The state of Wisconsin provides low-cost or free health insurance to over 900,000 residents through its Medicaid program that’s jointly funded and regulated by the federal government.
Wisconsin Medicaid coverage is available to eligible low-income residents of all ages, including dependent children, pregnant women, disabled and blind adults and senior citizens. It covers a full range of health care services such as doctor and specialist visits, inpatient and outpatient hospital care, lab work and X-rays, ambulance and nonemergency medical transportation, prescription drugs and institutional nursing home care.
Qualifying for Medicaid
Milwaukee residents who are U.S. citizens or legal immigrants can qualify for long-term care through Medicaid if they’re aged 65 or older or blind or disabled and aged 64 or younger. Individual applicants are limited to $2,313 per month in income and assets with a value of $2,000 or less.
Medicaid counts all sources of income when determining an applicant’s eligibility but disregards some assets such as an owner-occupied home, one vehicle, household and personal effects, and burial plots.
When only one married spouse needs coverage, the individual income and asset limits apply. To meet Medicaid’s requirements to prevent spousal impoverishment, the non-applicant may receive up to $3,160.50 of the applicant’s monthly income as a minimum monthly maintenance needs allowance. They may also retain up to $126,420 of the couple’s joint assets as a resource allowance.
Seniors with income above the limit may be able to use a Medicaid Deductible plan to qualify. This involves deducting the program’s current income limit from an applicant’s monthly income then multiplying by six. Once the resulting deductible figure has been spent on approved medical expenses, the applicant qualifies for six months of Medicaid coverage.
Applying for Medicaid
Milwaukee residents can apply for Wisconsin Medicaid online or call (800) 362-3002 for information or assistance completing an application.
The Wisconsin Medicaid program only provides institutional nursing home care as an entitlement. The state does offer two waivers that provide seniors who wish to remain in the community with alternatives to nursing home admission.
Family Care Waiver
The Family Care waiver program provides services through a managed care organization. Approved participants are assessed by their MCO, and a personalized care plan is developed to meet their needs. Based on this plan, seniors receive funds to pay for support services at home or in a community setting such as an assisted living facility.
Covered services may include:
- Relocation assistance
- Care coordination
- Assistance with daily living activities
- Occupational, physical and speech therapy
- Skilled nursing care
- Adaptive aides
- Medical supplies and equipment
- Medical transportation
To qualify for the program, applicants must be Medicaid-eligible, aged 65 or older or disabled/blind and aged 18 to 64, and need daily help to remain independent and avoid nursing home admission.
Include, Respect, I Self-Direct Waiver The
IRIS waiver provides participants with a monthly budget to use toward services and supports. The amount of funding received is based on a needs assessment and care plan developed by the participant’s assigned case manager.
To qualify, Milwaukee seniors must be Medicaid-eligible, aged 65 or older or disabled if younger, reside in a private home, residential care facility or adult family home, and need nursing-facility level care.
Participants may use their budget for various goods and services, including residential or adult day care, personal care, nursing services, medical equipment and supplies, nonmedical transportation, meals and assistive technologies.
To learn more about the Family Care and IRIS waiver programs or apply, seniors can contact the
Milwaukee County Department on Aging at (414) 289-6874.