Wisconsin Medicaid Eligibility 2025: Income Limits, Asset Rules & How to Apply

Wisconsin Medicaid, known as BadgerCare Plus for certain populations, is a health insurance program funded by federal and state dollars, providing medical and health-related services to low-income individuals, including children, pregnant women, parents, seniors, and disabled individuals. Administered by the Wisconsin Department of Health Services (DHS), this guide outlines the 2025 eligibility criteria, income limits, asset rules, and application process for Wisconsin Medicaid, based on federal and DHS guidelines, with a focus on long-term care for seniors (aged 65+), as well as other eligibility groups.

Wisconsin Medicaid Programs

Wisconsin Medicaid offers coverage for various groups, with specific eligibility requirements based on income, assets, age, and medical needs. The main programs include:

• Institutional / Nursing Home Medicaid: An entitlement program covering nursing home care, hospitals, and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). Requires a Nursing Facility Level of Care (NFLOC).
• Home and Community Based Services (HCBS) Waivers: Non-entitlement programs with limited slots, offering services like in-home care, adult day care, and delivered meals to help seniors and disabled individuals avoid institutionalization. Programs like Family Care or IRIS (Include, Respect, I Self-Direct) may have waiting lists.
• Regular Medicaid (Aged, Blind, and Disabled): Covers low-income elderly, blind, or disabled individuals, with less stringent medical requirements than long-term care programs.
• Medicaid for Children and Pregnant Women: Covers children up to age 19 and pregnant women with higher income limits through BadgerCare Plus, which includes the Children’s Health Insurance Program (CHIP).
• Medicaid for Adults (19–64): Covers low-income adults without dependent children, enabled by Wisconsin’s partial Medicaid expansion under the Affordable Care Act (ACA) since 2014, though with stricter income limits than full expansion states.

Eligibility for Wisconsin Medicaid

Eligibility varies by program and population. General requirements include:

• Residency: Must be a resident of Wisconsin.
• Citizenship: Must be a U.S. citizen, national, permanent resident, or legal alien with qualifying immigration status (e.g., refugees, asylees, or lawful permanent residents with 5+ years in the U.S.).
• Income: Varies by program, often based on a percentage of the Federal Poverty Level (FPL) or Federal Benefit Rate (FBR).
• Assets: Limits apply for long-term care and aged/blind/disabled programs.
• Medical/Functional Need: Long-term care programs require a Nursing Facility Level of Care (NFLOC), assessed through limitations in Activities of Daily Living (ADLs) or Instrumental Activities of Daily Living (IADLs).

Categorical Eligibility

Individuals receiving Supplemental Security Income (SSI) or certain means-tested benefits are often categorically eligible for Regular Medicaid, bypassing some income and asset tests.

Income Limits for Wisconsin Medicaid

Income limits vary by program and household status. Below are the 2025 income limits for Wisconsin, based on federal guidelines and state policies, expressed as monthly amounts unless noted.

Additional Notes on Income Limits

• Seniors/Disabled (Nursing Home/HCBS): Income above $2,901/month must go toward care costs, except for a Personal Needs Allowance ($45/month for nursing home, higher for HCBS), Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse. Wisconsin uses a medically needy pathway for excess income instead of Qualified Income Trusts (QITs).
• Married, One Spouse Applying: Applicant’s income limit is $2,901/month; non-applicant spouse’s income is not counted. The non-applicant may receive a Minimum Monthly Maintenance Needs Allowance (MMMNA) of up to $3,948/month if their housing and utility costs exceed $793.13/month (effective 7/1/25–6/30/26).
• Children/BadgerCare Plus: Limits may extend to 319% FPL ($4,147/month for one) for children under 19. Some children above 100% FPL may face premiums under BadgerCare Plus.
• Pregnant Women: Coverage extends 12 months postpartum, with limits up to 194% FPL ($2,596/month for one).
• ACA Expansion: Wisconsin’s partial Medicaid expansion since 2014 covers adults aged 19–64 with incomes up to 100% FPL (not 138% as in full expansion states), with no asset test. Those above 100% FPL may qualify for subsidized private plans through the Marketplace.

2025 Federal Poverty Level (FPL) Guidelines for Reference (48 States & D.C.)

Note: Use the FPL Calculator to estimate your household’s FPL percentage.

Asset Rules for Wisconsin Medicaid

Asset limits apply primarily to long-term care and aged/blind/disabled programs.

Long-Term Care Medicaid (Nursing Home and HCBS Waivers)

• Single Applicant: $2,000 in countable assets (e.g., bank accounts, stocks, bonds, secondary properties).
• Married, Both Applying: $3,000 total.
• Married, One Applying: $2,000 for the applicant; $157,920 for the non-applicant spouse (Community Spouse Resource Allowance, or CSRA).
• Home Equity Limit: $1,103,000 for the primary residence (if applicant/spouse resides there or intends to return).

Non-Countable Assets

• Primary home (if applicant/spouse resides there or intends to return)
• One vehicle
• Household goods and personal effects
• Pre-paid funeral contracts (irrevocable, up to $4,500)
• Medicaid Compliant Annuities
• Life insurance with a face value of $1,500 or less

Medicaid’s Look-Back Rule

Wisconsin enforces a 60-month look-back period for Nursing Home Medicaid and HCBS Waivers, reviewing asset transfers within 5 years of application. Transfers below fair market value (e.g., gifting) may result in a penalty period of ineligibility, though Wisconsin’s “divestment penalty divisor” (used to calculate penalty duration) is relatively lenient. No look-back period applies for Regular Medicaid.

Estate Recovery

Wisconsin’s Medicaid Estate Recovery Program seeks reimbursement for long-term care costs after a beneficiary’s death, often targeting the home if not protected. Consult a Certified Medicaid Planner to safeguard assets.

Regular Medicaid (Aged, Blind, and Disabled)

• Asset Limit: $2,000 for an individual; $3,000 for a couple.
• No home equity limit or look-back period.

Medicaid for Children, Pregnant Women, and Adults (ACA Expansion)

• No Asset Test: These programs focus solely on income.

Medical/Functional Requirements

For Nursing Home Medicaid and HCBS Waivers, applicants must demonstrate a Nursing Facility Level of Care (NFLOC), assessed through:

• Limitations in Activities of Daily Living (ADLs): Mobility, bathing, dressing, eating, toileting.
• Limitations in Instrumental Activities of Daily Living (IADLs): Cooking, shopping, managing finances.
• Cognitive or Behavioral Issues: E.g., Alzheimer’s or dementia, though diagnosis alone does not guarantee eligibility.

Regular Medicaid for the aged, blind, or disabled requires proof of disability or blindness per Social Security Administration criteria but not necessarily NFLOC.

Changes Due to Federal Policy

As of 2025, federal policy changes may affect Medicaid, though Wisconsin’s partial expansion status influences the impact:

• Work Requirements (Starting January 2027): May apply to ACA expansion adults (19–64) but not to seniors, disabled individuals, pregnant women, or children. Wisconsin has explored work requirements in the past.
• Reduced Retroactive Coverage (Starting January 2027): Medicaid will cover only 2 months prior to application (down from 90 days), increasing potential medical debt for late applicants.
• More Frequent Eligibility Checks (Starting December 2026): Beneficiaries must renew eligibility every 6 months, requiring regular documentation to avoid coverage gaps.
• New Out-of-Pocket Costs (Starting October 2028): Non-exempt beneficiaries may face up to $35 per visit for specialist services or procedures, but primary care and preventive services remain free.

Options if Over the Income or Asset Limit

If your income or assets exceed the limit, consider:

• Medically Needy Pathway: Wisconsin allows a spend-down program for long-term care and Regular Medicaid, where medical expenses reduce income to the eligibility limit (e.g., $967/month for a single person).
• Irrevocable Funeral Trusts (IFTs): Pre-paid funeral and burial expenses (up to $4,500) are exempt from asset limits.
• Spend Down: Convert countable assets into exempt ones (e.g., home repairs, purchasing a vehicle, or paying off debt).
• Certified Medicaid Planners: Professionals can help with financial strategies to achieve eligibility, such as Medicaid Compliant Annuities or asset restructuring.

Application Process

To apply for Wisconsin Medicaid:

• Online: Use the ACCESS Wisconsin Portal at access.wisconsin.gov or the federal Marketplace at healthcare.gov. Check eligibility with the Medicaid Eligibility Calculator.
• Phone: Call the Wisconsin Medicaid and BadgerCare Plus Enrollment Line at 1-800-362-3002 for assistance.
• In-Person or Mail: Complete and submit an application to a local County or Tribal Agency. Download the application from dhs.wisconsin.gov.
• Assistance: Contact the Wisconsin Aging and Disability Resource Centers (ADRCs) for program-related questions. Call 1-800-432-0008 for long-term care support.

Required documents include proof of income, assets, residency, citizenship, Social Security number, and medical records (for long-term care or disability programs). An interview may be required.

Processing Time

• Standard applications: Up to 45 days (90 days for disability-based applications).
• Expedited processing: May apply for urgent cases (e.g., pregnant women via presumptive eligibility for outpatient care).

Frequently Asked Questions

How do I apply for Medicaid in Wisconsin?

Apply online at access.wisconsin.gov or healthcare.gov, by phone at 1-800-362-3002, in person at a County or Tribal Agency, or by mail with a downloaded application from dhs.wisconsin.gov.

What are the 2025 Medicaid income limits for Wisconsin?

For seniors/disabled (Nursing Home/HCBS), the limit is $2,901/month (single) or $5,802/month (couple). Regular Medicaid (aged, blind, disabled) is $967/month (single) or $1,450/month (couple). Children qualify up to 319% FPL ($4,147/month for one), pregnant women up to 194% FPL ($2,596/month for one), and ACA expansion adults up to 100% FPL ($1,304/month for one).

Are there asset limits for Wisconsin Medicaid?

Yes, for long-term care and aged/blind/disabled programs: $2,000 (single), $3,000 (couple, both applying), or $157,920 for a non-applicant spouse. No asset tests for children, pregnant women, or ACA expansion adults.

What is the Medicaid look-back period in Wisconsin?

A 60-month look-back period applies to Nursing Home Medicaid and HCBS Waivers, penalizing asset transfers below fair market value. No look-back for Regular Medicaid.

Can I qualify for Medicaid if my income or assets are too high?

Yes, through the medically needy pathway, Irrevocable Funeral Trusts (IFTs), or spending down assets on exempt items. Consult a Certified Medicaid Planner for assistance.

How does Wisconsin’s Medicaid expansion affect eligibility?

Wisconsin’s partial ACA expansion since 2014 covers adults aged 19–64 with incomes up to 100% FPL, with no asset test. Those above 100% FPL may qualify for subsidized Marketplace plans.

This guide is based on 2025 federal and Wisconsin Department of Health Services guidelines. Verify details with the Wisconsin Medicaid program for accuracy.