Wisconsin
What Is Wisconsin Medicaid for Long-Term Care?
Wisconsin Medicaid provides health care coverage to low-income individuals of all ages, including elderly residents who need long-term care. For seniors age 65 and older, this may include care in nursing homes, assisted living, adult foster care, or non-medical supports to help them remain at home or with family.
What Types of Long-Term Care Medicaid Programs Are Available in Wisconsin?
What Is Institutional / Nursing Home Medicaid?
This program is an entitlement, meaning all who qualify receive services. Coverage is limited to care provided in licensed nursing homes.
What Are Medicaid Waivers / Home and Community-Based Services (HCBS)?
These are not entitlement programs, and availability may be limited due to enrollment caps. Services are designed to delay or avoid nursing home placement and may be delivered at home, in adult day care, or other community settings.
What Is Regular Medicaid for the Elderly, Blind, or Disabled (EBD)?
This entitlement program offers long-term care services like personal care or adult day care for those who meet eligibility requirements.
What Are the Financial Eligibility Limits in 2025?
What Are the Requirements for a Single Nursing Home Applicant?
As of 2025, an applicant must have:
- Monthly income below $2,901
- Assets under $2,000
- A need for nursing home-level care
Is There a Quick Way to Check Eligibility?
Seniors can take a free online Medicaid Eligibility Test offered by the American Council on Aging.
What Are the 2025 Eligibility Limits by Program and Marital Status?
| Type of Medicaid | Single | Married (both spouses applying) | Married (one spouse applying) |
|---|---|---|---|
| Institutional / Nursing Home Medicaid | $2,901 / month $2,000 in assets Nursing Home Level of Care | $5,802 / month $4,000 in assets Nursing Home Level of Care | $2,901 / month for applicant $2,000 in assets for applicant & $157,920 for non-applicant Nursing Home Level of Care |
| Medicaid Waivers / HCBS | $2,901 / month† $2,000 in assets Nursing Home or Intermediate Care | $5,802 / month† $4,000 in assets Nursing Home or Intermediate Care | $2,901 / month for applicant† $2,000 in assets for applicant & $157,920 for non-applicant Nursing Home or Intermediate Care |
| Regular Medicaid / EBD | $1,050.78 / month‡ $2,000 in assets Assistance with ADLs | $1,582.05 / month‡ $3,000 in assets Assistance with ADLs | $1,582.05 / month‡ $3,000 in assets Assistance with ADLs |
*All of a beneficiary’s monthly income, with the exception of a Personal Needs Allowance of $55/month, Medicare premiums, and potentially a spousal allowance, must go toward the cost of nursing home care.
†Depending on the care setting, beneficiaries may not retain income up to the maximum limit.
‡SSI recipients automatically qualify for Regular Medicaid if functional requirements are met.
What Types of Income Count for Medicaid?
What Is Counted as Income?
Most income sources—wages, pensions, Social Security, dividends, rental income—count toward eligibility. Holocaust restitution payments and VA Aid & Attendance are excluded in WI.
How Is Income Handled for Married Couples?
For Nursing Home Medicaid and Waivers, only the applicant’s income is considered. The non-applicant spouse may be eligible for a Spousal Income Allowance to maintain a minimum income level of $3,525/month. The maximum allowed is $3,948/month.
What About Regular Medicaid?
Both spouses’ incomes are counted toward the applicant’s eligibility. There is no spousal income allowance.
What Counts as an Asset for Medicaid Purposes?
What Assets Are Countable vs. Exempt?
Countable assets include cash, bank accounts, investments, life insurance, and non-residential real estate. Exempt assets include a primary home, one vehicle, personal items, and a non-applicant spouse’s retirement accounts.
How Are Assets Treated for Married Couples?
Assets are considered jointly owned. The non-applicant spouse may keep up to 50% of assets up to $157,920, or 100% if under $50,000.
What Is the Medicaid Look-Back Rule?
Wisconsin enforces a 5-year look-back period for Nursing Home Medicaid and Waivers. Gifts or asset transfers for less than market value during this period can trigger a penalty of ineligibility.
Can a Home Be Exempt from Medicaid Limits?
When Is a Home Considered Exempt?
If the applicant or their spouse lives in the home, or the applicant intends to return, the home is generally exempt. There is a $750,000 home equity limit in 2025.
Is the Home Protected from Estate Recovery?
No. After the death of a Medicaid recipient, the state may recover costs from the estate, which often includes the home.
What Functional Needs Are Required for Medicaid?
Applicants must demonstrate a medical need. For Nursing Home Medicaid and Waivers, a nursing facility level of care is required. For Regular Medicaid, assistance with daily activities (ADLs) may be enough.
Can You Qualify If You’re Over the Income or Asset Limit?
What Is the Medically Needy Pathway?
Also called the Spend Down program, seniors can qualify by using their income on medical expenses until they meet the Medicaid limit. In 2025, the income threshold is $1,304.17/month (individual) or $1,762.50/month (couple). Asset limits are $2,000 and $3,000, respectively.
What Is an Asset Spend Down?
Applicants may legally reduce countable assets by spending them on non-countable items like home modifications, burial arrangements, or debt payments. Keep detailed records due to the Look-Back Rule.
What Is Medicaid Planning?
Planning strategies by professionals can help over-income or over-asset individuals qualify without sacrificing all their resources. Planning may also protect assets like the family home from estate recovery.
What Long-Term Care Programs Are Offered in Wisconsin?
Family Care / Family Care Partnership Program
These managed care programs let seniors direct their own care. Family Care focuses on non-medical services; Partnership also includes medical care and prescriptions.
IRIS Program
Include, Respect, I Self-Direct allows seniors to create a personalized care plan and use a set budget to purchase needed services with a case manager’s help.
Medicaid Personal Care Provide
This program assists with ADLs and IADLs such as bathing, grooming, and preparing meals. It is also called Medical Assistance Personal Care (MAPC).
Program of All-Inclusive Care for the Elderly (PACE)
PACE combines Medicaid and Medicare benefits, offering all-inclusive medical and long-term care services. Dental and vision care may also be included.
Money Follows the Person
This federal program helps Medicaid recipients transition out of institutions and back into the community.
How Do You Apply for Wisconsin Medicaid?
What Are the Application Steps?
To apply for Family Care, Family Care Partnership, or IRIS, contact your local Aging and Disability Resource Center (ADRC). For Regular Medicaid or Personal Care, apply via the ACCESS website, by phone, or at a local agency.
What Should You Do Before Applying?
Ensure you meet the financial and functional criteria. If you’re over the limits, consult a Medicaid Planner to explore eligibility strategies and protect assets like your home.
