Medicaid is a government-funded health insurance program for low-income children, seniors, pregnant women and people with disabilities. It covers basic health benefits, such as physician care, hospital services, X-rays, lab tests and nursing home care. Additional state-specific benefits may be provided.
To qualify for long-term Wisconsin Medicaid benefits, seniors aged 65 and older must have a monthly income of $2,313 or less, and own $2,000 or less in countable assets. Income from all sources is included while some assets, such as a personal vehicle, an owner-occupied home, household furnishings and a prepaid burial contract, are exempt.
Medicaid Deductible Plan
Seniors who meet all Wisconsin Medicaid enrollment criteria except for the income limit rule may be able to qualify for coverage through the Medicaid Deductible plan.
Also known as a Medicaid spend-down or medically needy plan, it lets seniors who have high ongoing medical expenses deduct their out-of-pocket medical expenses from their declared income. The amount of the deductible is based on the amount of excess income the senior earns each six-month period. Once the deductible is met, Medicaid benefits are provided for the remainder of the six months.
To apply for Wisconsin Medicaid, call the member services hotline at (800) 362-3002.
Family Care
Family Care is a nursing home diversion program that gives eligible seniors additional Medicaid-funded services and supports delivered in an assisted living setting or another community-based placement. The program is delivered through a managed care organization, and services are assigned based on medical needs.
Family care services may include:
- Transitional support for seniors leaving a nursing facility
- Skilled nursing care
- Personal care
- Rehabilitation and day programming
- Medical equipment
In Dane County, Family Care services are delivered through two
Managed Care organizations: Care Wisconsin, and My Choice Family Care.
Include, Respect, I Self-Direct Waiver The IRIS waiver is a Wisconsin Medicaid home and community-based waiver program that gives participants funding for medically necessary services and supports. The program is designed to let seniors and adults with disabilities live in the least restrictive location, which may be an assisted living facility.
IRIS participants complete a comprehensive needs assessment. Individual funding is based on the assessment and goals are identified in a care plan developed by the designated case manager.
Seniors accepted into the IRIS program can self-direct their care by hiring their own caregivers, which may include friends and family members. IRIS money may be used to cover approved expenses at the discretion of the participant, such as personal care, adult day health services, mobility aids, medical supplies and transportation services.
For more information on the IRIS waiver and the Family Care program, contact the
Aging and Disability Resource Center of Dane County at (855) 417-6892.