Wisconsin Medicaid / Medical Assistance Personal Care (MAPC): Benefits & Eligibility

Last updated: March 12, 2024


Overview of Wisconsin Medical Assistance Personal Care

Wisconsin’s Medicaid Personal Care, or Medical Assistance Personal Care (MAPC), provides assistance for state residents who have functional limitations. While this Medicaid benefit is available to persons of all ages, it is especially relevant for the elderly, as with the natural progression of aging comes difficultly with functioning. Intended to assist persons in living independently, a “Personal Care Worker” (caregiver) under the supervision of a registered nurse provides in-home assistance with daily living activities. This includes assistance with bathing, dressing, using the toilet, mobility, transferring (from one position to another), laundry, and light housecleaning.

While many Medicaid long-term care programs allow program participants to self-direct their own care, this is not an option through MAPC. Personal Care Workers (PCWs) must be employed by a state-contracted Personal Care Agency and supervised by a registered nurse. Friends and relatives, however, with the exception of a spouse or parent of a minor child, can become an employee of a Personal Care Agency and serve as a PCW for a loved one.

Program beneficiaries can live in a variety of settings. This includes a private home (one’s own or that of a friend or relative), a group home, an assisted living facility, an adult foster care home (adult family home), or a community based residential facility with less than 20 resident beds.

Medical Assistance Personal Care is a benefit available through Wisconsin’s State Plan Medicaid program and is an entitlement. This means a waitlist never exists and meeting eligibility requirements equates to immediate receipt of Personal Care Services.

 Medicaid Waivers versus State Plan / Regular Medicaid
While home and community based services (HCBS) can be provided via a Medicaid Waiver or a State’s Regular Medicaid Plan, HCBS through Medicaid State Plans are an entitlement. Put differently, meeting the program’s eligibility requirements guarantees an applicant will receive benefits. On the other hand, HCBS via Medicaid Waivers are not an entitlement. Waivers have a limited number of participant enrollment slots, and once they have been filled, a waitlist for benefits begins. Furthermore, HCBS Medicaid Waivers require a program participant require the level of care provided in a nursing home, while State Plan HCBS does not always require this level of care.


Benefits of the Wisconsin Medical Assistance Personal Care

The exact services and the number of hours with which one is provided assistance is based on an individualized care plan. Assistance with the following activities may be provided.

– Bathing / Showering
– Dressing / Undressing
– Eating
– Eyeglass / Hearing Aids Care
– Grocery Shopping
– Hair Care
– Laundry
– Light Housecleaning (limited to home areas that are necessary to use while personal care assistance is provided)
– Meal Preparation
– Medical Accompaniment
– Mobility
– Nurse Delegated Tasks (i.e., catheter care, G-tube feeding, glucometer readings)
– Skin Care
– Teeth / Mouth / Denture Care
– Toileting
– Transferring (i.e., bed to chair)

While program participants can live in group homes, assisted living residences, adult family homes, and community based residential facilities with less than 20 resident beds, WI Medicaid does not cover the cost of room and board.

 Other Options: In Wisconsin, Medicaid-funded Personal Care Services can also be received via the IRIS Waiver and the Family Care / Family Care Partnership Programs. These programs are for seniors who require a Nursing Facility Level of Care, but allow an applicant a higher level of monthly income than does WI’s Medicaid State Plan Personal Care Services. Furthermore, these programs allow participants to self-direct their own care.


Eligibility Requirements for Wisconsin Medical Assistance Personal Care

Medicaid Personal Care is for Wisconsin residents of any age. Additional eligibility requirements follow and are relevant for seniors (65+ years old).

 The American Council on Aging now offers a quick and easy WI Medicaid Eligibility Test for seniors. 


Financial Criteria: Income, Assets & Home Ownership

In 2024, the individual applicant income limit is $1,026.78 / month. Married applicants, regardless of if one spouse or both are applicants, are limited to $1,547.05 / month in income.

 Many home and community based services Medicaid programs allow a non-applicant spouse to retain a larger portion of a couple’s income and assets. Wisconsin’s Medicaid Personal Care does not. However, WI’s IRIS Medicaid Waiver, which offers a variety of long-term services and supports, allows a non-applicant spouse a Monthly Maintenance Needs Allowance from their applicant spouse, as well as a Community Spouse Resource Allowance.

In 2024, the asset limit is $2,000 for a single applicant. For married couples, it is $3,000, regardless of whether one spouse or both are applicants.

Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.

While there is a 60-month Look-Back Rule in which Medicaid checks past asset transfers of those applying for Nursing Home Medicaid or home and community based services via a Medicaid Waiver, it is not relevant for Wisconsin’s Medicaid Personal Care.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our Medicaid Spend Down Calculator.

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. Applicants for Medicaid Personal Care need not worry. The home is exempt (non-countable), given the individual lives in it or has Intent to Return home. There are, however, other WI Medicaid programs, such as Family Care / Family Care Partnership, the IRIS Waiver, and Nursing Home Medicaid, that also have a home equity interest limit for home exemption. Learn more about home exemption and when Medicaid can and cannot take the home here.


Medical Criteria: Functional Need

For many Medicaid long-term care programs, one must require a Nursing Facility Level of Care (NFLOC). For Medicaid Personal Care, this is not required. The need for assistance, however, must be “medically necessary”. To make this determination, a registered nurse assesses the individual utilizing the Personal Care Screening Tool (PCST). One’s ability to complete their Activities of Daily Living (ADLs) and their need for in-home assistance with these activities is considered. ADLs include bathing, grooming, dressing, eating, mobility in the home, toileting, and transferring (i.e., moving from the bed to a wheelchair). Furthermore, a physician must authorize the need for Personal Care Services. While a person with Alzheimer’s disease or a related dementia could meet the functional criteria for MAPC, a diagnosis of dementia in and of itself does not mean one will do so.

 Learn more about long-term care Medicaid in Wisconsin.


Qualifying When Over the Limits

Having income and / or assets over Wisconsin Medicaid’s limit(s) does not mean an applicant cannot still qualify for Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.

WI has a Medically Needy Medicaid Program called the Medicaid Deductible Program for Medicaid applicants who have high medical expenses relative to their income. Also known as a spend-down program, applicants are permitted to spend “excess” income on medical expenses and health care premiums, such as Medicare Part B, in order to meet Medicaid’s Medically Needy Income Limit. The amount that must be “spent down” for each six-month period can be thought of as a deductible. Once one’s “deductible” has been met for the period, WI Medicaid will pay for Personal Care Services.

When persons have assets over the limit, Irrevocable Funeral Trusts (IFTs) are an option. IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Another option are Medicaid Asset Protection Trusts (MAPTs), which not only protects assets from Medicaid’s asset limit, but also preserves them as inheritance by protecting them from Medicaid’s Estate Recovery Program. There are many other options when the applicant has assets exceeding the limit.

Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Wisconsin to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, while Medicaid’s 60-month Look-Back Rule does not apply to WI’s Medicaid Personal Care, it is not unusual that one require more extensive care, such as home and community based services via a Medicaid Waiver or Nursing Home Medicaid, in the future. For these programs, the Look-Back Rule is relevant, and violating it results in a Penalty Period of Medicaid ineligibility. While there are many Medicaid planning strategies, they should only be implemented with careful planning and well in advance of the need for long-term care. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.


How to Apply for Wisconsin Medical Assistance Personal Care

Before You Apply

Prior to submitting an application for Wisconsin Medicaid, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid Eligibility Test.

As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, previous bank statements, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are held up is required documentation is missing or not submitted in a timely manner.


Application Process

Persons must be enrolled in WI’s Medicaid program to receive Medical Assistance Personal Care. Persons can apply for WI Medicaid online via ACCESS, by contacting their local county or tribal agency, by calling Member Services at 800-362-3002, or by submitting a completed application for Elderly, Blind, or Disabled Medicaid to the address on the application.

Persons already enrolled in WI Medicaid, should contact the MAPC Provider Agency of their choosing to initiate the process of enrolling in Medicaid Personal Care. A Personal Care Agency directory can be found on this webpage.

Although not necessarily intended for a consumer audience, more information about Personal Care Services can be found here.

The Wisconsin Department of Health Services (DHS) administers Medicaid Personal Care Services. The Division of Quality Insurance certifies and regulates Medicaid Personal Care Agencies.


Approval Process & Timing

The WI Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further.

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