Does Medicaid Pay for Home Health Care in Wisconsin?

Yes, Medicaid does cover home health care services for eligible seniors in Wisconsin. Individual applicants must meet certain income and asset thresholds and require assistance with two or more activities of daily living to demonstrate functional eligibility. Once eligible, the range of home health services covered by Medicaid can include skilled nursing care, therapy, assistance with daily activities, and essential medical equipment and supplies.

What are the Basics of Medicaid and Home Health Care for Seniors?

What is Medicaid and How it Relates to Seniors’ Health Care Needs?

Medicaid is a jointly funded state and federal health insurance program that provides coverage for low-income individuals, families and children, pregnant women, the elderly, and people with disabilities. In Wisconsin, Medicaid is administered by the Wisconsin Department of Health Services.

For seniors specifically, Medicaid helps pay for long-term care services that are not typically covered by Medicare. This includes nursing home care and assistance with daily living activities provided in a senior’s home or community setting. Medicaid functions as a safety net for older adults who cannot afford to pay the high costs associated with long-term care on their own.

How Does Home Health Care Benefit Seniors?

Home health care allows seniors to receive skilled nursing care and assistance with daily living activities in their own home, rather than having to move into a nursing facility or assisted living. Home health care services that can benefit seniors include:

  • Skilled nursing services (wound care, injections, etc.)
  • Physical, occupational, and speech therapy 
  • Assistance with activities of daily living like bathing, dressing, eating
  • Housekeeping and meal preparation
  • Transportation to medical appointments

Home health care supports aging in place, allowing seniors to maintain independence and remain in a comfortable, familiar environment. This can help improve physical and mental health outcomes in older adults.

What are the Eligibility Requirements for Medicaid Coverage of Home Health Care in Wisconsin?

To receive Medicaid coverage of home health care services in Wisconsin, there are certain income, asset, and functional eligibility requirements that must be met. 

What Role Do Income and Asset Requirements Play in Eligibility?

In 2022, the income limits to qualify for Wisconsin Medicaid are:

  • Single individual – $11,097/year 
  • Married couple – $16,717/year

The asset limits are:

  • Single individual – $2,000 
  • Married couple – $3,000 

Applicants must fall below these thresholds in order to meet Medicaid’s eligibility criteria. Certain assets like an individual’s primary home and car are exempt from the limit.

How Are Activities of Daily Living (ADLs) and Functional Eligibility Determined?

Seniors must also demonstrate need for care by requiring assistance with certain daily living activities, like:

Requiring help with 2 or more of these activities of daily living (ADLs) helps establish functional eligibility for Medicaid coverage of home health services.

Which Types of Home Health Care Services Does Medicaid Cover in Wisconsin?

Once eligible, Medicaid will cover several categories of home health careservices for seniors in Wisconsin:

  • Skilled nursing care
  • Physical, speech, respiratory and occupational therapy
  • Home health aide assistance with ADLs
  • Medical equipment & supplies 

Are Assisted Living and Nursing Home Services Covered Under Wisconsin’s Medicaid Program?

For seniors who require more intensive long-term care, Wisconsin Medicaid does provide coverage for:

  • Nursing homes – For seniors needing 24-hour skilled nursing services
  • Assisted living facilities – For help with ADLs in a residential setting 

So Medicaid can pay for care in either an in-home or facility-based setting, depending on a senior’s needs and preferences.

What is the Role of Waivers in Obtaining Additional Services?

Wisconsin has several Medicaid waivers – the Family Care Waiver, Family Care Partnership, PACE, and IRIS self-directed care – that allow seniors to access expanded home health and community-based services beyond what traditional Medicaid covers. These waivers provide more flexibility but have limited space.

How to Apply for Medicaid Coverage of Home Health Care in Wisconsin: A Step-By-Step Guide

To receive Medicaid home health benefits, eligible seniors must enroll in the program. Here are the steps:

Where Can You Find Contact Information for the Wisconsin Medicaid Office?

  • Call 1-800-362-3002 to reach the Wisconsin Medicaid Member Services hotline
  • Visit a local Income Maintenance Consortium agency to apply in-person 
  • Apply online via the ACCESS Wisconsin web portal

When applying, have the following documents ready:

  • Proof of identity 
  • Income statements
  • Asset documentation 
  • Medical information/records

How does Self-Directed Care Fit into the Picture of Medicaid Funded Home Healthcare in Wisconsin?

For seniors wanting more control over their home care, Wisconsin’s IRIS (Include, Respect, I Self-Direct) program allows self-direction of Medicaid funded services. With IRIS:

  • Participants craft their own care plans and budgets
  • They directly hire, train, and supervise care workers 
  • An IRIS consultant agency provides assistance as needed

So IRIS offers seniors more flexibility and independence in managing their home health services.

How Does Other Financial Assistance like Medicare, Social Security Interact with Medicaid Benefits for Elderly’s home healthcare?

Medicare provides limited coverage for skilled home health care that supplements Medicaid. And some seniors may use Social Security income to help pay for additional home care services or household costs not covered by Medicaid.

  • Medicare covers limited home nursing care after hospital/rehab stay
  • Social Security income can help cover gaps in Medicaid coverage
  • Medicaid remains central source of home health funding for low-income seniors

Are there any Additional Resources Available for Seniors Needing Home Health Care?

For help navigating the system, Wisconsin has Aging and Disability Resource Centers (ADRCs) located regionally that assist seniors in accessing:

  • Medicaid and Medicare benefits
  • Care planning and coordination 
  • Transportation, food programs 
  • Housing and finances

The Eldercare Locator (eldercare.acl.gov) also connects Wisconsin seniors to local services and provides guidance to caregivers. Utilizing these resources helps ensure vulnerable older adults can access affordable home health care.

In summary, Medicaid does cover home health services for eligible low-income seniors in Wisconsin, providing a crucial benefit to help older adults age comfortably and independently in their own homes.

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