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

Wisconsin is one of the most structurally unusual states in the country when it comes to Medicaid expansion — and understanding the difference matters if you’re trying to figure out whether you qualify.

Wisconsin has not expanded Medicaid under the standard ACA framework that covers adults up to 138% FPL. Instead, Wisconsin covers childless adults up to 100% FPL through a Section 1115 BadgerCare waiver, extended through December 2029.

This creates a distinct situation: there is no “coverage gap” in Wisconsin (unlike Tennessee or South Carolina, where childless adults below 138% FPL may be left with nothing). But adults earning between 100%–138% FPL are directed to Marketplace private plans with subsidies rather than Medicaid.

On the long-term care side, Wisconsin’s IRIS (Include, Respect, I Self-Direct) program gives participants the most control of any HCBS model in this series — an individualized budget managed with a case manager’s help, used to purchase any qualified services the participant chooses. And Family Care/Family Care Partnership allows participants to hire their own caregivers, including spouses.

Wisconsin Medicaid is administered by the Wisconsin Department of Health Services (DHS) through the ForwardHealth system and the ACCESS portal at access.wisconsin.gov.

This guide covers every Wisconsin Medicaid program, 2026 income limits, the BadgerCare waiver structure, IRIS and Family Care, and how to apply. For comparison to other states, see Medicaid income limits across all 50 states.

Wisconsin Medicaid Programs

BadgerCare Plus is Wisconsin’s Medicaid brand covering children, pregnant women, parents, and the 100% FPL adult population.

BadgerCare Plus covers doctor visits, hospital care, prescriptions, dental care, vision care, and mental health services. Children receive full EPSDT benefits. Adults may have small copays for some services.

BadgerCare Plus Childless Adult Waiver (100% FPL) covers adults aged 19–64 without dependent children with incomes up to 100% FPL — through the Section 1115 BadgerCare waiver, approved in 2018 and extended through December 2029.

This is the core structural difference from full expansion states: Wisconsin Medicaid covers adults to 100% FPL ($1,304/month single) with no asset test. Adults earning 100%–138% FPL are not covered by Medicaid — they’re directed to Marketplace subsidized plans at healthcare.gov.

FPOS (Family Planning Only Services) covers birth control and family planning for people who don’t qualify for full Medicaid, up to 306% FPL ($4,070/month for one person) with no asset test.

FPOS is available to both men and women and provides contraception, STI screening and treatment, and related services. The 306% FPL threshold is much higher than standard adult Medicaid.

Wisconsin Well Woman Medicaid provides coverage for women with breast or cervical cancer who qualify through the Wisconsin Well Woman Program.

Regular Medicaid (EBD — Elderly, Blind, and Disabled) covers low-income elderly (65+), blind, or disabled Wisconsinites who don’t need nursing home care.

Income limit: $967/month (single). Asset limit: $2,000 (single).

MAPP (Medicaid Purchase Plan) covers working adults with disabilities with incomes up to 250% FPL.

MAPP allows people with disabilities to maintain employment while accessing Medicaid. Above 100% FPL, participants pay a monthly premium. This is a particularly important program because it incentivizes work for disabled adults rather than penalizing earned income.

Nursing Home / Institutional Medicaid covers long-term care in Medicaid-certified nursing facilities and ICF/IID facilities.

This is an entitlement. Income limit: $2,901/month (single). Asset limit: $2,000 (single).

Family Care is one of Wisconsin’s two primary managed care HCBS programs.

Family Care covers non-medical HCBS including adult day care, assisted living, adult foster care, home-delivered meals, home modifications, and personal emergency response systems. Participants direct their own care and can hire caregivers of their choosing — including their spouse.

Family Care Partnership extends Family Care’s HCBS benefits to also cover medical care and prescription drugs, coordinating both in a single managed care plan.

Both Family Care programs require a functional need for nursing home-level care and are coordinated through local ADRCs (Aging and Disability Resource Centers).

IRIS (Include, Respect, I Self-Direct) is Wisconsin’s fully consumer-directed HCBS waiver.

IRIS gives participants an individualized budget and near-complete control over how that budget is spent. With assistance from a case manager, the participant develops a plan of care and directly purchases services — which may include adult day care, nursing services, home modifications, live-in caregivers, and other supports.

Participants in IRIS act as the employer of record for their caregivers. This is the most self-directed HCBS model in this series — participants have more budget flexibility than in Virginia’s CCC Plus, West Virginia’s Personal Options, or Washington’s COPES.

CLTS (Children’s Long-Term Support) Waiver provides HCBS for children with significant disabilities, intellectual disabilities, or developmental disabilities.

Children’s Long-Term Support covers therapeutic services, respite care, assistive technology, and other supports to keep children with families at home.

Income Limits — 2026

All figures are monthly gross income. The Federal Benefit Rate (FBR) is $967/month for 2026.

The 100% FPL Coverage Structure Explained

Wisconsin’s Medicaid adult threshold is $1,304/month for one person — compared to $1,799/month in full expansion states.

Adults earning between $1,304/month and $1,799/month (100%–138% FPL) do not qualify for Wisconsin Medicaid. They qualify instead for heavily subsidized Marketplace plans through healthcare.gov.

Why no coverage gap? Most non-expansion states like South Carolina, Tennessee, and Texas only cover parents with very low incomes and exclude childless adults entirely. Wisconsin’s waiver extends coverage to all adults at or below 100% FPL regardless of parental status — eliminating the coverage gap that traps people in other non-expansion states.

Why not 138% FPL? Governor Scott Walker declined full expansion in 2013–2014, partly over concerns that the federal government would not maintain the promised 90/10 federal-state cost split indefinitely.

$45/month Personal Needs Allowance — Wisconsin nursing home residents retain $45/month for personal spending after income goes toward care costs. This is the same as Pennsylvania and Utah in this series — mid-range.

No QIT required. Wisconsin uses the Medically Needy spend-down pathway. When income exceeds the LTC limit, qualifying medical expenses reduce countable income to the eligibility threshold. No separate trust account is required.

Community Spouse Asset Share (CSAS) — Wisconsin’s local name for the Community Spouse Resource Allowance. The community spouse keeps 50% of total countable assets, up to a maximum of $162,660. Wisconsin’s minimum floor is $50,000 — higher than the federal minimum floor of $32,532 used by most states. This protects more assets for the at-home spouse.

Postpartum coverage: 12 months after delivery, regardless of income changes.

Federal Poverty Level Reference — 2026

Use the federal poverty level calculator to find the exact threshold for your household size.

Asset Rules for Wisconsin Medicaid

No asset test applies to BadgerCare Plus adults, children, or pregnant women. Asset limits apply to nursing home, Family Care, IRIS, and EBD programs.

Home equity limit: $1,103,000 — same high federal maximum as Washington state. Wisconsin’s elevated home equity threshold reflects the same rationale: protecting homeowners whose property values may be substantial in the Milwaukee, Madison, or Door County markets.

Exempt (Non-Countable) Assets

• Primary home (within the $1,103,000 equity cap)
• One vehicle
• Household goods and personal effects
• Pre-paid funeral contracts (irrevocable, up to $4,500)
• Medicaid Compliant Annuities
• Life insurance with face value $1,500 or less

Wisconsin’s Look-Back Period and “Divestment Penalty Divisor”

Wisconsin enforces a 60-month (5-year) look-back for Nursing Home Medicaid and HCBS Waivers.

All asset transfers within 5 years before the application date are reviewed. Transfers below fair market value trigger a penalty period of ineligibility — calculated using Wisconsin’s “divestment penalty divisor.”

The penalty divisor determines how long a person is ineligible based on the amount of assets transferred. Wisconsin’s divestment penalty divisor is considered relatively lenient compared to many other states — meaning a given transfer produces a shorter penalty period in Wisconsin than in states with a higher divisor.

This is a meaningful planning detail: the penalty for a $50,000 asset transfer will last fewer months in Wisconsin than in Pennsylvania or Texas. Consult a Wisconsin Certified Medicaid Planner or elder law attorney to evaluate specific look-back implications.

No look-back applies to EBD Regular Medicaid, BadgerCare Plus adults, children, or pregnant women.

The BadgerCare Work Requirement History

Wisconsin’s Section 1115 BadgerCare waiver for childless adults has included proposals for work requirements since 2017.

The BadgerCare Reform Demonstration — approved by CMS in October 2018 — included work and community engagement requirements as one of its provisions. The Biden administration revoked federal approval for the work requirement component in April 2021.

The state’s expanded substance use disorder provision (covering short-term residential treatment in institutions for mental diseases) was part of the extended waiver through 2029 but was still under CMS review as of early 2026.

Under the OBBBA, federal work requirements for expansion adults take effect in January 2027 — which puts Wisconsin, like Virginia, in a position to reactivate its existing work requirement framework through CMS. No work requirements are currently in effect.

For context on how work requirements function and who is exempt, see how SNAP work requirements apply. For full OBBBA context: how the One Big Beautiful Bill affects Medicaid and SNAP.

Medical and Functional Requirements

To qualify for Nursing Home Medicaid, Family Care, or IRIS, applicants must demonstrate Nursing Facility Level of Care (NFLOC) through documented limitations in:

ADLs: Mobility, bathing, dressing, eating, and toileting.

IADLs: Cooking, shopping, managing finances, medication management.

Cognitive or behavioral issues: Alzheimer’s or dementia — diagnosis alone is not sufficient.

For EBD Regular Medicaid, proof of disability or blindness per SSA standards is required — NFLOC is not necessary.

Medicaid Estate Recovery

Wisconsin’s Medicaid Estate Recovery Program may seek reimbursement for LTC costs after a beneficiary’s death.

Recovery most commonly targets the primary home when not protected through a surviving spouse, child under 21, or blind/disabled child.

Wisconsin Medicaid and FoodShare (SNAP)

Wisconsin SNAP is called FoodShare and uses the Quest Card — Wisconsin’s branded EBT card.

FoodShare is administered by DHS through county and tribal agency offices and can be applied for through the same ACCESS portal (access.wisconsin.gov) as Medicaid — one of the more integrated benefit delivery systems in the series.

Wisconsin has 11 federally recognized tribal nations. Medicaid eligibility for tribal members is processed through Income Maintenance and Tribal Agency offices — a distinct administrative pathway that reflects Wisconsin’s significant Native American population. These tribal agencies can process BadgerCare Plus, FoodShare, and other benefits.

FSET (FoodShare Employment and Training) is Wisconsin’s SNAP employment and training program. Contact your county agency for available activities.

Useful links for Wisconsin residents:

• Wisconsin FoodShare SNAP benefits and eligibility
• How to apply for FoodShare SNAP in Wisconsin
• Wisconsin WIC income guidelines
• Whether seniors on Social Security can also qualify for food stamps

How to Apply for Wisconsin Medicaid

Online: Apply through ACCESS Wisconsin at access.wisconsin.gov.

This covers BadgerCare Plus, EBD Medicaid, FoodShare, and other DHS benefits. For Family Care, Family Care Partnership, and IRIS, contact your local ADRC (Aging and Disability Resource Center) directly.

By Phone: Call the Wisconsin Medicaid and BadgerCare Plus Enrollment Line at 1-800-362-3002.

For long-term care support and ADRC referrals: 1-800-432-0008.

In Person or By Mail: Visit your local county or tribal agency office (72 counties and tribal agencies statewide). Download Form F-16019 from dhs.wisconsin.gov.

Family Care / Family Care Partnership / IRIS: Contact your local ADRC at 1-800-432-0008. The ADRC is the entry point for all long-term care programs and will conduct the functional assessment and refer you to the appropriate program.

For the complete step-by-step application guide: applying for Medicaid in Wisconsin.

Documents You’ll Need

• Wisconsin residency proof (utility bill, lease, or official mail)
• U.S. citizenship or qualifying immigration status documentation
• Income proof: pay stubs, SSA award letters, pension statements
• SSNs for all household members
• For LTC / EBD: bank statements, property records, 60 months of financial history
• For disability: SSA disability documentation or physician letter

Processing Times

• Standard applications: Up to 45 days
• Disability-based applications: Up to 90 days
• Pregnant women / urgent cases: Expedited processing available

Frequently Asked Questions

Why does Wisconsin cover adults only to 100% FPL instead of 138%?

Wisconsin chose not to accept the standard ACA Medicaid expansion that covers adults to 138% FPL, citing concerns about long-term federal funding reliability.

Instead, Governor Scott Walker opted for a Section 1115 BadgerCare waiver covering childless adults to 100% FPL ($1,304/month for one person). CMS approved this in 2018 and extended it through December 2029. Adults between 100%–138% FPL are directed to Marketplace subsidized plans rather than Medicaid. Importantly, there is no coverage gap — every childless adult below 100% FPL qualifies, unlike true non-expansion states (SC, TN, TX) that exclude most childless adults entirely.

What is the IRIS waiver and how is it different from Family Care?

IRIS (Include, Respect, I Self-Direct) provides an individualized budget managed with a case manager’s help, which participants use to directly purchase any qualified services — adult day care, home modifications, nursing services, live-in caregivers, and more.

Family Care is a managed care model where services are coordinated through a care plan. Both allow consumer direction and permit hiring family members. The distinction: IRIS gives participants greater budget flexibility and purchasing autonomy; Family Care operates within a managed care structure with more plan-managed coordination. IRIS participants act as the employer of record for their own caregivers. Contact your local ADRC at 1-800-432-0008 to determine which program fits your situation.

Does Family Care allow hiring a spouse as a paid caregiver?

Yes — Family Care and Family Care Partnership both allow participants to hire caregivers of their own choosing, including their spouse.

This is more permissive than the ADW Personal Options program in West Virginia (which excludes spouses) and similar to Virginia’s CCC Plus (which permits spouses). Wisconsin’s allowance of spousal caregiving reflects the program’s emphasis on participant self-direction and is particularly meaningful for couples where one spouse needs intensive care.

Does Wisconsin require a QIT/Miller Trust for excess income?

No — Wisconsin uses the Medically Needy spend-down pathway with no Qualified Income Trust requirement.

When a Wisconsin senior’s income exceeds the nursing home Medicaid limit, qualifying medical expenses (nursing home bills, prescriptions, Medicare premiums) are deducted to bring countable income below the threshold. No separate trust account is required. This is the same approach used by Vermont, Virginia, Washington, and West Virginia.

What is Wisconsin’s Community Spouse Asset Share (CSAS)?

Wisconsin uses the term CSAS (Community Spouse Asset Share) for what most states call the CSRA.

The community spouse keeps 50% of the couple’s total countable assets, up to a maximum of $162,660. Wisconsin’s minimum floor is $50,000 — significantly higher than the federal minimum of $32,532. If the community spouse’s 50% share falls below $50,000, they may keep up to the full $50,000. This is more protective than most states’ floor amounts.

Can I apply for both Medicaid and FoodShare through the same portal?

Yes — both use the ACCESS portal at access.wisconsin.gov.

A single application can establish eligibility for BadgerCare Plus and FoodShare (Wisconsin’s SNAP) simultaneously. For long-term care programs (Family Care, IRIS), the entry point is your local ADRC rather than ACCESS. FoodShare is administered through county and tribal agencies; Wisconsin’s tribal agencies serve members of the state’s 11 federally recognized tribes. See Wisconsin FoodShare SNAP benefits and eligibility for income limits and details.

Last updated: 2026 | Sources: Wisconsin Department of Health Services (DHS), ForwardHealth, DHS.Wisconsin.gov, healthinsurance.org/medicaid/wisconsin, CMS BadgerCare waiver documentation, USDA FPL guidelines. Verify current thresholds at access.wisconsin.gov or by calling 1-800-362-3002. This guide is for informational purposes only — eligibility is determined by DHS and local agencies.