Wisconsin Medicaid Long Term Care Eligibility
Wisconsin Long Term Care
1. Residency and Citizenship – the applicant must be a resident of Wisconsin and a U.S. citizen or have proper immigration status.
2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested.
3. Income Limitations – If single, the applicant’s monthly income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be no higher than 300% the Federal SSI Benefit Level ($2,205) to become eligible for Medicaid. Even when someone becomes eligible for Medicaid, most of their income must be used to pay nursing home bills, with Medicaid paying remaining costs.
- There is a personal needs allowance of $45.00/month that is not factored into the total countable income.
4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. The state has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away. Basically, all money and property, and any item that can be valued and turned into cash, is a countable asset unless it is listed as exempt.
Exempt assets for an applicant in Wisconsin include:
i. $2,000 or less in cash/non-exempt assets if single. If married and both spouses need nursing home level of care the limit is raised to $3,000.
ii. One home is exempt (equity limit $840,000) if planning to return, a spouse, a child under 21, or a disabled person resides in it. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum.
iii. One automobile, no equity amount specified.
iv. Irrevocable burial trust or other burial funds, maximum value of $1,500.
v. Non-saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects are not counted.
vi. Cash surrender value of life insurance policies with a face value of less than $1,500.
vii. Some property used in a trade or business (may include farm or income producing rental property).
Amount of assets community spouse may retain: The community spouse can keep one-half of countable assets with a maximum value of $120,900. If the community spouse’s assets do not equal the minimum of $50,000, the community spouse is able to retain assets from the institutionalized spouse until the minimum is reached.
Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has a monthly income of less than $2,706.66. The maximum amount of income that can be retained is $3,022.50 varying by case, depending on unique shelter expenses. Shelter costs include rent or mortgage, maintenance fees, taxes and insurance. Wisconsin is an “income first” state, meaning the state limits the right to petition for an increased community spouse resource amount (CSRA) to couples whose combined income fails to meet the community spouse’s income needs. Basically, this means a community spouse can petition for an increased CSRA where there’s an income gap only after factoring in the nursing home spouse’s income first.
Wisconsin long term care insurance partnership:
This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used, you may apply for Medicaid with $155,000 worth of assets exempted.
Wisconsin Medicaid for the Elderly, Blind or Disabled with information on specific programs: https://www.dhs.wisconsin.gov/medicaid/index.htm