Medicaid is a joint federal and state program that helps cover medical costs for some individuals with limited income and resources. The federal government has general rules that all state Medicaid programs must follow, but each state runs its own program. This means eligibility requirements and benefits can vary from state to state. Wisconsin has several Medicaid programs avaliable for Medicare Beneficiaries who meet both income and asset requirements, also known as “EBD” Elderly Blind or Disabled Medicaid."
As a payor of last resort, it’s important for beneficiaries to understand the coordination of EBD Medicaid with Medicare. Title 19 and D-SNP (dual eligible special needs plan) enrollment are some selections which allow coordination that may suit an individual's needs.
Health care programs for people who live in Wisconsin who are elderly (age 65 or older), blind, or disabled. A person may qualify if a U.S. Citizen or qualifying immigrant and have income/assets at or below the program limits.
Standard Medicaid (SSI-MA)
Provides health care coverage for individuals who meet program qualifiers (financial and non-financial). This program is also known as Supplemental Security Income (SSI)-Related Medicaid.
Medicaid Deductible (Spend Down)
An individual whose income is over the income limit for Standard Medicaid, but meets other program requirements, may be able to qualify for Medicaid by meeting a deductible. This deductible is calculated in six-month increments, based on the difference between their monthly counted income and the program income limit.
The cost of unpaid and recently paid bills for medical expenses can be used to meet the deductible. Examples of medical costs include health insurance premiums, personal medical bills, and medical bills of a child or spouse (after Medicare and private insurance has paid).
Medicaid Purchase Plan (MAPP)
The Medicaid Purchase Plan provides health care coverage for people with a disability (age 18 or older) who are working or interested in working (even just a few hours a month). Depending on an individual's income, a premium payment may be required. Visit the website Medicaid Purchase Plan for more information.
Many people who are elderly, blind, or disabled need help in accomplishing everyday tasks and caring for their health. Long term care services may include personal care, housekeeping, or nursing. These services may be provided in a person’s home, residential care facility or group home, or in a nursing facility. Long term care service programs are designed to meet these needs.
Home and Community-Based Service Waiver Programs (Family Care, IRIS)
These programs help persons who are elderly, blind, or disabled continue living in their own homes or the community instead of a state medical facility or nursing home. They pay for community services not usually covered by Medicaid. Programs include Family Care, Family Care Partnership, and IRIS (Include, Respect, I Self-direct). To be eligible, a person must meet all the non-financial and financial requirements. A cost-sharing may apply.
This program provides Medicaid coverage of medical services for those who reside in a medical care facility which include skilled nursing facilities (SNF), intermediate care facilities (ICF), institutions for mental disease (IMD), and hospitals.
Spousal Impoverishment Protection
Special financial provisions in Medicaid that affect how income/assets are counted for a married person’s determination of eligibility when applying for/receiving nursing home or community waiver services. This provision may allow the spouse to keep assets and income that are above the Medicaid program financial limits.
BadgerCare Plus is a health care program for low-income Wisconsin residents typically between the ages of 0-65. House hold size, tax affiliations and income limits are the primary requirements to obtain this coverage.
Wisconsin Well Woman Medicaid
Provides medical treatment for women under age 65, who are not covered by other private or public health insurance, who have been diagnosed with breast or cervical cancer or certain precancerous conditions of the cervix. Other program qualifiers must be met.
Please visit the websites Wisconsin Well Woman Program and Wisconsin Well Woman Medicaid Eligibility for more information.
