Medicaid, a government-funded health plan for needy children, seniors, and adults with disabilities, gives approximately 16% of Wisconsin residents access to basic health care services. By law, Medicaid participants are guaranteed certain benefits, such as inpatient and outpatient hospital services, physician services and nursing home care.
Because each state administers its own Medicaid program, optional state-specific benefits may also include personal care, vision and dental care, prescription medication coverage and case management.
Qualifying for Long-Term Medicaid
Seniors aged 65 and older may be eligible for long-term Wisconsin Medicaid benefits if they meet the financial and care needs criteria. To qualify, applicants must have a monthly income of $2,313 or less and have assets valued at $2,000 or less.
If both spouses in a married couple require Medicaid, the monthly joint income limit is set at $4,626 and the joint asset limit is $3,000. When only one spouse needs Medicaid, individual asset and income limits apply, and any income earned by the non-applicant is disregarded.
The non-applicant may receive top-up funds from the applicant’s income to prevent spousal impoverishment. Under the minimum monthly needs allowance rule, a monthly spousal income transfer can raise the non-applicant’s monthly income to a maximum of $3,160.50.
Medicaid Deductible Plan
Seniors who have income that exceeds Medicaid limits but otherwise meet the enrollment criteria may be able to enroll in a Medicaid Deductible plan.
This plan allows seniors to subtract the cost of out-of-pocket medical expenses from their income up to a predetermined deductible amount that resets every six months. Once the senior meets their deductible, Medicaid coverage is activated for the remainder of the six-month period.
To apply for Wisconsin Medicaid and learn more about the Medical Deductible plan, call the Member Services Hotline at (800) 362-3002.
Include, Respect, I Self-Direct Waiver
Wisconsin’s IRIS waiver is a self-directed nursing home diversion program that provides eligible Medicaid enrollees with a monthly budget for use towards personal care and support services.
The amount of money each IRIS receives each month is based on their care needs as determined by a case manager. Seniors are encouraged to manage their own IRIS budget, prioritize their care needs and choose the services that best fit their personal preferences and goals.
Participants can use their IRIS funds to pay for a wide range of approved expenses, such as:
- Adaptive and communication aids
- Adult day health services
- Home-delivered meals
- A medical alert system
- Home care
- Transportation
- Counselling and rehabilitation therapy
Under the IRIS, participants can hire friends and family members to provide personal care services. Participants who reside in an assisted living setting are eligible for IRIS funding, however, IRIS money cannot be used to pay for assisted living costs.
Family Care Family Care provides Medicaid-eligible seniors who need the level of care normally provided in a nursing home with long-term care services delivered through a managed-care organization. These services are designed to let seniors remain in a noninstitutional setting, such as an assisted living facility, and may include:
- Skilled nursing
- Personal care
- Mobility devices
- Adult day health programming
- Respite care
- Transportation
- A personal emergency response system
Services are assigned based on the needs of each participant as identified by an interdisciplinary care management team consisting of a case manager and a registered nurse. In Douglas County, the Family Care program is administered by
Inclusa. Note: Seniors may enroll in either Family Care or IRIS.
For more information on the IRIS waiver and the Family Care program, contact the
Douglas County Aging and Disability Resource Center at (715) 395-1234.