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Medicaid Forms

Below is a list of all Medicaid forms. 

When you are searching for a document, enter the number or a portion of the title in the search box below.

Assigned number Title Division Language Release date Available to order
F-00180C Wisconsin Medicaid Provider Agreement and Acknowledgement of Terms of Participation (Word) DMS English 10/2026 No
F-00180CS Wisconsin Medicaid Provider Agreement and Acknowledgement of Terms of Participation, Spanish (Word) DMS Spanish 10/2026 No
F-03357 Wisconsin Medicaid Provider Enrollment Waiver or Variance Request (Word) OIG English 01/2025 No
F-10140 Wisconsin Medicaid Supplement to FoodShare Wisconsin Application (PDF) DMS English 10/2012 No
F-10140S Wisconsin Medicaid Supplement to FoodShare Wisconsin Application, Spanish (PDF) DMS Spanish 10/2012 No
F-10129 Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application (PDF) DMS English 06/2023 No
F-10129H Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application, Hmong (PDF) DMS Hmong 06/2023 No
F-10129S Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application, Spanish (PDF) DMS Spanish 06/2023 No
F-10147 Wisconsin Veterans Home at King - Medicaid Review (PDF) DMS English 07/2008 No
F-10075 Wisconsin Well Woman Medicaid Application and Renewal (PDF) DMS English 10/2024 Yes
F-10075S Wisconsin Well Woman Medicaid Application and Renewal, Spanish (PDF) DMS Spanish 10/2024 No
F-13509 Wisconsin Well Woman Program Provider Certification (PDF) OIG English 01/2021 No
F-01170 Written Correspondence Inquiry (Word) DMS English 07/2012 No
F-01170 Written Correspondence Inquiry (PDF) DMS English 07/2012 No
F-10150A Your Rights and Responsibilities for Health Care (PDF) DMS English 06/2018 No
F-10150 Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare (PDF) DMS English 07/2018 No
F-10150AR Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare, Arabic (PDF) DMS Arabic 07/2018 No
F-10150CM Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare, Chinese (Simplified) (PDF) DMS Chinese (Simplified) 07/2018 No
F-10150G Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare, German (PDF) DMS German 07/2018 No
F-10150H Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare, Hmong (PDF) DMS Hmong 07/2018 No
F-10150L Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare, Laotian (PDF) DMS Lao 07/2018 No
F-10150R Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare, Russian (PDF) DMS Russian 07/2018 No
F-10150SO Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare, Somali (PDF) DMS Somali 07/2018 No
F-10150S Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare, Spanish (PDF) DMS Spanish 07/2018 No
F-10150AH Your Rights and Responsibilities for Health Care, Hmong (PDF) DMS Hmong 06/2018 No
F-10150AS Your Rights and Responsibilities for Health Care, Spanish (PDF) DMS Spanish 06/2018 No

DHS is required under Wis. Stat. § 15.04(1) to establish and maintain a forms management program, appoint a forms officer, and establish and maintain a numbering and filing system for official forms.

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Last revised September 30, 2025