Wisconsin Medicaid Personal Care (Medical Assistance Personal Care)

Program Description

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

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 home and assisted living residences provided they have less than 20 residents.  

 There is considerable confusion associated with this program due to the variety of names by which it is referred and due to the fact that Wisconsin has several other programs which also offer personal care.

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 CIP-II and COP-W Waivers, the IRIS Program or the Family Care and Partnership Programs.

 

Eligibility Guidelines

MAPC is a benefit of Wisconsin Medicaid's State Plan. Interested parties must be eligible for the state Medicaid. Applicants can be considered Categorically Needy, meaning their incomes and assets are such that they automatically qualify for the program. Alternatively, they can be Medically Needy, which means their incomes or assets may exceed the Categorically Needy levels but their medical expenses and care costs are such that they still cannot afford to pay for them themselves.

In 2017, to be Categorically Needy, a single applicant must have an income of no more than the SSI limit of $735 / month. One's countable assets, which do not include a home and car, cannot be valued at greater than $2,000. Applying couples have monthly income and asset limits at $1,103 and $3,000, respectively.

For Categorically Needy participants, there are no fees or copayments. Medically Needy individuals are required to spend down their income and assets over the Categorically Needy limits on their care costs to such a level where they become Categorically Needy. At this point, Medicaid covers their remaining costs.

 

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. 

If one is uncertain about their financial eligibility, they should consider speaking with a Medicaid planning professional prior to application. One can read more about Medicaid planning options here.