MedicaidCoverageHigh impact
Upcoming Changes for Noncitizen Member Eligibility
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Oct 1, 2026
We identified it
Sep 5, 2026
Summary
Effective October 1, 2026, Wisconsin Medicaid will restrict eligibility for noncitizen adults to only U.S. citizens, nationals, lawful permanent residents, Cuban-Haitian entrants, and Compact of Free Association citizens. Adults with statuses like refugees, asylees, parolees, trafficking victims, and VAWA self-petitioners will lose coverage. Children under 19, pregnant individuals, and young adults under 21 in mental health institutions remain eligible. Providers must verify member eligibility before delivering services to avoid claim denials.
Action Required
By September 30, 2026: Billing team must update member eligibility verification procedures in the billing system to flag noncitizen members with newly nonqualifying immigration statuses (refugees, asylees, conditional entrants, foreign-born tribal members, persons with withholding of removal, parolees, special immigrants, trafficking victims/families, VAWA self-petitioners). Front desk staff must verify immigration status before scheduling services. Implement workflow to check member eligibility in ForwardHealth system prior to service delivery. Train all staff on exception categories (children under 19, pregnant individuals, young adults under 21 in mental health institutions remain eligible). Implement process to inform affected members of coverage loss and inform them of backdated coverage eligibility through September 2026. Document all eligibility verifications per Wis. Admin. Code § DHS 106.02(9). Claims for ineligible members after October 1, 2026 will be denied and subject to recoupment. Contact Provider Services at 800-947-9627 or email DHSForwardHealthPartners@dhs.wisconsin.gov with questions.