Wisconsin Medicaid for seniors and long-term care

Last verified: June 2026

Family Care and IRIS: Wisconsin's two LTSS pathways

Wisconsin offers two primary pathways for home and community-based long-term services and supports (LTSS) for eligible adults age 18 and older: Family Care and IRIS (Include, Respect, I Self-Direct). The choice between them depends on the individual's preference for managed care vs. self-direction.

Functional eligibility for both programs requires meeting the nursing home level of care standard and having a disability or aging-related condition. Financial eligibility is determined separately by ForwardHealth. To be evaluated for Family Care or IRIS, contact your local Aging and Disability Resource Center (ADRC) — find yours at dhs.wisconsin.gov/adrc.

Asset limits for long-term care Medicaid in Wisconsin

Source: Wisconsin DHS ForwardHealth long-term care eligibility policy; federal CSRA rules under 42 U.S.C. § 1396r-5. Wisconsin applies the federal minimum CSRA of $50,000 and maximum of $154,140, with the exact amount determined by the spousal asset assessment.

Nursing facility coverage

Wisconsin Medicaid covers nursing facility care for individuals who meet the nursing home level of care standard and financial eligibility. Residents in a Medicaid-covered nursing facility contribute most of their monthly income toward their care — the state sets a Personal Needs Allowance (PNA) that residents keep for personal expenses.

Wisconsin operates a comprehensive nursing home survey and certification process through DHS's Division of Quality Assurance. Information about Wisconsin nursing home quality ratings is available through the CMS Care Compare tool at medicare.gov/care-compare.

PACE: program of all-inclusive care for the elderly

Wisconsin has PACE programs operating in select areas, including the greater Milwaukee metro region. PACE serves adults age 55 and older who need nursing facility level of care but can safely live in the community. PACE integrates Medicare and Medicaid services through a single, coordinated care team. For Medicaid-eligible participants, PACE has no monthly premium. Contact the National PACE Association at npaonline.org or Wisconsin DHS (dhs.wisconsin.gov) for current PACE site locations.

Medicaid as the primary payer for long-term care

Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.

Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. Wisconsin's share of that population is administered through Wisconsin Medicaid (ForwardHealth). The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.

Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.

Nursing facility coverage

Wisconsin Medicaid (ForwardHealth) covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance (which varies by state but is often $30–$50 per month). Medicaid covers the gap.

If income exceeds the institutional Medicaid limit, Wisconsin may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible. Not all states allow this; verify whether Wisconsin uses this approach with Wisconsin Medicaid (ForwardHealth).

Home and community-based services (HCBS)

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through Wisconsin Medicaid (ForwardHealth) differs from what's available in neighboring states.

Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.

Contact Wisconsin Medicaid (ForwardHealth) to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.

Asset limits for long-term care Medicaid

Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.

Exempt assets are not counted. The primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt.

Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult Wisconsin Medicaid (ForwardHealth) or a Medicaid planning attorney before transferring assets.

Spousal protections

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.

The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. Wisconsin's current CSRA is set by Wisconsin Medicaid (ForwardHealth) and published on their website.

The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).

What long-term care Medicaid typically covers

• Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
• Physical, occupational, and speech therapy provided in a nursing home
• Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
• Home health aide visits for those receiving care at home
• Adult day health care programs
• Respite care to give family caregivers temporary relief
• Durable medical equipment prescribed by a physician
• Transportation to and from medical appointments