How families actually pay for care
Wisconsin has not adopted the ACA's Medicaid expansion. Instead, Wisconsin runs BadgerCare Plus, which covers childless adults up to 100% of the Federal Poverty Level (reduced from an earlier 200% FPL policy) without an enrollment cap. Because coverage tops out at 100% FPL rather than the ACA's 138% FPL threshold, Wisconsin is classified as a partial-expansion / non-expansion state. This is a completely separate question from long-term-care Medicaid eligibility for seniors, which uses Wisconsin's own aged/blind/ disabled (non-MAGI) income and asset rules — do not conflate the two.
Wisconsin's Medicaid long-term-care benefit is generally delivered through one of two programs, both administered through the local Aging & Disability Resource Center (ADRC) for enrollment:
- Family Care — a managed long-term care program in which a Managed Care Organization coordinates a care plan and provider network for the member.
- IRIS (Include, Respect, I Self-Direct) — a self-directed Medicaid long-term-care program. Participants (or their legal representative) choose their own supports, manage an individualized budget, and can hire and direct their own workers, supported by an IRIS consultant agency. IRIS is only available for home, apartment, adult family home, or RCAC settings — not a CBRF or nursing home — and requires passing Wisconsin's Long-Term Care Functional Screen.
CBRF and RCAC care services can be covered through Family Care or IRIS as home-and- community-based supports, but room and board is generally not covered by either program — verify this per placement, not by assumption. Nursing home (skilled nursing) Medicaid is a different Medicaid benefit category (institutional long-term care Medicaid) with its own income/asset rules, separate from the Family Care/IRIS pathway. Could not verify from a primary source: the exact current income/asset limits for Wisconsin's institutional nursing-home Medicaid pathway, and whether Family Care is available in all four core counties today (it has had regional rollout differences historically) — confirm both directly with DHS before treating either as settled.
VA Aid and Attendance is a federal (not state-specific) benefit that can help cover the cost of assisted living or in-home care for eligible wartime veterans and their surviving spouses; rates change annually and should be confirmed directly with the VA.
