State of Wisconsin
Department of Health Services

HISTORY

The policy on this page is from a previous version of the handbook. 

21-02 Version of 39.4 Elderly, Blind, or Disabled Assets and Income Tables

39.4.1 Elderly, Blind, or Disabled Assets and Income Table

The values in the following table were effective January 1, 2021.

Group Size

Category

 

1

 

2

SSI-Related Categorically Needy Limits

Assets

$2,000.00

Assets

$3,000.00

Income

$877.78

Income

$1,323.05

SSI-Related Medically Needy Limits

Assets

$2,000.00

Assets

$3,000.00

Income

$1,073.33 (effective 2/1/2021)

Income

$1,451.67 (effective 2/1/2021)

SSISupplemental Security Income. A program based on financial need operated by the Social Security Administration that provides monthly income to low income people who are age 65 or older, blind, or disabled. Payment Level

Federal SSI Payment Level

Income

$794.00

Income

$1,191.00

SSPState Supplementary Payment

Income

$83.78

Income

$132.05

Total

Income

$877.78

Income

$1,323.05

SSI Payment Level + E Supplement

Income

$973.77
(Home Maintenance Maximum Allowance)

 

$1,668.41

SSI E Supplement

Income

$95.99

 

$345.36

Community Waivers Special Income Limit

Income

$2,382.00

 

 

Institutions Categorically Needy Income Limit

Income

$2,382.00

 

 

Substantial Gainful Activity Limit (non-blind individuals)

Income

$1,310.00

 

 

Substantial Gainful Activity Limit (blind individuals)

Income

$2,190.00

 

 

Medicaid Savings Programs

QMB

Income

At or below 100% FPL

 

 

SLMB

Income

At least 100% FPL but less than 120% FPL

 

 

SLMB+

Income

At least 120% FPL but less than 135% FPL

 

 

QMB, SLMB, SLMB+

Assets

$7,970

 

$11,960

QDWI

Income  

At or below 200%

 

 

Assets

$4,000

 

$6,000

39.4.2 Elderly, Blind, or Disabled Deductions and Allowances

The cost-of-living adjustments in the following table were effective January 1, 2021.

Description

Amount

Personal Needs Allowance (effective 7/1/01)

$45.00

EBD Maximum Personal Maintenance Allowance

$2,382.00

EBD Deeming Amount to an Ineligible MinorA minor is a person less than age 18.

$397.00

Community Waivers Basic Needs Allowance

$974.00

Parental Living Allowance for Disabled Minors

1 Parent

2 Parent

$794.00

$1,191.00

 

The spousal impoverishment values in the following table were effective July 1, 2021.

Description

Amount

Community Spouse Lower Income Allocation Limit

$2,903.34

Community Spouse Excess Shelter Cost Limit

$871.00

Community Spouse Maximum Income Allocation (monthly)

The lesser of $3,259.50 (as of 1/2021) or the Lower Income Allocation Limit plus excess shelter expenses

Family Member Income Allowance

$725.84

Community Spouse asset share (CSAS) maximum

$130,380.00 as of 1/2021

39.4.3 Institutional Cost of Care Values

The values in the following table were effective January 1, 2021.

Description

Amount

Daily Average Private Pay Nursing Home Rate

$303.38

Monthly Average Private Pay Nursing Home Rate

$9,227.81

Monthly Rate for State Centers for Persons with Developmental Disabilities

$25,709.69

39.4.4 Maximum Cost Share Amount for Family Care, Family Care Partnership, or PACE

The values in the following table were effective February 1, 2021.

Description

Amount

Maximum Cost Share Amount for an individual in Group B+ for Family Care, Family Care Partnership, or PACE

$2,903.45

This page last updated in Release Number: 21-02
Release Date: 08/30/2021
Effective Date: 08/30/2021


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