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Medicaid Expansion vs. Long-Term Care Medicaid

Wisconsin has not adopted the ACA's Medicaid expansion, and that is a different question entirely from long-term-care Medicaid eligibility for seniors.

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Home›State Rules›Medicaid Expansion vs. Long-Term Care Medicaid

Two separate Medicaid questions

Short answer

Wisconsin has not adopted the ACA's Medicaid expansion. Instead it runs BadgerCare Plus, covering childless adults up to 100% of the Federal Poverty Level. This is a completely separate eligibility pathway from long-term-care Medicaid for seniors, which uses Wisconsin's own aged/blind/disabled (non-MAGI) income and asset rules.

  • BadgerCare Plus covers childless adults up to 100% FPL, without an enrollment cap, but below the ACA's 138% FPL expansion threshold -- adults between 100-138% FPL are directed to marketplace subsidies instead. This classifies Wisconsin as a partial-expansion / non-expansion state.
  • Long-term-care Medicaid for seniors (nursing home Medicaid, and the Family Care/IRIS home-and-community-based pathways) is assessed under a separate aged/blind/disabled income and asset test, not the BadgerCare Plus expansion pathway. Do not conflate the two when researching eligibility for a parent.
The exact current income/asset limits for Wisconsin's institutional (nursing-home) Medicaid pathway were not confirmed from a primary source in our most recent research pass -- pull them directly from DHS's Medicaid eligibility pages before relying on a specific dollar figure.

Questions families ask

How do I know it's time to consider hospice for a family member in Milwaukee?

Hospice is generally appropriate when a physician certifies a life expectancy of six months or less if the illness runs its normal course, and when the goal of care shifts from curative treatment to comfort. A physician referral, not a family decision alone, formally starts the process.

Where can hospice care happen -- does it require moving to a special facility?

No. Hospice care is delivered wherever the patient lives -- a private home, an assisted living community, or a nursing facility -- and is also available at dedicated inpatient hospice units for patients who need a higher level of symptom management than can be managed at home.

Does Medicare pay for hospice care?

Yes. Hospice is a well-established Medicare benefit, covering hospice-related physician services, nursing care, medical equipment, medications related to the terminal diagnosis, and grief/bereavement support for the family, once a physician certifies eligibility.

What is the 'We Honor Veterans' program mentioned by some Milwaukee-area hospice providers?

It's a national partnership between hospice providers and the Department of Veterans Affairs that trains hospice staff on veteran-specific end-of-life needs and helps recognize a veteran's military service as part of their hospice care. VITAS Healthcare's Milwaukee office describes running this program on its own site.

What's the difference between hospice and palliative care?

Palliative care focuses on comfort and symptom relief and can be provided alongside curative treatment at any stage of a serious illness. Hospice is specifically for patients who have stopped curative treatment and have a physician-certified life expectancy of six months or less if the illness runs its normal course.

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