit is also more generous than the $2,000 SSI standard: MAPP permits individual assets up to $15,000. Retirement and pension accounts are not automatically excluded; when registered as Independence Accounts, amounts already in them before enrollment count toward the $15,000 limit, while deposits, interest, gains, and dividends added after registration do not count while the person remains in MAPP.

How the Premium Works

MAPP premiums are based on gross monthly income before taxes and deductions. If gross monthly income is below 100% of the federal poverty level, no monthly premium is required; above that level, a premium is required. The premium remains far below the cost of private health insurance — especially for individuals with complex medical needs.

The premium is paid monthly to the Wisconsin Department of Health Services. Premiums are due on the 10th of each month; if a premium is not paid by the end of the following month, Wisconsin DHS says the member will be disenrolled.

MAPP and Section 1619(b)

MAPP is not the only work-while-keeping-Medicaid option. Section 1619(b) of the Social Security Act allows former SSI recipients to keep Medicaid even after their SSI cash benefit stops due to earned income, as long as they meet the program's requirements; Wisconsin's 2026 threshold amount is $51,711 per year.

The practical difference: Section 1619(b) continues standard Medicaid at no cost but requires that the individual previously received SSI. MAPP is available to working adults with disabilities who may never have received SSI, and uses its own 250%-of-FPL income limit, $15,000 asset limit, work requirement, and possible premium.

For many adults, 1619(b) is the first line of defense. If earnings exceed the 1619(b) threshold, MAPP may be an alternative if the person meets its disability, income, asset, work, and premium requirements.

MAPP and Long-Term Care

Here is a nuance that matters for families navigating the waiver system: MAPP provides Medicaid coverage, but it does not automatically qualify someone for Family Care or IRIS. Waiver eligibility requires passing the Long-Term Care Functional Screen through the ADRC, with its own income standard of $2,982 per month in 2026.

However, active MAPP coverage may serve as the Medicaid component for a Family Care or IRIS application, but it does not replace the separate functional and program eligibility review. An adult working part-time who cannot get SSI due to earnings can use MAPP Medicaid as a bridge to Family Care or IRIS — as long as they also meet the functional eligibility standard.

How to Apply

MAPP applications go through the Wisconsin ACCESS portal (access.wi.gov) or through the county Income Maintenance agency. You will need proof of employment or job-seeking activity, medical documentation of your disability, and financial records.

The Wisconsin SSI at 18 & Adult Disability Benefits Guide covers MAPP alongside other work incentives — Section 1619(b), the Student Earned Income Exclusion, and the Plan to Achieve Self-Support — so families can identify which pathway fits their situation.

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