Wisconsin Medicaid Long Term Care Eligibility in 2025

Wisconsin Long Term Care

Eligibility for 2025:

Wisconsin Medicaid provides long-term care services for eligible seniors and individuals with disabilities. These services are available in nursing homes, assisted living residences, and adult foster care homes, as well as through home and community-based programs designed to help individuals remain at home or in their community.

To qualify, applicants must meet residency, medical, income, and asset requirements. Additional programs offer non-medical supports, such as personal care assistance, adult day care, and home modifications, through Medicaid Waivers and other initiatives.

1. Residency and Citizenship – Applicants must be Wisconsin residents and U.S. citizens or have proper immigration status.

2. Age/Disability – Applicants must be 65 or older, blind, or disabled and meet medical requirements consistent with a Nursing Facility Level of Care (NFLOC).

3. Income Limitations – Income limits for 2025 are:

Single applicant: $2,901/month.
Married applicants (both spouses): $5,802/month.
Married (one spouse applying): $2,901/month for the applicant.

Most of a Medicaid recipient’s income must go toward care costs, with Medicaid covering remaining expenses. A $55/month personal needs allowance is excluded from income calculations for nursing home residents.

4. Asset Limitations – Applicants must have $2,000 or less in countable assets. Married couples applying together have an asset limit of $4,000. Exempt assets include a primary residence, one vehicle, personal belongings, and irrevocable burial funds.

Exempt Assets in 2025 for Wisconsin Medicaid Include:

Primary home (equity limit: $750,000) if the applicant or their spouse resides there, or if there is an Intent to Return.
One vehicle of any value used for medical or daily living needs.
Household furnishings, clothing, and personal items.
Irrevocable burial funds (up to $1,500).
Life insurance policies with a face value of less than $1,500.
Non-saleable property or business-related assets (e.g., farm equipment).

Spousal Rules in 2025:

**Community Spouse Resource Allowance (CSRA):** The community spouse may retain up to $157,920 of the couple’s countable assets. If the community spouse’s assets are below $50,000, they may retain additional assets from the institutionalized spouse until this minimum is reached.

**Monthly Maintenance Needs Allowance (MMNA):** The community spouse may retain income up to $3,948/month. Additional income from the institutionalized spouse may be transferred to meet this allowance.

Wisconsin is an “income-first” state, meaning the institutionalized spouse’s income is used to meet the community spouse’s needs before adjusting the CSRA.

Specific Wisconsin Medicaid Programs

Family Care & Family Care Partnership: Consumer-directed programs providing services like adult day care, meal delivery, and personal care assistance.
IRIS (Include, Respect, I Self-Direct): A self-directed waiver program offering services like nursing, home modifications, and caregiver support.
PACE (Program of All-Inclusive Care for the Elderly): Combines Medicare and Medicaid benefits, including dental and vision care.
Money Follows the Person (MFP): Assists institutionalized individuals in transitioning back to community living.

How to Apply for Wisconsin Medicaid

To apply for Medicaid or learn more, contact your local Aging and Disability Resource Center (ADRC) or visit Wisconsin’s ACCESS Portal. Assistance is also available through local Income Maintenance and Tribal Agencies.