Wisconsin Medicaid Personal Care: Eligibility and Benefits

Program Description

Personal Care from Wisconsin Medicaid provides in-home assistance with the Activities of Daily Living to functionally and financially qualified state residents. This program’s name is abbreviated as MAPC (Medical Assistance Personal Care). Some additional benefits may also be included under the Personal Care umbrella, such as house cleaning and laundry.

The process by which Medicaid beneficiaries receive MAPC is as follows. A registered nurse assesses the individual’s home care needs and determines the number of hours of assistance they require. An official “Plan of Care” is developed, which after receiving a doctor’s sign-off, is submitted to Wisconsin Medicaid for final approval. Services are then provided by the counties who often contract out the hands on delivery of care to Medicaid approved home care agencies. Providers then come to the participant’s home and provide the human assistance services outlined in the Plan of Care.

A participant’s “home” is broadly defined and can include adult foster care homes and assisted living residences provided they have less than 20 residents.  

In Wisconsin, there are multiple programs that offer personal care or personal attendant services. To clarify, here we are referring to Personal Care provided under the Medicaid State Plan, not under the Medicaid IRIS Program or the Family Care and Partnership Programs.

Eligibility Guidelines

MAPC is a benefit of Wisconsin Medicaid’s State Plan, and therefore, interested parties must be eligible for state Medicaid. Applicants can be considered Categorically Needy, meaning their income and assets are such that they automatically qualify for the program. Alternatively, applicants can fall under the Medically Needy category. This means their income may exceed the Categorically Needy level, but their medical expenses and care costs are such that they still cannot afford to pay for them themselves.

In 2020, to be Categorically Needy, a single applicant must not have income in excess of $605.78 / month plus up to $261.00 / month in actual shelter costs. One’s countable assets, which do not include an applicant’s primary home (given the applicant lives in the home, or has “intent” to return to the home, and his / her equity interest value is no greater than $750,000) and a car, cannot be more than $2,000. Married couples cannot have monthly income and assets greater than $915.38 plus up to $391.67 in actual shelter costs, and $3,000, respectively.

For Categorically Needy participants, there are no fees or copayments for care services. Medically Needy individuals are required to spend down their income on their care costs to the Medically Needy income limit. At this point, Medicaid covers their remaining costs. As of 2020, the Medically Needy income limit is $1,063.33 for a single applicant and $1,436.67 for a married couple.

Benefits and Services

Personal Care, under Wisconsin Medicaid, is defined by assistance with the activities of daily living. These are bathing, toileting, transferring (in and out of bed, for example), feeding, dressing, and basic mobility. Certain non-personal care activities are also covered such as laundry, meal preparation, food shopping and accompanying the care recipient to medical appointments.

How to Apply / Learn More

There are several ways by which state residents can apply for Medicaid. Applications are available for download from the State website. One can also apply online through the ACCESS website. Alternatively, if application assistance is necessary, one can contact their local Area Agency on Aging in Wisconsin.