State of Wisconsin Department of Health Services

Release 26-03 August 12, 2026

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27.5 ILTC Financial

27.5.1 ILTC Assets

Refer to 16.1 Assets Introduction to determine when an asset is countable. If countable assets exceed the appropriate limit, the Medicaid applicantA person who has submitted a request for coverage for whom no decision has been made regarding eligibility/member is ineligible.

Note:

Prepayment to a nursing home for the extra cost of a private room is an available asset.  The applicant has the legal ability to make the prepayment available for his or her support and maintenance (16.2 Assets Availability).

1. Unmarried memberA recipient of Medicaid; formerly referred to as a "client." - See 39.4 EBD Assets and Income Tables or the EBT asset limits for an unmarried member
2. Married member (Spousal Impoverishment ) -The assets of both the institutionalized person and his or her community spouse are counted in the initial asset test. For information about how to determine a married member’s asset limit and the community spouseA person recognized under federal law as another person’s legal partner through marriage. This includes a marriage (including common law marriage) that was valid in the state where it was entered into. For marriages entered into outside the United States, this includes a marriage that was valid in the place where it was entered into and could have been entered into in the United States. asset share refer to 18.4 Spousal Impoverishment Assets.

27.5.2 ILTC Income

Follow the policies listed in 15.1 Income Introduction to determine an applicant’s income. The income limit is the same for non-spousal impoverishment institutionalized persons as for spousal impoverishment cases. But, for spousal impoverishment cases, after the institutionalized person becomes eligible, he or she is allowed to allocate some of his or her income back to his or her community spouse (see 18.6 Spousal Impoverishment Income Allocation)

If income is greater than Institutions Categorically Needy Income Limit (39.4 EBD Assets and Income Tables) the person is ineligible for categorically needy Medicaid.

If the income is greater than need (see 27.6 ILTC Monthly Need) the person is ineligible for medical needy Medicaid.

Sometimes, when both spouses are institutionalized, the income of one is greater than his or her monthly need and the income of the other is less than his or her monthly need.  When this occurs, calculate the couple’s combined monthly need and compare it with their combined income.  If the total need is greater than the total income, and if the spouse with greater income is willing to combine it with his or her spouse’s lesser income, both spouses could be eligible.

27.5.3 Divestment  

See 17.1 Divestment Introduction for Divestment policies.

27.5.4 Instructions for Manual Eligibility Determinations

Use the following to determine which financial worksheet to use:

1. Medical institution (27.1 Institutions) residents with no community spouse .
   Use the Medicaid Institution Worksheet (Worksheet #4).
2. Medical institution residents who have a community  spouse and who became institutionalized before 09-30-89:
   Use the F-10095 Medicaid Asset Assessment Medical Institution/Community Waiver Resident and Community Spouse Form and the Medicaid Institution Worksheet (Worksheet #4).
3. Medical institution residents who have a community spouse and who became institutionalized on or after 09-30-89:
   Use the F-10095 Medicaid Asset Assessment Medical Institution/Community Waiver Resident and Community Spouse form and the Spousal Impoverishment Income Allocation Worksheet (Worksheet #7).
4. Community waiver applicants with no community spouse:  
   Use the F-20919
5. Community waiver applicants with a community spouse:
   Use the F-10095 Medicaid Asset Assessment Medical Institution/Community Waiver Resident and Community Spouse form the Medicaid Waiver Eligibility and Cost Sharing Worksheet, and the Spousal Impoverishment Income Allocation Worksheet (Worksheet #7).

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The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 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-10030