Wisconsin Medicaid for Senior Care
Complete guide to Medicaid eligibility, coverage, and application process for nursing homes, assisted living, and home care in Wisconsin.
7.6 million Medicaid long-term care recipients nationwide
Wisconsin Department of Health Services - Division of Medicaid Services
Processing Time
30-45 days for standard BadgerCare Plus (Medicaid); Family Care enrollment typically occurs within 30-60 days of Medicaid approval
Wisconsin Medicaid Eligibility Requirements (2026)
To qualify for Medicaid long-term care in Wisconsin, applicants must meet both financial eligibility criteria (income and assets) and medical criteria (level of care needs). Wisconsin follows federal Medicaid guidelines with some state-specific variations.
Income Limits
Individual Applicant
$2,982/month
Married Couple (One Applying)
$5,964/month
Income includes Social Security, pensions, annuities, interest, dividends, and rental income.
Asset Limits
Individual Applicant
$2,000
Community Spouse (At-Home Spouse)
$3,000
Primary residence, one vehicle, personal belongings, and prepaid burial arrangements are exempt from asset limits.
5-Year Look-Back Period
Wisconsin Medicaid reviews all financial transactions for the 60 months prior to application. Asset transfers or gifts during this period can result in a penalty period of Medicaid ineligibility. The penalty is calculated by dividing the transferred amount by $9,411/month average (semi-private), $10,333/month (private) (the average monthly nursing home cost in Wisconsin).
Medical Eligibility
Applicants must demonstrate need for nursing facility level of care through a state assessment. This typically requires assistance with 2-3 Activities of Daily Living (bathing, dressing, toileting, transferring, eating) or cognitive impairment requiring supervision.
Assessments are performed by state-designated evaluators (nurses or social workers) and typically take 45-90 minutes. The assessment can occur at home, in a hospital, or at the care facility.
What Medicaid Covers in Wisconsin
Nursing Home Care
Medicaid pays 100% of nursing home costs in Wisconsin once eligibility is established. The average monthly cost is $9,411/month average (semi-private), $10,333/month (private). Recipients contribute most of their monthly income toward care costs, keeping only $50-75 for personal needs.
Coverage includes room, board, 24-hour nursing care, meals, medications, therapy services, and all medical care provided at the facility.
Assisted Living Coverage
Family Care - Residential Services: Wisconsin's Family Care program includes coverage for individuals residing in Community-Based Residential Facilities (CBRFs) or Residential Care Apartment Complexes (RCACs)—Wisconsin's terms for assisted living. Medicaid covers personal care services, medication administration, and care coordination through Family Care MCOs. Room and board costs are not covered—residents pay housing from their monthly income.
Note: This program covers personal care services but does not cover room and board costs. Residents need approximately $1,500-$2,500/month from Social Security or other income to cover housing expenses.
Home and Community-Based Services (HCBS) Waivers
Wisconsin offers 3 HCBS waiver programs that provide in-home care and community services as an alternative to nursing facility placement.
Family Care Program
Wisconsin's comprehensive managed long-term care program serving individuals age 65+ or adults with disabilities who meet functional eligibility. Delivered through managed care organizations (MCOs) that coordinate all long-term services. Includes adult day services, adaptive aids, care management, home-delivered meals, personal care, respite, supportive home care, residential services, and more. Over 50,000 participants statewide—one of the largest managed LTSS programs nationally.
Program Details →IRIS (Include, Respect, I Self-Direct)
Self-directed long-term care option available as alternative to Family Care in most counties. Participants manage their own budgets and hire caregivers. Provides maximum flexibility and control.
Program Details →Community Options Program (COP-W)
Waiver program available in counties without Family Care. Provides similar services including personal care, supportive home care, adult day care, respite.
Program Details →How to Apply for Medicaid in Wisconsin
Wisconsin Medicaid applications typically take 30-45 days for standard BadgerCare Plus (Medicaid); Family Care enrollment typically occurs within 30-60 days of Medicaid approval. Starting the process early and submitting complete documentation helps avoid delays.
Application Methods
You can apply for Medicaid in Wisconsin through:
- Online at access.wi.gov (Wisconsin Benefits Portal)
- Phone: 1-888-701-1251 (BadgerCare Plus customer service) or 1-877-888-4040 (Family Care enrollment)
- Download application and mail to local county/tribal human or social services agency
- In-person at local consortium (ADRC) or county agency office
Step 1: Gather Required Documents
Before starting your application, collect:
- •Birth certificate and Social Security card
- •Proof of citizenship (passport, naturalization)
- •5 years of bank statements
- •Investment and retirement account statements
- •Property deeds and mortgage statements
- •Life insurance policies
- •Social Security award letter
- •Pension benefit statements
- •Medicare card
- •Doctor's statement of care needs
Step 2: Submit Your Application
Complete and submit your application through one of the methods listed above. If applying online or by mail, keep copies of all submitted documents.
Step 3: Medical Assessment
A state assessor will evaluate level of care needs. This assessment typically takes 45-90 minutes and covers functional abilities, medical needs, cognitive status, and safety concerns.
Step 4: Financial Review
Medicaid staff review all financial documents and investigate any transfers or gifts made in the past 60 months. They may request additional documentation during this process.
Step 5: Receive Determination
You'll receive written notification of approval or denial. Approved applications include the effective date of coverage (often retroactive up to 3 months), patient responsibility amount, and covered services.
Get Free Application Help
Free Medicaid application assistance is available in Wisconsin from:
- •Area Agency on Aging: Call 1-800-677-1116 (Eldercare Locator) to find your local office
- •SHIP counselors: Free Medicare/Medicaid counseling
- •Nursing facility social workers: In-facility application support
- •Elder law attorneys: Paid help for complex financial situations ($2,000-$5,000)
Wisconsin-Specific Programs and Resources
Medicare Savings Programs (QMB/SLMB/QI/QDWI)
QMB pays Medicare premiums, deductibles, and coinsurance. SLMB pays Part B premiums. QI pays Part B premiums (limited funding). QDWI pays Part A premiums for working disabled individuals.
Learn MoreSeniorCare (Prescription Drug Assistance)
State-funded prescription drug program for Wisconsin seniors age 65+ with affordable copays ($5-$15). Can be used alongside Medicare Part D.
Learn MoreAging and Disability Resource Centers (ADRCs)
Statewide network of local resource centers providing information, counseling, and assistance with long-term care options and Medicaid applications.
Learn MoreNeed Help with Wisconsin Medicaid?
Contact Wisconsin Department of Health Services - Division of Medicaid Services for specific questions about eligibility, application status, or covered services.
Main Office Phone
1-800-362-3002Application Helpline
1-888-701-1251