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April 15th, 2023 |

Wisconsin Medicaid Eligibility and Long-Term Care: What To Watch For In 2023

By Attorney Michael J. Keepman, The McLario Firm The Mclario Firm

Reading Time: 2 minutes

Greetings everyone! I’m very grateful to have recently joined The McLario Firm located in beautiful downtown Menomonee Falls. I look forward to meeting and working with many of you over the coming months and years.

One of the top issues I’ve heard from clients lately concerns Medicaid eligibility for seniors needing long-term care services in a nursing home. Seniors today are understandably alarmed by the prospect of having to pay for long-term care with funds they’ve worked so hard over the years to preserve for themselves and their families.

Paying out-of-pocket for long-term care in a nursing home is not a viable option for most seniors. Monthly costs for long-term care in a nursing home can easily exceed $10,000.00, which can quickly erode retirement savings. Unfortunately, Medicare and traditional health care insurance plans normally do not cover long-term care. Although long-term care insurance is available on the private market, those policies are generally only available years in advance of the actual need for long-term care services. Therefore, Medicaid often becomes the only feasible choice for seniors finding themselves in need of long-term care.

Facts On Wisconsin Medicaid Program For Seniors

  • Wisconsin Medicaid is a jointly funded (Federal/State) health care program for, among other groups, Wisconsin residents who are 65 or older with limited resources, and who are in need of long-term care.
  • Income Requirements: If single, the Medicaid applicant’s monthly income can be no more than around $2,523.00 for 2022. If married, the income for the “well” spouse, or what Medicaid refers to as the “community spouse,” cannot exceed $3,715.50 or $3,051.66, plus an excess shelter allowance, whichever is less. There is a monthly personal needs allowance of $45.00 that is not counted as income.
  • Asset Limits: $2,000 or less in cash and/or nonexempt assets for the Medicaid applicant. The community spouse can generally retain up to half of the couple’s countable assets (up to $148,620.00). Exempt assets generally include: (a) a home; (b) an automobile; (c) household furnishings, clothing, and other personal effects; (d) life insurance policies with a cash value of less than $1,500.00; and (e) an irrevocable burial trust with a maximum value of $1,500.00.
  • Wisconsin Medicaid has a “five-year look-back” rule. That means any gifts or similar transfers made by otherwise Medicaid-eligible seniors during the five-year period prior to the application date will result in a period of disqualification from Medicaid benefits.

Fortunately, Wisconsin Medicaid rules provide asset-protection opportunities both for seniors who foreseeably need long-term care down the road, and those who haven’t pre-planned and are in immediate need of long-term care.

Thank you for reading about Wisconsin Medicaid eligibility and long-term care in 2023. If you or a loved one is in need of long-term care, it’s important to stay informed and be aware of any changes in Medicaid eligibility requirements. Contact our experienced attorneys at the McLario Firm to learn more about how we can help you navigate the complex world of Medicaid and long-term care. Don’t wait until it’s too late, take action now to protect your future.

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