State of Wisconsin Department of Health Services

Release 25-02 April 9, 2025

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42.1 Long-term Care Eligibility Requirements for Childless Adults Eligible for BadgerCare Plus

Institutionalized childless adults who do not meet the eligibility criteria for EBDElderly, Blind, or Disabled Medicaid but are eligible for BadgerCare Plus are eligible to have their LTClong-term care services covered by BadgerCare Plus if they are functionally eligible. "Institutionalized" means the individual has resided in a medical institution for 30 or more consecutive days or is likely to reside in a medical institution for 30 or more consecutive days. However, an individual is not considered “institutionalized” if they meet this 30-day test but is in a medical institution solely for the purpose of receiving residential substance use disorder treatment.

Note	Once institutionalized and considered out of the home, a parent would be considered a childless adult and may qualify for long-term care as a childless adult.

42.1.1 Long-Term Care Eligibility Requirements for Childless Adults Eligible for BadgerCare Plus

In order to be eligible to have their LTC services covered by BadgerCare Plus while they are institutionalized, childless adults must meet the following requirements:

• They do not meet the eligibility criteria for EBD Medicaid. This includes any of the following:
  • They do not meet the asset test for EBD Medicaid.
  • They do not meet the income test for EBD Medicaid.
  • They fail to provide or verify asset information or any other information needed to determine EBD Medicaid eligibility.
  • They have not yet been determined disabled.
  • They have not yet been determined presumptively disabled.
• They are eligible for BadgerCare Plus as a childless adult.
• They have not divested in order to qualify for receipt of LTC services (see Medicaid Eligibility Handbook, Chapter 17 Divestment). Institutionalized childless adults who divest are not eligible for LTC services although they remain eligible for Medicaid services.
• They disclose information about any annuities purchased on or after January 1, 2009, in which they or their community spouse have an interest.
• They designate the state of Wisconsin as the remainder beneficiary of any annuities purchased or created on or after January 1, 2009.
• If they own their own home, the equity interest in the home must not exceed $750,000 (see Medicaid Eligibility Handbook, Section 16.8.1.4 Home Equity over $750,000.00) in order to receive LTC services.
• They assign to the state of Wisconsin their rights to payments from a nursing home, hospital, or LTC insurance policy and send any payments to the state of Wisconsin that they received from a nursing home, hospital, or LTC insurance carrier while receiving BadgerCare Plus.

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The information concerning the BadgerCare Plus program provided in this handbook release is published in accordance with: Titles XI, XIX and XXI of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapter 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2 and 101 through 109 of the Wisconsin Administrative Code.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10171