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Example 2 In April, Edna applied for institutional Medicaid and requested a two-month backdate to February, when she first became institutionalized. Her backdated request is denied because her assets exceed program limits, but institutional Medicaid is approved effective April 1, with a $1200/month patient liability. Edna has an outstanding balance of $6,000 at the nursing home for February and March dates, which is a countable medical expense for both her monthly need and patient liability calculations. The expense can be applied for April to August ($1,200 x 5 months =$6,000).

Edna’s expense decreases her patient liability to $0, but she pays the nursing home the calculated patient liability of $1,200/month, which is applied to the outstanding balance through August. For September, there is no balance remaining on her bill and the expense is removed. She continues to pay the $1,200/month patient liability.

This page last updated in Release Number: 26-03 Release Date: 08/12/2026 Effective Date: 08/12/2026 27.8 ILTC Nursing Home Contracts Certain nursing home contract provisions require prospective residents to be on private pay status for a period of time, usually 12 to 18 months, before applying for Medicaid (Medicaid). In essence, this requires the prospective resident waive the right to apply for Medicaid for a period of time as a precondition to admittance. The prospective residents, who are typically on a higher private pay status at the time, would generally qualify for Medicaid before the contract provision expires. Nursing homes must honor residents’ rights guaranteed by HSS 132.31, Wis. Admin. Code, in order to participate in the Medicaid program. The standards must be enforced as a condition of federal funding. They apply to all residents in a Medicaid certified nursing home, both Medicaid and private pay, as a condition of participation in the Medicaid program. A resident can be involuntarily discharged or transferred essentially only for: 1. medical reasons, 2. his or her welfare or that of other patients, or 3. nonpayment. Changing status from private pay to Medicaid and any corresponding loss of revenue to the nursing home are not to be considered nonpayment. Thus, contract provisions prohibiting a person from applying for Medicaid by requiring a certain length of stay as a private pay resident can’t be enforced by threats of discharge. DHS has notified all Wisconsin nursing home providers that: 1. violations of private pay duration of stay contract provisions aren’t grounds for discharge, and 2. they must notify all present and prospective residents of this.