Wisconsin Medicaid spend-down, explained

If you're elderly, blind, or disabled (EBD) and your income is over the Medicaid limit, you're not necessarily out — Wisconsin lets unpaid medical bills count against your income to bring you down to eligibility. This is called spend-down.

How it works

1. DHS calculates your monthly excess income. Take your countable monthly income (mostly Social Security, pensions, wages) minus the EBD Medicaid limit (~$1,304/mo for a single adult in 2026). The difference is your monthly excess.
2. You incur medical bills. Doctor visits, hospital stays, prescriptions, dental care, medical equipment — anything Medicare didn't pay counts. So do health insurance premiums (Medicare Part B, supplemental, drug plans).
3. Once your incurred bills equal your monthly excess, you qualify for the rest of the month. DHS's “deductible period” runs in 6-month windows — you spend down up to 6 × your monthly excess, and once you hit it, Medicaid kicks in for the rest of the period.
4. After the deductible is met, Medicaid pays the rest. For the rest of the 6-month window, Medicaid covers your medical costs as if you'd been eligible from day one. The bills that pushed you over the line stay your responsibility — but everything after is covered.

Worked example

What counts toward spend-down

• Medicare Part B and Part D premiums
• Medigap / Medicare Supplement premiums
• Co-insurance and deductibles you paid (or are billed)
• Doctor / dentist / specialist bills not covered by other insurance
• Prescription costs you paid
• Durable medical equipment (wheelchair, walker, oxygen)
• Home-care services not covered by Medicare
• Transportation to medical appointments (in some cases)
• Health insurance for dependents

How to apply

1. Apply for EBD Medicaid through ACCESS or by calling 1-800-362-3002. Specifically ask about the deductible / spend-down option.
2. Save every medical bill, receipt, and Explanation of Benefits. You'll submit them to your IM worker as proof of incurred expenses.
3. Track your monthly excess. ADRC counselors can help you calculate this — call your local ADRC.
4. When you've hit the deductible, notify DHS. Medicaid is retroactive within the 6-month window once you trip the threshold.

Watch out for

• The asset test still applies — EBD Medicaid limits assets to $2,000 single / $3,000 couple. Spend-down handles income; assets are separate.
• Bills get counted in the month they're incurred, not paid. A $5,000 surgery bill sitting unpaid still counts toward this month's spend-down.
• You can't double-count: a bill that gets paid by Medicare or other insurance can't also count toward spend-down. Only your out-of-pocket share counts.
• The 6-month deductible window restarts each period — so a year with sporadic medical needs won't accumulate across periods.

Spend-down rules are detailed and case-specific. WI ADRCs can run the calculation for you — find yours at dhs.wisconsin.gov/adrc. Disability Rights Wisconsin (1-800-928-8778) can also help if you're hitting bureaucratic friction.