Medicaid provides health insurance for over 72 million low-income people across the United States. The federal government regulates and jointly funds the program, and each state defines and administers its own Medicaid plan within the established federal parameters.
The Wisconsin Medicaid program provides vital health care services to eligible residents of all ages, including seniors and those with disabilities. To qualify for Medicaid coverage that includes long-term nursing home care, applicants must be U.S. citizens or qualified immigrants and aged 65 or older, blind or disabled.
Applicants are limited to $2,313 in monthly income and a total of $2,000 in countable assets per person. Income from all sources is considered, but some assets are disregarded, including a primary home valued below $858,000, one automobile, burial plots, household furnishings and personal effects.
Those with high medical bills and income over the above-mentioned limits may qualify through a Medicaid Deductible plan. This requires applicants to reach a specific medical care deductible before receiving Medicaid coverage for a six-month period. The deductible amount is calculated by subtracting the program’s income limit, currently $591.67, from the applicant’s countable income.
Milwaukee County residents can apply for Wisconsin Medicaid online or call (800) 362-3002 for information or assistance completing an application.
Regular Wisconsin Medicaid only covers long-term care in a nursing facility. However, the state also offers waivers that allow elderly and disabled individuals to receive care services in community-based residential settings, including assisted living. Currently, there are two such waiver programs available.
Family Care Waiver
Wisconsin residents who participate in the Family Care waiver program are enrolled with a long-term managed care provider to receive assistance developing a personal service plan to match their needs. Funding is then provided so they can pay for the plan’s services and supports in the community setting of their choice.
To qualify, applicants must be aged 18-64 and disabled or aged 65 and older and need daily assistance to continue living independently and avoid nursing home placement.
Those approved for the Family Care program can receive services, such as health care coordination, transitional assistance, help with activities of daily living, skilled nursing care, medical transportation, residential services, speech, physical and occupational therapy, necessary medical equipment and supplies and adaptive aids.
Include, Respect, I Self-Direct Waiver
The IRIS waiver gives seniors and disabled adults the means to direct their care based on their needs. Those enrolled in the program work with a case manager to develop a personalized care plan and budget they can then allocate for their plan’s services and supports. To qualify, Wisconsin residents must:
- Be Medicaid-eligible
- Over age 65 or aged 18-64 and disabled
- Require a nursing home level of care but prefer to live in a community setting
- Reside in a private home, adult family home or approved residential care setting
The IRIS program can cover a number of goods and services for participants, such as personal care assistance, adult day care, residential care, meals, nonmedical transportation, assistive technology, nursing care and specialized medical equipment and supplies.
Seniors and disabled adults can learn more about the Family Care and IRIS waiver programs or apply by contacting the
Milwaukee County Department on Aging at (414) 289-6874.