Wisconsin Medicaid Eligibility for Long Term Care: Income & Asset Limits

Last updated: February 11, 2022

 

Wisconsin Medicaid Definition

Medicaid is a jointly funded state and federal health care program for low-income people of all ages. This includes pregnant women, children, families, disabled individuals, and seniors. The focus of this page, however, is on Medicaid eligibility for Wisconsin senior residents (65 and over). Specifically, long-term care Medicaid is covered. In addition to nursing home care and services in adult foster care homes and assisted living residences, WI Medicaid also pays for non-medical support services to help frail seniors remain living at home or in the home of a loved one.

In WI, the Wisconsin Department of Health Services’ Division of Medicaid Services (DMS) administers the state’s long-term care Medicaid Programs for the elderly.

  The American Council on Aging now offers a free, quick and easy Medicaid eligibility test for seniors.

 

Income & Asset Limits for Eligibility

There are several Medicaid long-term care programs for which Wisconsin seniors may be eligible. These programs have varying eligibility requirements, as well as benefits. Eligibility for these programs is complicated by the facts that the criteria vary with marital status and that Wisconsin offers multiple pathways towards Medicaid eligibility.

1) Institutional / Nursing Home Medicaid – This is an entitlement program; Anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.

2) Medicaid Waivers / Home and Community Based Services (HCBS) – These are not entitlement programs; The number of participants is limited and wait lists may exist. Intended to prevent and delay nursing home admissions, benefits are provided at home, adult day care, an adult family home / adult foster care home, or in assisted living. More on waivers.

3) Regular Medicaid / Elderly, Blind, or Disabled – This is an entitlement program; If eligibility requirements are met, services will be received. Various long-term care services, such as personal care assistance or adult day care, may be available.

The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a Wisconsin Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for long-term care Medicaid in WI. More.

2022 Wisconsin Medicaid Long Term Care Eligibility for Seniors
Type of Medicaid Single Married (both spouses applying) Married (one spouse applying)
Income Limit Asset Limit Level of Care Required Income Limit Asset Limit Level of Care Required Income Limit Asset Limit Level of Care Required
Institutional / Nursing Home Medicaid $2,523 / month* $2,000 Nursing Home $5,046 / month* $4,000 Nursing Home $2,523 / month for applicant* $2,000 for applicant & $137,400 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $2,523 / month† $2,000 Nursing Home or Intermediate Care Facility $5,046 / month† $4,000 Nursing Home or Intermediate Care Facility $2,523 / month for applicant† $2,000 for applicant & $137,400 for non-applicant Nursing Home or Intermediate Care Facility
Regular Medicaid / Elderly Blind, or Disabled (EBD) $924.78 / month $2,000 Help with ADLs $1,393.05 / month $3,000 Help with ADLs $1,393.05 / month $3,000 Help with ADLs
*All of a beneficiary’s monthly income, with the exception of a personal needs allowance of $45 / month, Medicare premiums, and potentially a monthly income allowance for a non-applicant spouse, must go towards the cost of nursing home care.

†Based on one’s living setting, a beneficiary may not be able to keep monthly income up to this level.

 

What Defines “Income”

Any income that a Medicaid applicant receives is counted. This income can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, Veterans benefits, rental income, and stock dividends. Medicaid makes an exception for Covid-19 stimulus checks and Holocaust restitution payments, as they are not counted as income.

When just one spouse of a married couple applies for nursing home Medicaid or a Medicaid waiver, only the income of the applicant is counted towards eligibility. This means the non-applicant’s income is disregarded and does not impact the income eligibility of their spouse. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse. The MMMNA is a spousal impoverishment rule and is the minimum amount of monthly income a non-applicant spouse is said to require to avoid living in poverty. In WI, the MMMNA is $3,051.66 (effective 7/1/22 – 6/30/23). If a non-applicant’s monthly income falls under $3,051.66, income can be transferred from their applicant spouse, bringing their income up to this level.

A non-applicant spouse can further increase their spousal income allowance if their housing and utility costs exceed a “shelter standard” of $915.50 / month (effective 7/1/22 – 6/30/23). However, in 2022, a spousal income allowance cannot put a non-applicant’s monthly income over $3,435. This is the Maximum Monthly Maintenance Needs Allowance. Learn more about how the spousal income allowance is calculated.

Income is counted differently when only one spouse applies for regular Medicaid / Elderly, Blind, or Disabled; The income of both spouses counts toward the income eligibility of the applicant spouse. More on how Medicaid counts income.

 

What Defines “Assets”

Countable assets (resources) include cash, stocks, bonds, life insurance policies, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. There are also many assets that Medicaid considers to be exempt (non-countable). Exemptions include personal belongings, household items, such as furniture and appliances, an automobile, and irrevocable burial trusts. While an applicant’s IRA / 401K is not exempt, a non-applicant spouse’s IRA / 401K is exempt. One’s primary home is also generally exempt. For home exemption, the Medicaid applicant must live in their home or have intent to return, and in 2022, their home equity interest must be no greater than $750,000. The amount of the home’s value owned by the applicant is their equity interest. The home is also exempt, regardless of any other circumstances, if the applicant has a spouse living in it.

 While one’s home is usually exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s estate recovery program. Following a long-term care Medicaid beneficiary’s death, Wisconsin’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.

All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, a spousal impoverishment rule permits the non-applicant spouse of a Medicaid nursing home or waiver applicant a Community Spouse Resource Allowance (CSRA). In Wisconsin, this is called a Community Spouse Asset Share (CSAS). In 2022, the community spouse (the non-applicant spouse) can retain 50% of the couples’ assets, up to a maximum of $137,400, as the chart indicates above. If the non-applicant’s half of the assets falls under $50,000, 100% of the assets, up to $50,000 can be retained by the non-applicant.

Wisconsin has a 5-year Medicaid Look-Back Period that immediately precedes one’s date of long-term care Medicaid application. During this period, Medicaid checks to ensure no assets were gifted or sold under fair market value. If this has been done, even by a non-applicant spouse, the Medicaid agency assumes it was done to meet Medicaid’s asset limit. Violating the look back period results in a penalty period of Medicaid ineligibility.

 Non-Financial Eligibility Requirements – For Wisconsin long-term care Medicaid eligibility, an applicant must have a functional need for such care. For nursing home Medicaid and Medicaid waivers, a nursing facility level of care (NFLOC) is required. Furthermore, additional criteria may need to be met for specific program benefits. As an example, for a waiver to cover the cost of home modifications, an inability to safely and independently live at home without modifications may be required. For long-term care services via the regular Medicaid program, a functional need with the activities of daily living is required, but a NFLOC is not necessarily required.

 

Qualifying When Over the Limits

Elderly Wisconsin residents (65 and over), who do not meet the eligibility requirements above, can still qualify for Medicaid.

1) Medically Needy Pathway – Wisconsin has a Medicaid Deductible Program for seniors who have income over Medicaid’s limit. Also called a Spend Down program, persons “spend down” the majority of their income on medical bills to become income-eligible for Medicaid services. As of February 2022, the income limit for this program is $1,132.50 / month for an individual and $1,525.83 / month for a couple. The “deductible” / “spend down” amount is the difference between one’s monthly income and the program’s income limit. In WI, this amount is calculated for a 6-month period. Once the “deductible” has been met, one will be Medicaid income eligible for the remainder of the period. The Medicaid Deductible Program asset limit is $2,000 for an individual and $3,000 for a couple.

2) Asset Spend Down – Seniors who have assets over Medicaid’s limit can “spend down” extra assets for Medicaid qualification. Persons reduce countable assets by spending them on ones that are non-countable. Examples include paying for home modifications (i.e., wheelchair ramps or stair lifts), prepaying funeral and burial expenses, and paying off debt. Remember, Wisconsin Medicaid has a “Look-Back” period of 5 years that prohibits assets from being gifted or sold under fair market value. Therefore, it is recommended one keep documentation of how assets were spent as proof the look back rule was not violated.

 Our free spend down calculator can assist persons in determining if they might have a spend down, and if so, provide an estimate of the amount.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income”, “over-asset”, or both, but they still cannot afford their cost of care. For these individuals, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their home from Medicaid’s estate recovery program. Read more or connect with a Medicaid planner.

 

Specific Wisconsin Medicaid Programs

Like all states, Wisconsin Medicaid pays for nursing home care for those persons who medically require a nursing home level of care and are financially eligible. WI also offers programs for seniors who require nursing home level care or have slightly lesser care requirements and do not wish to reside in a nursing home. These programs provide care at home or “in the community”.

1) Family Care and Family Care Partnership – Two managed care waiver programs that allow program participants the freedom to direct their own care, including hiring the caregiver of their choosing. This even includes hiring a spouse. The Partnership program covers medical care and prescription drugs, while Family Care only covers non-medical care.

2) IRIS Program – This Medicaid Waiver, Include, Respect, I Self-Direct, is a consumer directed program, and with the assistance of a case manager, a plan of care is put into place. Benefits may include adult day care, adult foster care, home modifications, live-in caregivers, and more.

3) Medicaid Personal Care – Also called Medical Assistance Personal Care (MAPC), assistance with Activities of Daily Living (ADLs) and some Instrumental Activities of Daily Living (IADLs), such as bathing, grooming, mobility, meal preparation, and laundry is provided.

4) Program of All-Inclusive Care for the Elderly (PACE) – The benefits of Medicaid, including long-term care services, and Medicare are combined into one program. Additional benefits, such as dental and eye care, may be available.

 

How to Apply for Wisconsin Medicaid

To apply for Family Care/Family Care Partnership or IRIS in Wisconsin, or to learn more about these programs, seniors should contact their local Aging and Disability Resource Center (ADRC). To apply for regular Medicaid, which includes Medicaid Personal Care, seniors can do so online at ACCESS, by phone, in person via their local Income Maintenance and Tribal Agency, or by submitting a completed paper application.

It is vital that seniors be certain that they meet all eligibility requirements (in detail above) prior to submitting their completed WI Medicaid application. Elderly applicants who have income and / or resources in excess of the limit(s) should consider Medicaid planning for the best chance of receiving Medicaid benefits. While the application process can be complicated and lengthy, persons can learn more here.

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