Long-Term Care Medicaid in Wisconsin: 2026 Guide

In Wisconsin, Medicaid is run by the Wisconsin Department of Health Services (DHS), and eligibility is decided by your local income maintenance (IM) agency. Long-Term Care Medicaid can pay for nursing home care and for care at home or in assisted living through Family Care, IRIS and Family Care Partnership. Wisconsin protects more for the spouse at home than many states. This guide explains the 2026 rules in plain language.

At a glance: Wisconsin 2026 figures

Figures last updated for 2026. Sources are listed at the end of this page.

Figures change periodically. Double-check current amounts with the Wisconsin Department of Health Services before relying on them.

What Long-Term Care Medicaid covers in Wisconsin

Nursing home care. Medicaid pays for care in a certified nursing facility. You pay most of your income toward the cost each month (your “cost share” or patient liability), and Medicaid pays the rest.

Family Care. Wisconsin’s main long-term care program for older adults and adults with disabilities. A managed care organization (MCO) and a care team plan and arrange services such as personal care, supportive home care, adult day care, home-delivered meals, home changes, and care in assisted living, adult family homes or nursing homes.

IRIS (Include, Respect, I Self-Direct). A self-directed option. You manage a monthly budget and choose your own workers and services, with help from an IRIS consultant agency.

Family Care Partnership. Combines Family Care long-term care with health care, including Medicare and Medicaid benefits, in one plan in some areas. PACE is also available in some areas.

Assisted living. Medicaid does not pay room and board in assisted living. Family Care, Partnership and IRIS can pay for care services in approved residential settings.

Who qualifies

A person generally must:

• be 65 or older, or 18 or older with a physical or intellectual or developmental disability;
• live in Wisconsin and be a U.S. citizen or qualified non-citizen;
• meet the functional need. Your local Aging and Disability Resource Center (ADRC) does the Long Term Care Functional Screen to see whether you need a nursing home level of care (or a lower level for some Family Care services);
• meet the income and asset rules below, as decided by the income maintenance agency.

Income rules

In 2026, the institutional categorically needy income limit is $2,982 a month. People with higher income may still qualify through other routes, depending on the program.

Once you are on Medicaid in a nursing home, most of your income goes to the facility. You keep a personal needs allowance of $55 a month, and money can be set aside for a spouse at home and for health insurance premiums. People in Family Care or IRIS at home keep a larger amount for living costs; the state guide’s income section explains how it is figured.

Asset rules

In 2026, a single applicant can have up to $2,000 in countable assets. For a couple who both need care, the limit is $3,000.

Countable assets include cash, bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts that can be cashed in, life insurance cash value above set amounts and real estate other than the home.

Usually exempt:

• Your home (equity up to $752,000) if you live there or plan to return, or a spouse or dependent relative lives there
• One vehicle
• Household goods and personal belongings
• Burial plots and limited burial funds, within DHS rules

Spousal protections

Wisconsin counts the couple’s combined assets at the start of the first continuous nursing home stay of 30 days or more, or when the person is first found functionally eligible for a waiver program, whichever is earlier. You can ask for this assessment before you apply.

• Assets: If the couple’s countable assets are $100,000 or less, the spouse at home can keep $50,000 and the applicant $2,000. Between $100,000 and $325,320, the spouse at home keeps half. At $325,320 or more, the spouse at home keeps $162,660. After approval, the couple has one year to move assets so that no more than $2,000 is in the applicant’s name.
• Income: The spouse at home keeps their own income. Wisconsin starts from a lower income allocation limit of $3,606.66 a month (from July 1, 2026) and adds an excess shelter allowance if the spouse’s housing costs are above $1,082 a month. If the spouse’s own income is below the result, part of the applicant’s income can go to them, up to a maximum of $4,066.50 a month.

Look-back and penalties

When you apply, Wisconsin looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.

Common examples of transfers that can cause a problem:

• Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
• Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
• Selling a house or car to a relative for much less than it is worth.
• Paying a family member for care without a written agreement made at the time.

Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.

How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor ($352.06 a day ($10,708.49 a month)).

Example: Suppose you gave your daughter $50,000 three years before applying. $50,000 divided by $10,708.49 is about 4.7 months without Medicaid payment for long-term care.

The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.

Estate recovery in Wisconsin

Wisconsin’s Estate Recovery Program is run by DHS.

• What is recovered: Medicaid paid for long-term care and related services received at age 55 or older, and for some people of any age in a nursing facility. Wisconsin can also recover from the estate of a surviving spouse in some cases; ask DHS how this works.
• When it is put off: federal rules prevent recovery while a spouse is alive, or if there is a child under 21 or a child who is blind or disabled.
• Hardship waivers: DHS can waive or put off recovery in some situations. Ask DHS for the current rules.
• Family members and personal representatives can contact the DHS Estate Recovery Program with questions.

How to apply

• Start with your ADRC. Your local Aging and Disability Resource Center explains the options, does the functional screen and helps you apply. DHS lists ADRCs by county.
• Online: ACCESS Wisconsin, the state’s benefits website
• In person, by phone or by mail: through your local income maintenance agency
• For Family Care, IRIS or Partnership: after you are found eligible, the ADRC helps you choose a program and enroll.

After you apply. Your income maintenance agency will send you a written notice saying whether you qualify, from what date, and how much of your income goes toward your care each month. If you disagree with a decision, you have the right to ask for a fair hearing. The notice explains how to ask and the deadline for asking. Keep copies of everything you send and receive.

Gather what you can before you apply. The caseworker may ask for:

• Photo ID, Social Security card and Medicare card
• Proof of age and of U.S. citizenship or immigration status
• Proof that you live in the state (for example, a utility bill or lease)
• Proof of all income: Social Security award letter, pension statements, annuity statements
• Bank, credit union and investment statements (often for the full 60-month look-back period)
• Deeds, property tax bills and the value of any real estate
• Life insurance policies (showing cash value) and prepaid funeral or burial contracts
• Vehicle titles
• Health insurance cards and long-term care insurance policies
• Power of attorney or guardianship papers, if someone is applying for you
• For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start

If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.

Free public help in Wisconsin

• Aging and Disability Resource Centers (ADRCs): free, unbiased information on long-term care options, functional screening and enrollment help.
• DHS and your income maintenance agency: Medicaid applications and eligibility.
• Wisconsin SHIP (State Health Insurance Assistance Program): free Medicare counseling, through the Board on Aging and Long Term Care and local partners.
• Board on Aging and Long Term Care Ombudsman Program: free advocates for residents of nursing homes and assisted living, and for Family Care, Partnership and IRIS members 60 and older.

Recent and upcoming changes

A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including Wisconsin:

• Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
• Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). Wisconsin’s 2026 home equity limit, $752,000, is already below the new cap, so this change is not expected to affect Wisconsin’s limit.

The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.

State programs

Each program below has its own page with who qualifies, services, how to apply and waiting lists:

• Wisconsin Family Care and Family Care Partnership
• Wisconsin IRIS
• Wisconsin Medical Assistance Personal Care

Frequently asked questions

What is the difference between Family Care and IRIS? In Family Care, a managed care organization and care team arrange your services. In IRIS, you manage your own budget and choose your own workers, with help from a consultant.

How much can my spouse keep in Wisconsin? If the couple has $100,000 or less, $50,000. Above that, half of the couple’s countable assets, up to $162,660 in 2026. The home, a car and belongings are not counted.

Where do I start? At your local Aging and Disability Resource Center. It screens your needs, explains the options and helps you apply.

Does Medicaid pay for assisted living in Wisconsin? Family Care, Partnership and IRIS can pay for care services in approved settings. You pay room and board.

How long is the penalty for a gift? Divide the gift by $352.06 to get the number of days. A $20,000 gift would mean about 57 days without Medicaid payment for long-term care.

Will the state take my home after I die? DHS can seek repayment for long-term care paid after age 55, which can include the home. Recovery is put off while a spouse or a young or disabled child survives, and hardship waivers exist.

Figures change periodically. Double-check current amounts with the Wisconsin Department of Health Services before relying on them.

Sources

• DHS, Medicaid EBD Handbook 39.4, Assets and Income Tables
• DHS, Medicaid EBD Handbook 18.6, Spousal Impoverishment Income
• DHS, Medicaid EBD Handbook 18.4, Spousal Impoverishment Assets
• DHS, Medicaid Spousal Impoverishment Protection
• DHS, Wisconsin Medicaid Spousal Impoverishment Protection (P-10063)
• ACCESS Wisconsin
• CMS, 2026 SSI and spousal impoverishment standards
• Public Law 119-21 (2025)

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.