Wisconsin Medicaid operates within the framework of the federal Medicaid program, which delivers health care coverage to one in five Americans. Over 900,000 Wisconsin residents receive low-cost or free medical and long-term care services through the program. To qualify for coverage, Oshkosh residents must:
- Be a U.S. citizen or qualified immigrant
- Be aged 65 or older, or disabled if younger
- Have an income of $2,313 or less per month
- Have a maximum of $2,000 in assets
It’s important to note that all types of income count toward the limit, including wages, Social Security and VA benefits, pension payments, rental income, IRA withdrawals and investment dividends. Several asset types don’t count, such as a primary residence valued at less than $858,000, household and personal effects, one vehicle and burial plots.
The state program offers a Medicaid deductible plan that may help over-income seniors with high medical expenses qualify for coverage. A deductible is determined by reducing an applicant’s income by the program’s current income limit (presently $591.67). Once this amount is spent on medical expenses, the applicant becomes eligible for Medicaid coverage for a period of six months.
Oshkosh residents can
apply for Medicaid coverage online or call
Wisconsin Access member services at (800) 362-3002 to learn more or receive help submitting an application.
In an effort to reduce the number of nursing home admissions and the overall cost of long-term care, Wisconsin Medicaid offers two waiver programs that cover a variety of services and supports for Medicaid-eligible seniors wishing to remain in the community.
Include, Respect, I Self-Direct Waiver The
IRIS waiver program is designed to give eligible seniors and disabled adults the ability to make choices about their long-term care goals and where they live. The program provides the services of a case manager to help enrollees develop their own services and supports plan and matching budget. Participants can use their budgeted funds to pay for goods and services of their choosing. These might include:
- Nursing services
- Residential care
- Prepared meals
- Assistance with personal care
- Medical equipment and supplies
- Assistive technology
- Nonmedical transportation
To qualify for the IRIS program, applicants must be aged 64 or younger and disabled or over age 65 and in need of a nursing facility level of care.
Family Care Waiver The
Family Care waiver enrolls qualified seniors with a managed care organization to develop a medical and long-term care plan tailored to their specific needs. The program allows seniors to receive services where they live, such as a community-based residential care facility. Covered supports and services can include:
- Care coordination
- Assistance with activities of daily living
- Residential services
- Medical transportation
- Physical and speech therapy
- Durable medical equipment
- Adaptive aids
- Necessary supplies
- Skilled nursing care
- Transitional assistance
To qualify for the Family Care program, applicants must be 65 or older or 64 or younger and disabled. They must also be assessed as needing daily assistance to maintain their independence and avoid admission to a nursing home.
To learn more about the IRIS or Family Care waiver programs or to apply, seniors can contact the
Greater Wisconsin Agency on Aging at (608) 243-5670.