Millions of Americans rely on nursing homes and assisted living to help them as they get older. Whether you need to to recover from an injury or illness or require ongoing long-term care, a nursing home or assisted living in your own home are options that may be best. Unfortunately, this type of care can be quite expensive. Many people cannot afford the high costs associated with assisted living. It may be helpful for you and your family to understand whether Medicaid will pay for assisted living in Wisconsin.
What is Medicaid?
Medicaid is a subsidized medical assistance program for low-income seniors, children, and people with disabilities. Medicaid provides basic care to qualified participants. Medicaid is funded by both the federal and state governments. The Medicaid program uses the Modified Adjusted Gross Income (MAGI) method of income review for eligibility for many applicants. Seniors over age 65 or those who are disabled are exempt from this method of qualification and instead are eligible for other reasons.
Assisted Living
Assisted living offers a way for seniors and others to get help with their regular daily needs. Assisted living facilities are also sometimes called nursing homes, where those who require help may reside. Assisted living also applies when a person remains in their home and seeks outside help on a regular basis. Some assisted living facilities may accept Medicaid under certain circumstances, typically only after a person has exhausted his or her savings. Generally, Medicaid won’t cover room and board unless you have a special waiver.
A common situation that many people face is that they are accepted to a facility before they have Medicaid. These people pay out-of-pocket. Later, a person may need to apply for Medicaid when their savings run out. It is important to understand the policy of the facility before you sign a contract. Make sure that the facility will allow you to switch to Medicaid for payment without requiring you to leave. An attorney will help you review the contract.
Wisconsin Medicaid Waiver Programs
Although Medicaid generally does not cover room and board or other expenses associated with assisted living, there are some exceptions. Wisconsin has Medicaid Home and Community-Based Services (HCBS) waiver programs that may be available to help you pay for assisted living. These programs are designed to provide help to those who wish to remain in their homes but require assistance. These programs include Family Care, Family Care Partnership, and IRIS (Include Respect I Self-Direct). They offer long-term care options for people who need assisted living.
These programs are typically offered through the Wisconsin Department of Human Services (DHS). The Board on Aging and Long-Term Care (BOALTC) has an Ombudsman program that offers advocacy for seniors in need of long-term care. DHS offers Aging and Disability Resource Centers (ADRCs), which provide resources and programs to seniors and those with disabilities.
It can be challenging for families to deal with the complexities of assisted living and Medicaid. An experienced elder law attorney will help you navigate the issues and learn the options that are available. Contact us at Moen Sheehan Meyer, Ltd. at (608) 784-8310 or online for a consultation.