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What Happens When the Money Runs Out

Spend-down, Medicaid waiver transitions, and why you should ask a community about this before you move in.

HomeCosts & PayingWhat Happens When the Money Runs Out
Short answer

If private funds run out, the options generally are a Medicaid HCBS waiver for care inside a licensed community, Medicaid nursing facility coverage, or moving to a community that holds a waiver provider agreement. Confirm your state's specific programs before relying on this.

Ask before you move in, not after

This is the single most consequential question families skip. A community that does not hold a Medicaid waiver provider agreement will ask your parent to leave when private funds are exhausted — often with short notice, at the point when moving is hardest.

Ask directly: do you hold a Medicaid waiver provider agreement, and how many current residents use it? A community can technically hold an agreement and still have no waiver capacity available.

How families pay for care. Wisconsin's two Medicaid long-term-care pathways are Family Care (managed care) and IRIS (self-directed); room and board is generally not covered by either, and Wisconsin has not adopted ACA Medicaid expansion. Read the full explanation →
The local long-term care ombudsman. All four core counties are covered by the single statewide Wisconsin Board on Aging and Long-Term Care Ombudsman Program, 1-800-815-0015. Read the full explanation →

Questions families ask

Are there faith-based senior care options in the Milwaukee metro?

Yes -- several verified Milwaukee-metro continuing-care campuses are explicitly faith-based nonprofits, including St. Camillus (Catholic), Clement Manor (sponsored by the Franciscan Sisters of Christian Charity), Tudor Oaks (operated by American Baptist Homes of the Midwest), and Cedar Community, each describing on-site chapels, pastoral care, or faith-specific programming on their own websites.

Does the Milwaukee metro include Racine?

No. This site's coverage area is the 4-county core Milwaukee-Waukesha-West Allis Metropolitan Statistical Area as defined by the U.S. Census Bureau -- Milwaukee, Waukesha, Ozaukee, and Washington counties. Racine forms its own separate Metropolitan Statistical Area under Census Bureau delineation.

Does Wisconsin have one 'assisted living license' like some other states?

No. Wisconsin runs four separate license/certification types -- Community-Based Residential Facility (CBRF), Residential Care Apartment Complex (RCAC), Adult Family Home (AFH), and nursing home -- each licensed by the DHS Division of Quality Assurance, Bureau of Assisted Living, under different rule chapters. There is no single umbrella 'assisted living' license the way some states use the term.

What is a CBRF in Wisconsin?

A Community-Based Residential Facility (CBRF) is a residential setting where 5 or more unrelated adults live together and receive room and board, supervision, and support services, plus up to 3 hours of nursing care per week per resident. CBRFs are licensed under Wis. Admin. Code ch. DHS 83 by the DHS Bureau of Assisted Living.

What is an RCAC and how is it different from a CBRF?

A Residential Care Apartment Complex (RCAC) offers independent apartment units, not shared rooms, where residents receive room and board, personal care, and nursing services -- up to 28 hours per week of supportive care per resident, a materially higher ceiling than a CBRF's 3 hours. Both are licensed/certified by the DHS Bureau of Assisted Living.

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