Doula services aren’t covered by Wisconsin Medicaid – known as BadgerCare – as of April 2026.
Doulas provide emotional support and education around childbirth. Unlike midwives (which are covered), they don’t perform medical tasks.
A Wisconsin Department of Health Services spokesperson confirmed doulas aren’t covered as a stand-alone benefit for Medicaid recipients.
State law requires the health department to get legislative approval before making changes to Medicaid. Doula coverage has been proposed by Gov. Tony Evers and Democratic lawmakers but has not come to pass.
According to the National Health Law Program, 26 states and Washington, D.C., are actively reimbursing for Medicaid coverage of doula care. Seven more are in the process of doing so.
For many families across the Midwest, discussing end-of-life planning is about as comfortable as a January blizzard on Highway 175. However, proactive planning is a final act of care that prevents legal headaches and ensures a legacy stays within the family. In Wisconsin, specific statutes — ranging from marital property laws to unique transfer-on-death rules — make it essential to use the right tools. Whether you are a young parent or assisting aging parents, these are the legal and financial cornerstones for a solid plan.
Write a will and consider a living trust
A last will and testament is the traditional bedrock of any plan. In Wisconsin, a will allows you to name an executor (the person who will manage your estate) and a guardian for minor children. Without a will, a state judge — not your family — decides who raises your kids and how your assets are split.
For many Wisconsin families, a revocable living trust is a powerful alternative or supplement.
Benefit: Unlike a will, which must go through the public, often costly probate court process, a trust allows assets to pass privately and immediately to heirs.
Midwest reality: If you own property in multiple states (like a cabin in Michigan’s Upper Peninsula or a farm in Iowa), a trust can prevent your family from having to open probate cases in every state where you own land.
Assign power of attorney: health care and finances
Control is often lost not at death, but during a period of incapacity. Wisconsin law recognizes two distinct roles:
Financial power of attorney: This grants a “trusted agent” the authority to pay your mortgage, manage your taxes and handle your bank accounts. Under Wisconsin Chapter 244, these are “durable” by default, meaning they remain valid even if you lose mental capacity.
Health care power of attorney: This allows someone to make medical decisions if you cannot. In Wisconsin, your spouse is not automatically authorized to make all medical decisions for you without this document. It requires two witnesses who are not related to you or responsible for your health care costs.
Create an advance directive (living will)
While a health care power of attorney names who makes decisions, an advance directive (often called a “declaration to physicians” in Wisconsin) tells them what those decisions should be. This document outlines your wishes regarding life-sustaining treatments, such as ventilators or feeding tubes, specifically if you are in a terminal condition or a persistent vegetative state.
For Wisconsin residents, the Department of Health Services provides standard forms that are legally recognized across all state health systems.
Name beneficiaries for accounts and insurance
One of the most common mistakes is assuming a will covers everything. In reality, beneficiary designations on life insurance policies, 401(k)s and IRAs “trump” what is written in a will. If your will says your estate goes to your children, but your 20-year-old life insurance policy still lists an ex-spouse, that money will likely go to the ex-spouse.
To keep things simple, many Wisconsin banks offer payable-on-death (POD) options for checking and savings accounts, which keeps that cash out of the probate court’s hands.
Transfer-on-death deeds
Wisconsin is one of the states that allow a transfer-on-death (TOD) deed for real estate. This is a game changer for the “family home.”
How it works: You file a TOD deed with your local register of deeds (such as the one in Juneau for Dodge County). It names who inherits your home, but it has no effect while you are alive. You can still sell the house or change your mind at any time.
The catch: Because Wisconsin is a marital property state, if you are married, your spouse generally must sign the TOD deed even if the spouse’s name isn’t on the original title.
Note: For small estates, Wisconsin offers a “transfer by affidavit” process for estates valued under $50,000. This allows heirs to collect assets without a full court proceeding, provided they follow strict notification rules for the state’s Medicaid Estate Recovery Program.
This story is published in collaboration with Multi-Media Channels. It originally appeared in Multi-Media Channels’ print “Dignity in Care” publication.
Hi, Wisconsin! Health reporter Addie Costello here.
I spent last Saturday with around 80 attendees of a senior breakfast in Merrill, and it was one of my best-spent weekends so far in 2026.
Northwoods residents packed a banquet hall to eat, talk with neighbors and list the biggest issues they face as older adults.
The Senior Empowerment Project, an organizing group focused on issues impacting older people in rural areas and small towns, organized the event and asked me to give a short presentation about my reporting on long-term care issues. The most exciting part? Once I finished talking, a microphone was passed from table to table as older adults shared the questions and issues they think about the most.
Where can they get transportation on the weekends? How can older adults afford to stay in their homes as property taxes increase? Where can they get nutritious food?
Wall decor is shown at the Northwoods Senior Breakfast at the Eagles Club in Merrill, Wis., March 28, 2026. (Addie Costello / Wisconsin Watch)
I left the event with a long list of questions I plan to answer in a new project. We’re calling it Q&Aging, a series of short stories where I interview experts to answer your questions about getting older in Wisconsin — whether about health care, housing or what comes next.
I reported this as part of our collaboration with several Multi-Media Channels, which cover swaths of northeast and central Wisconsin. Find the full Dignity in Care project here.
Choosing a long-term care provider is an important, expensive decision. Like test-driving a car, unannounced visits can provide helpful insight.
So what should someone do before a “walk-in” visit?
Wisconsin Watch asked two experts to weigh in:
Devon Christianson, director of the Aging and Disability Resource Center of Brown County.
Mike Pochowski, president and CEO of the Wisconsin Assisted Living Association.
Here’s what they recommend:
Start with a scheduled tour. The person giving tours likely has important information about a facility’s care and costs. The state health department provides a guide for comparing assisted living providers, and the federal government has a similar guide for nursing homes. ADRCs can also help people prepare for tours.
Ask about “walk-in” visits. Facility staff might list certain times that are not ideal or explain security concerns, especially in a facility that offers memory care. But if the answer is an absolute no, that is something to consider when comparing providers.
Be transparent. The goal of drop-in visits is not to catch a provider doing something bad. Prospective residents or their family members should tell staff who they are and go through the normal guest registration process.
Be respectful. Nursing and assisted living facilities are people’s homes. Visit at a reasonable time and stay in common areas.
Ask residents and their families if they would be open to talking, Christianson said. Don’t base your decision around one resident’s experience. Use these conversations as a tool to help inform your decision.
This article was inspired by a reader sharing an experience touring facilities for a loved one. Do you have something to share? Please reach out.
Q&Aging
Aging comes with big questions — whether it’s about health care, housing or what comes next.
Wisconsin Watch is working to answer questions and share practical tips about aging in Wisconsin. To ask a question or offer a suggestion, fill out this form or contact reporter Addie Costello via email (acostello@wisconsinwatch.org) or phone (608-616-5239).
People cannot avoid death, but they often avoid talking about it. That’s why many people don’t receive as much — or any — hospice care they qualify for, experts say.
“There’s a real taboo in society that hospice equals death,” said Alisa Gerke, the board chair of Wisconsin Hospice and Palliative Care Collaborative and executive director at Unity Hospice and Palliative Care, a nonprofit provider that serves 14 northeast Wisconsin counties.
The goal of hospice isn’t to speed up the dying process; it’s to make people more comfortable — treating the symptoms of an illness instead of trying to cure it.
Once families enroll in hospice, Gerke said, they often ask: “How come nobody told us about this sooner?”
When to talk about hospice
Don’t wait for your provider to bring up hospice.
Patients and providers often wait for the other person to bring hospice up, said Angela Novas, an advanced certified hospice and palliative care nurse and consultant at the nonprofit Hospice Foundation of America. Let providers know that’s something you might be interested in.
Patients or their loved ones can also reach out to hospice providers directly and ask for an eligibility assessment, Novas said.
The basic requirements for adults to receive hospice care under Medicare include:
Verification from two physicians that a patient has a life expectancy of six months or less.
A patient’s willingness to pursue treatments to provide comfort instead of treatments aimed at extending life expectancy.
Clearing up misunderstandings about hospice
Some people may have misperceptions about hospice. Here is what it is not:
A place. Instead, it’s a model of care, Gerke said. While some providers may run facilities, hospice care can be provided at home and in nursing homes, assisted living facilities, hospitals and other settings.
Constant nursing care. Hospice is meant to supplement care from family or facility caregivers, Novas said. But providers should be readily accessible for questions and concerns.
Stopped if someone lives longer than six months. Instead, providers work to re-certify that someone is still likely to die within the next six months, Gerke said. Patients are no longer eligible for hospice if their life expectancy unexpectedly improves.
Permanent. Patients can decide to stop hospice and try curative treatment. If their outlook doesn’t improve, they can return to hospice, Gerke said. They can also freely switch providers.
So what’s palliative care?
Palliative care is a philosophy and medical speciality focused on alleviating suffering, according to Dr. Sara Johnson, a palliative care physician and University of Wisconsin School of Medicine and Public Health professor.
Hospice is a form of palliative care for people at the end of life. But people with a serious illness can access palliative care earlier in their diagnosis and while receiving curative treatments.
Palliative care services are becoming more accessible, Johnson said.
Palliative care specialists add a layer of support for patients and their families, Johnson said.
There is no harm in asking a provider about palliative care options, Johnson said. “If you’re thinking about it, just ask.”
How to find the right provider
Ask local providers for hospice care recommendations, Novas said. But don’t be afraid to shop around. Experts recommend asking these questions before choosing a provider:
How long have you served this area, and where are your staff located?
“Having staff that know that community, live in that community, are a part of that community is huge,” Gerke said.
What is your response time?
A patient’s condition can quickly change, making it important to know how quickly staff will answer calls or arrive in those cases.
What is your relationship with nearby providers?
If you know you want to use a particular nursing home, hospital or physician, it helps to know whether hospice providers have relationships and contracts with them.
What grief support do you offer?
Medicare requires hospice companies to provide families with bereavement services. But the level of those services can range widely.
What is your Medicare rating?
Medicare.gov offers a hospice look-up tool with quality care ratings. The federal agency provides comparative ratings based on family surveys and metrics like nursing visits in patients’ last days before death.
Are you for-profit or nonprofit?
Private equity and publicly traded companies are increasingly taking hold of the hospice industry. Those providers have been associated with lower quality of care, according to a Cornell University study.
For-profits face expectations around financial performance and typically have obligations to shareholders, Gerke said.
But a nonprofit status does not guarantee better care, Novas said. People should prioritize whether a provider fits their specific needs.
What services do your volunteers provide?
Medicare requires hospice providers to have a volunteer program. Do volunteers play games with patients? Provide pet therapy? Read to people? Some volunteer programs are more robust than others, Novas said.
What medications do you not cover?
Not all medications and supplies are covered under the Medicare hospice benefit, Novas said. It’s important to know what you might have to pay for out-of-pocket or with other health coverage.
Aging comes with big questions — whether it’s about health care, housing or what comes next.
Wisconsin Watch is working to answer questions and share practical tips about aging in Wisconsin. To ask a question or offer a suggestion, fill out this form or contact reporter Addie Costello via email (acostello@wisconsinwatch.org) or phone (608-616-5239).
Wisconsin Watch is a nonprofit, nonpartisan newsroom. Subscribe to our newsletters for original stories and our Friday news roundup.
Nine of Wisconsin’s 72 counties are “maternity care deserts”: no hospitals and birth centers offering obstetric care and no obstetric providers such as obstetricians.
The nine, according to the latest March of Dimes report (2024), are largely rural:
Adams, Douglas, Forest, Kewaunee, Lafayette, Marquette, Oconto, Pepin and Rusk.
Maternal care deserts drive maternal mortality rates, which generally are higher for Black women and women in rural areas, according to a 2025 study by Brown University researchers.
Individuals in states with a high prevalence of maternity care deserts had 34.2% greater risk of maternal mortality and 18.3% greater risk of infant mortality, Yale University researchers found in 2025.
The Wisconsin Office of Rural Health at the University of Wisconsin-Madison recommended extending pregnant women’s Medicaid coverage to 12 months postpartum, from two months, to improve care and hospital finances.
Gov. Tony Evers recently signed legislation for that extension.
This fact brief is responsive to conversations such as this one.
The Versiti Blood Center of Wisconsin is experiencing a major decline in organ donors while waitlists for patients in need of transplants grow.
There are 1,450 Wisconsin patients awaiting an organ transplant, but there’s been a 350% increase in the number of people removing themselves from the Wisconsin donor registry, according to Colleen McCarthy, vice president of organ and tissue donation at Versiti.
“Organ donation is built on public trust, and we are losing it,” McCarthy said. “There is much national news with misinformation that creates fear in people.”
McCarthy wants people to understand that an organ donation specialist’s role includes supporting families, medically managing donated organs, allocating them based on priority and offering public education.
Especially on misconceptions.
Some people worry that their life won’t be saved if they become an organ donor or that they’re too old to donate one.
“We make every effort to save a life,” McCarthy said. “The oldest organ donor in the United States is 96 years old, so we evaluate all ages regardless of medical history.”
McCarthy emphasizes that if you have multiple health conditions like diabetes, hepatitis C or HIV, there are other organs in the body that can be safe for a transplant.
“There’s very few rule-outs in organ donation,” she said. “We just have to make sure that those organs are matched with the right recipient.”
Navigating life without a kidney
Versiti Blood Center of Wisconsin is in need of kidneys, livers, hearts, lungs and other organs to save lives.
“The kidney is the organ in most need,” McCarthy said.
Among the patients waiting for a kidney transplant is Kelly Norlander, who has known since she was a teenager that she’d be in need of a kidney one day.
“It’s never easy when you know it’s coming, but I was able to wrap my head around it and process it all,” she said.
Norlander has a genetic condition called polycystic kidney disease, which causes continuous growth of cysts in the kidney.
She was put on the transplant list two years ago and has been receiving dialysis treatments three times a week for four hours each day for the past year and a half.
Dialysis is a process that filters toxins from the body when kidneys stop working.
Although Norlander works full time remotely, she’s stuck bringing her computer to dialysis with her most days.
“Dialysis feels like a part-time job within itself,” Norlander said. “The longer dialysis is, the harder the transplant will be on your body.”
“I hope people think about Kelly and the others who are waiting on a transplant,” McCarthy said. “We understand that donating is a personal choice, but I think people need to spend some time thinking about getting accurate information on organ donation.”
Norlander’s father passed away seven years ago from the same condition because he didn’t qualify for a transplant.
Norlander also wants people to consider the life-saving impact they can have by becoming an organ donor.
“You’re not just saving one life, you’re saving several,” she said.
Keeping a consistent blood supply
The harsh winter, including the most recent blizzard, is causing residents to donate less blood this year, which has led to a blood supply shortage for Versiti.
According to Versiti, 11 of its donor centers and six mobile drives were canceled on Monday. Versiti was hoping to schedule 450 appointments to make up for the ones that were canceled.
Versiti is also trying to prepare for the warmer seasons, as sometimes the supply can drop during good weather, too.
“It doesn’t take much to disrupt the supply,” said Lauren Patzman, recovery services supervisor at Versiti. “When people are traveling and getting ready to go somewhere for spring break or the holidays, those are the times we see declines in donations.”
Throughout the year, Versiti relies heavily on high school students, as many of their schools host blood drives. But when school is out, finding volunteers becomes harder.
Patzman said the organization attends festivals and local events during the summer to spread awareness about blood, organ and eye donation. However, sometimes it’s hard to utilize its mobile bus because people aren’t always prepared to give blood.
“It’s hot, people are walking around all day and may not be hydrated or had a good breakfast beforehand,” Patzman said.
The organization is urging more residents to donate blood to prevent another shortage.
It’s in need of all donated blood types, especially donors with a rare blood type called Ro.
According to Versiti Research Blood Institute, Ro blood is found only within 4% of donors and is often given to sickle cell patients. Many sickle cell patients in Milwaukee require blood transfusions every three to four weeks and need over 60 red blood cell units each year.
Other individuals, including burn victims, cancer patients, a mother giving birth and more can receive donated blood.
Patzman said the organization tries to keep three to five days of blood supply available to share with hospitals.
“If and when a blood shortage happens, hospitals do have to make difficult decisions that may include delaying surgeries and adjusting treatments,” she said.
Taking next steps with a quick visit
Patzman reminds individuals there’s always room to put donating blood on your to-do list.
“People don’t realize how easy it is to just walk in and out within an hour, and it’s not as scary as people think it is,” Patzman said. “Blood is perishable and it has a shelf life.”
If you are interested in donating blood, click here to enter your ZIP code to find nearby donor centers or mobile drives.
To become an organ, tissue and eye donor, click here for more details.
Reading Time: 6minutesClick here to read highlights from the story
Federal immigration officials could gain access to sensitive Medicaid data — but not yet. A judge has temporarily limited what information the Department of Homeland Security can access in states, like Wisconsin, that are suing to block a data-sharing agreement.
Advocates warn the data-sharing risks chilling health care access — potentially even discouraging some from enrolling in programs for which they’re eligible.
Undocumented immigrants are categorically ineligible for full Medicaid, but two narrower options exist. In Wisconsin, emergency care and prenatal coverage are available regardless of immigration status, covering about 3,200 people as of late 2025.
State Republicans unsuccessfully sought to ban any public funding for health care for people without legal immigration status, citing rising Medicaid costs. Gov. Tony Evers vetoed the proposal, arguing it would create confusion and solve problems that don’t exist.
Can federal immigration officials access personal data on every Wisconsinite enrolled in Medicaid?
Not for now, but the question is winding its way through federal courts.
The U.S. Department of Health and Human Services last summer signed an agreement with the Department of Homeland Security to give immigration enforcement officers broad access to Medicaid data, which includes names, addresses, claim information and banking details. Trump administration officials claim the agreement is needed “to ensure that Medicaid benefits are reserved for individuals who are lawfully entitled to receive them.”
“Millions of individuals’ health information was transferred without their consent,” the lawsuit argues. “In doing so, the Trump administration silently destroyed longstanding guardrails that protected the public’s sensitive health data.”
In December, a federal judge in California ordered that, in states involved in the lawsuit, DHS can only access the names and contact information of undocumented immigrants in states involved in the lawsuit.
But patient advocates say it’s unclear how the agency could separate the records of undocumented immigrants from those of immigrants with legal status.
“The sharing of data is dangerous for all of us at the end of the day,” said Esther Reyes, movement-building director with the national advocacy group Protecting Immigrant Families.
How does immigration status affect eligibility for Medicaid and other health programs?
Federal law bars undocumented immigrants and many other recent immigrants from receiving full-benefits Medicaid coverage. Most legal permanent residents and new arrivals with legal status become eligible for full Medicaid coverage only after five years in the U.S. A list of exceptions to that rule shrank last year when President Trump signed his trademark “big beautiful bill” into law.
But the White House claims many undocumented immigrants still access Medicaid benefits, largely citing state-funded health care programs — including a now-shuttered program in Illinois — that provided coverage for undocumented adults. While those programs must operate without federal dollars to avoid running afoul of federal law, the Trump administration argues a tax “loophole”, which it moved to close last week, made them possible.
Medicaid rules make one exception for immigrants ineligible for full coverage: Under federal law, hospitals must provide emergency care for any uninsured patient. Emergency Medicaid coverage can reimburse hospitals for those costs, meaning people of any legal status can receive temporary coverage in dire circumstances — though receiving that emergency coverage is not guaranteed.
“Emergency Medicaid is exclusively available when you go to the emergency room if you don’t qualify for Medicaid because of your immigration status, and it covers services that states by law are required to cover — life or death situations,” Reyes said.
Absent that reimbursement, hospitals may distribute the costs of emergency care for people without insurance across other patients.
Some states also rely on the federal Children’s Health Insurance Program, which is separate from Medicaid, to cover prenatal care for pregnant patients regardless of immigration status.
How do those programs work in Wisconsin, and how much do they cost?
In Wisconsin, those two options are called Medicaid Emergency Services and BadgerCare Plus Prenatal, respectively. The prenatal program is open both to immigrants ineligible for other coverage and to pregnant inmates in Wisconsin’s prisons and jails.
Immigrant patients can receive emergency services coverage until their “condition is no longer considered an emergency,” according to state guidelines. Patients enrolled in the prenatal plan remain covered through their pregnancy, though many then become eligible for two months of emergency care coverage.
Roughly 3,200 people were enrolled in the two programs combined in October 2025, according to Wisconsin’s Department of Health Services’ data. That marked the programs’ lowest monthly enrollment since the start of the COVID-19 pandemic.
The state paused reviews of Medicaid recipients’ eligibility during the pandemic, allowing some enrollees in the emergency services and prenatal programs to remain insured beyond the standard cutoff, but enrollment plummeted after Wisconsin DHS resumed reviews in June 2023 in a process often called the “unwinding.”
Not all patients enrolled in the programs are undocumented, and Wisconsin DHS records do not break down enrollment by legal status.
Spending on the two programs dipped from about $60 million in fiscal year 2024 to about $57 million in 2025 — less than 0.4% of the state’s overall medical assistance spending that year.
Why did Wisconsin Republicans try to block state-funded health care for undocumented immigrants last year?
The Republican-controlled Legislature voted last year to bar Wisconsin agencies and local governments from funding any form of health services for undocumented immigrants.
Rep. Alex Dallman, R-Markesan, one of the bill’s co-sponsors, pointed to Illinois’ expansion of health coverage to some undocumented adults as reason for Wisconsin to preemptively block any similar expansion; the Illinois program’s costs consistently exceeded projections, prompting the state to end the program last year.
“We’re in such a deficit on Medicaid already that it’s hard to keep up as it is,” he told Wisconsin Watch. Wisconsin is on track to overspend its Medicaid budget by $213 million by the end of the current budget cycle, state DHS Secretary-designee Kirsten Johnson wrote in a letter to state lawmakers at the end of December.
Dallman noted that the bill made an exception for health care spending required under federal law. “If they go to the emergency room, they are still going to get emergency care,” he said. As he understood it, Dallman said, that language in the bill would have shielded emergency Medicaid.
Rep. Alex Dallman, R-Markesan, is seen during a hearing of the Legislature’s Joint Finance Committee at the Wisconsin State Capitol on Feb. 15, 2023. He co-sponsored legislation to bar Wisconsin agencies and local governments from funding any form of health services for undocumented immigrants. (Amena Saleh / Wisconsin Watch)
But opponents say it isn’t clear that Wisconsin’s emergency services program would have been left untouched. Some also argue that the proposal could also require immigration status checks to access any form of subsidized health care, spanning far beyond hospitals alone.
“If a child is at school and they’re sick… does the school nurse need to figure out how to verify their status before they provide health care?” asked William Parke-Sutherland, government affairs director of Kids Forward, which advocates for low-income and minority families.
“It would have affected health care services for people if they are in need of emergency services like EMTs,” he added. “We have a primarily county-based crisis mental health system — I think that this would have applied to those as well.”
Could sharing Medicaid data deter patients from seeking health care?
Health outreach workers warn that giving federal immigration officials access to even some Medicaid patient data could discourage people from enrolling in programs for which they are eligible — including U.S. citizens.
The database shared with immigration authorities, called the Transformed Medicaid Statistical Information System, doesn’t clearly distinguish between undocumented immigrants and immigrants with legal status who are ineligible for full-coverage Medicaid for various reasons.
In December, U.S. District Court Judge Vince Chhabria of northern California ruled that immigration authorities may access data only on undocumented immigrants — and only if it can be separated from data on citizens and eligible immigrants.
It’s still unclear whether officials can do that.
Regardless, the data-sharing agreement alone is enough to make many immigrants — and some citizens with immigrant family members — “think twice about whether they actually access programs like Medicaid,” Reyes said.
But health care navigators say skipping coverage can be far riskier than the potential for their address to land in the hands of immigration enforcement officers.
“You’re protecting the life of your child — and yours” by enrolling in the prenatal program, said Francisco Guerrero, a health coverage navigator with the Wisconsin Institute for Public Policy and Service.
For now, advocates are urging people to be cautious when deciding whether to drop their coverage. If people are already enrolled in the emergency or prenatal programs and haven’t changed their address, leaving the program won’t wipe their information from the database, Reyes said. U.S. citizens don’t have to disclose the immigration status of anyone in their household, she added, and immigrant parents enrolling U.S.-born children do not need to share their own legal status.
“We want people to make informed decisions and understand the risks,” Reyes said. “We understand, though, that it’s really critical to get the care that you need for yourself and for your children.”
Wisconsin Watch is a nonprofit, nonpartisan newsroom. Subscribe to our newsletters for original stories and our Friday news roundup.
In Walworth County, Wisconsin, a grassroots effort is reimagining what care can look like across generations. A local community group has launched the “Nursery to Nursing Home” campaign, a proposal to transform a vacant wing of the county’s nursing home into a combined child care center and living space for older adults, addressing caregiving shortages.
“Some of the issues we’ve seen as top concerns in Walworth County include a lack of child care, a lack of senior care and the loneliness that comes with living in a rural community with an aging population and harsh winters. Together, it all creates a perfect storm for feeling isolated,” said Maddie Sweetman, who lives in Walworth County. “(The intergenerational care center) would be a beautiful way to not only address the need for seats and beds, but also to bring these two vulnerable communities together.”
The Lakeland Health Care Center, a county-owned skilled nursing facility in Elkhorn, has had a vacant wing since 2019 when staff shortages forced the facility to downsize. Now, Groundswell Collective, a local community group with a track record of advocating for older residents, is leading an effort to turn that space into 12 apartments for older people and a child care center that serves 60 to 70 children. After nearly a year of community organizing around the proposal, the Walworth County Board approved funding for a feasibility study in November for the intergenerational care center, a major step in advancing the project.
“In Walworth County, all 2,240 licensed child care slots, spread across the 35 active centers listed on the DCF (Department of Children and Families) website, are already full. That leaves nearly 2,680 children without stable care,” said Abriana Krause, who lives and works in East Troy as a child care provider, at a board committee meeting. “At the same time, Wisconsin is projected to need 30,000 additional senior beds by 2030 .… We are facing two parallel crises, child care and senior care, and the vacant wing at Lakeland Health Care Center offers us a rare opportunity to address both at once.”
As part of the proposal, county employees would get priority for child care slots.
Sweetman, a mother of two who is a full-time student and employee at the University of Wisconsin-Whitewater, knows firsthand how valuable this benefit could be for parents. When Sweetman’s children were younger, her husband worked at Lakeland Health Care Center as a certified nursing assistant while he completed nursing school. Unable to afford child care, Sweetman stayed home with her young children.
“I wonder whether having a child care facility under the same roof would have given me more access to child care, allowing me to return to school work sooner, graduate sooner, and be working full time now,” Sweetman said. “I also think about how that might have changed our overall trajectory, and what it would have meant for me personally as I managed two kids under two on my own and all the mental health challenges that came with that.”
Now, Sweetman is part of Groundswell Collective and advocating for other families to have the opportunity she did not.
“That (child care opportunity) didn’t happen for us, but I think about how it could happen for people going forward and for our community, not just for those who have children but also for seniors and for people who may soon need assisted living,” Sweetman said.
Groundswell Collective has leaned heavily on research to make its case.
“We have looked into the evidence-based benefits of intergenerational care,” said Deb Gill-Dorgan, a retired speech language pathologist and member of Groundswell Collective. “We know that adults report less loneliness, better health, a renewed sense of purpose in life, and it improves children’s social skills and educational outcomes.”
Research shows that intergenerational care sites boost well-being for both children and older people, reducing isolation, improving cognitive and physical health for older people, and cultivating empathy and connection in young children. Studies also find that these programs create cost efficiencies, especially when facility expenses and other operational costs can be shared.
Jill Juris, Ph.D., professor and chair of the Department of Recreation Management and Physical Education at Appalachian State University, is seeing these benefits through her research with BRIDGE2Health, an intergenerational mentoring program. The program is a collaboration between the Cooperative Extensions in Ohio and Virginia that connects high school students with older adults and is generating qualitative and quantitative data demonstrating increases in social connections and life skills.
“These findings align with other research indicating intergenerational interaction improves empathy, peer relationships and academic performance in younger populations, while increasing the quality of life and sense of purpose for older adults,” Juris said. “By bridging the gap between ages, these programs truly make a difference, improving the all-around well-being of everyone involved.”
Groundswell Collective urges the Walworth County Board to support intergenerational care at Lakeland Health Care Center. (Courtesy of Groundswell Collective)
Sheri Steinig, director of strategic initiatives and communications at Generations United, said that intergenerational care fosters relationships that transcend age that can serve the community as a whole.
“There’s a breakdown of age stereotypes that we see at a very young age when babies and toddlers are around older people,” Steinig said. “There are these characteristics of care, compassion and empathy that ripple out into both the families and the communities.”
In intentionally creating spaces that bring older and younger people together, these benefits organically emerge in daily interactions.
“By eliminating or reducing barriers that we’ve unintentionally put up between connecting younger and older people, there’s just a wealth of benefits that we can see in terms of educational outcomes, well-being, physical and mental health,” Steinig said.
“Intergenerational spaces offer opportunities for meaningful interactions through repeated connections that foster lasting relationships,” Juris said. “Children and older adults seeing each other within a daily routine allows for magical moments of interaction to occur.”
Those benefits extend to the caregiving staff. Steinig said that daily interaction with both children and older adults can enhance the work environment and make intergenerational centers more rewarding for staff.
Gill-Dorgan said she hopes that prioritizing county employees for child care placements at the proposed intergenerational center will help retain nursing staff, who can experience high turnover while managing their own family caregiving responsibilities.
For many involved in Groundswell Collective, the intergenerational center proposal offers a path forward on common ground at a time of uncertainty.
“As gaps widen at the federal level, I feel like there’s this turn to local solutions and our local government, and how can we fill the gaps? I see this intergenerational facility as part of that effort,” Sweetman said.
Pastor Lily Brellenthin, a mother of three who leads a Lutheran church in Walworth that serves an older congregation, has found hope through her community work with Groundswell Collective.
“In a world that’s so divided, to have some people now linking arm and arm to come together in our little place of the world is so uplifting,” said Brellenthin. “I feel like it’s proving that we are stronger in community.”
“We hope this is just the beginning,” Gill-Dorgan said. “We hope something like this will be seen as being beneficial and a wonderful idea, and hopefully other people will get involved and build more such centers.”
This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations, and The Commonwealth Fund.
The Senate on Thursday rejected legislation to extend Affordable Care Act tax credits, essentially guaranteeing that millions of Americans will see a steep rise in costs at the beginning of the year.
Senators rejected a Democratic bill to extend the subsidies for three years and a Republican alternative that would have created new health savings accounts — an unceremonious end to a monthslong effort by Democrats to prevent the COVID-19-era subsidies from expiring on Jan. 1.
Ahead of the votes, Senate Democratic Leader Chuck Schumer of New York warned Republicans that if they did not vote to extend the tax credits, “there won’t be another chance to act,” before premiums rise for many people who buy insurance off the ACA marketplaces.
“Let’s avert a disaster,” Schumer said. “The American people are watching.”
Republicans have argued that Affordable Care Act plans are too expensive and need to be overhauled. The health savings accounts in the GOP bill would give money directly to consumers instead of to insurance companies, an idea that has been echoed by President Donald Trump.
Senate Majority Leader John Thune, R-S.D., said ahead of the vote that a simple extension of the subsidies is “an attempt to disguise the real impact of Obamacare’s spiraling health care costs.”
But Democrats immediately rejected the GOP plan, saying that the accounts wouldn’t be enough to cover costs for most consumers.
The dueling Senate votes are the latest political messaging exercise in a Congress that has operated almost entirely on partisan terms, as Republicans pushed through a massive tax and spending cuts bill this summer using budget maneuvers that eliminated the need for Democratic votes. In September, Republicans tweaked Senate rules to push past a Democratic blockade of all of Trump’s nominees.
The Senate voted 51-48 not to move forward on the Democratic bill, with four Republicans — Maine Sen. Susan Collins, Missouri Sen. Josh Hawley and Alaska Sens. Lisa Murkowski and Dan Sullivan — voting with Democrats. The legislation needed 60 votes to proceed, as did the Republican bill, which was also blocked on a 51-48 vote.
No interest in compromise
Some Republicans have pushed their colleagues to extend the credits, including Sen. Thom Tillis of North Carolina, who said they should vote for a short-term extension so they can find agreement on the issue next year. “It’s too complicated and too difficult to get done in the limited time that we have left,” Tillis said Wednesday.
But there appeared to be little interest in compromise. Despite the potential for bipartisan agreement, Republicans and Democrats have never engaged in meaningful or high-level negotiations on a solution, even after a small group of centrist Democrats struck a deal with Republicans last month to end the 43-day government shutdown in exchange for a vote on extending the ACA subsidies. Most Democratic lawmakers opposed the move as many Republicans made clear that they wanted the tax credits to expire.
Still, the deal raised hopes for bipartisan compromise on health care. But that quickly faded with a lack of any real bipartisan talks.
An intractable issue
The votes were also the latest failed salvo in the debate over the Affordable Care Act, President Barack Obama’s signature law that Democrats passed along party lines in 2010 to expand access to insurance coverage.
Republicans have tried unsuccessfully since then to repeal or overhaul the law, arguing that health care is still too expensive. But they have struggled to find an alternative. In the meantime, Democrats have made the policy a central political issue in several elections, betting that the millions of people who buy health care on the government marketplaces want to keep their coverage.
“When people’s monthly payments spike next year, they’ll know it was Republicans that made it happen,” Schumer said in November, while making clear that Democrats would not seek compromise.
Even if they view it as a political win, the failed votes are a loss for Democrats who demanded an extension of the benefits as they forced a government shutdown for six weeks in October and November — and for the millions of people facing premium increases on Jan. 1.
Maine Sen. Angus King, an independent who caucuses with Democrats, said the group tried to negotiate with Republicans after the shutdown ended. But, he said, the talks became unproductive when Republicans demanded language adding new limits for abortion coverage that were a “red line” for Democrats. He said Republicans were going to “own these increases.”
A plethora of plans, but little agreement
Republicans have used the looming expiration of the subsidies to renew their longstanding criticisms of the ACA, also called Obamacare, and to try, once more, to agree on what should be done.
Thune announced earlier this week that the GOP conference had decided to vote on the bill led by Louisiana Sen. Bill Cassidy, the chairman of the Senate Health, Labor, Education and Pensions Committee, and Idaho Sen. Mike Crapo, the chairman of the Senate Finance Committee, even as several Republican senators proposed alternate ideas.
In the House, Speaker Mike Johnson, R-La., has promised a vote next week. Republicans weighed different options in a conference meeting on Wednesday, with no apparent consensus.
Rep. Kevin Kiley, R-Calif., has pushed for a temporary extension, which he said could be an opening to take further steps on health care.
If they fail to act and health care costs go up, the approval rating for Congress “will get even lower,” Kiley said.
Wisconsin Watch is a nonprofit and nonpartisan newsroom. Subscribe to our newsletters to get our investigative stories and Friday news roundup.This story is published in partnership with The Associated Press.
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Free clinics like Bread of Healing in Milwaukee and Open Arms Free Clinic in Walworth County serve as a final safety net for community members who can’t afford health care.
They are bracing for higher demand as more residents are expected to forgo insurance as a crucial tax credit is set to expire and premiums spike.
Clinic staff say they may need more resources to meet demand.
The U.S. Senate on Thursday rejected dueling plans related to helping people pay for plans on the federal marketplace.
Listen to Addie Costello’s story from WPR.
Editor’s note: This story has been updated to note the U.S. Senate’s rejection on Thursday of legislation to address the expected rise in health care premiums.
Cars filled the small parking lot outside of Milwaukee’s Cross Lutheran Church on a recent Monday afternoon. The church’s pews sat empty, but downstairs visitors waited around folding tables. Not to hear a sermon, but to see a volunteer physician.
Staff and volunteers walked patients past a row of dividers used to separate the “waiting room” from the folding tables where doctors and counselors filled out paperwork.
In front of the free health clinic’s four exam rooms, two phones rang.
“This is the Bread of Healing Clinic. Can you hold for a moment?” asked Diane Hill Horton, the free health clinic’s assistant.
Across from Hill Horton, another staff member scheduled an appointment in Spanish.
On a typical Monday, the clinic sees up to 30 patients. Bread of Healing treated 2,400 patients in 2024 across three clinics it runs in Milwaukee. Patients typically lack any health coverage and aren’t asked to pay for their visits.
“We don’t turn anyone away,” Hill Horton said.
Diane Hill Horton talks with a patient at the Bread of Healing Clinic, Nov. 24, 2025, in Milwaukee. (Jonathan Aguilar / Milwaukee Neighborhood News Service / CatchLight Local)
Dr. Greg Von Roenn talks with Dr. Barbara Horner-Ibler at the Bread of Healing Clinic, Nov. 24, 2025, in Milwaukee. (Jonathan Aguilar / Milwaukee Neighborhood News Service / CatchLight Local)
But without action from lawmakers in Washington, clinic staff worry that it will become harder to answer every call.
Free clinics like Bread of Healing serve as a final safety net for community members who can’t afford health care. They are bracing for higher demand as more residents are expected to forgo insurance as a crucial tax credit is set to expire and premiums spike.
Affordable Care Act premiums in Wisconsin will increase on average by 17.4% next year, a previous Wisconsin Watch analysis showed, with wide variation depending on age, income, family status and geography. Meanwhile, experts estimate more than 270,000 Wisconsinites rely on the enhanced premium tax credit to make insurance more affordable. It will expire at the end of the month without intervention.
People without insurance are less likely to get preventative care. Bread of Healing focuses on treating chronic conditions to prevent people from overwhelming emergency rooms, said Executive Director Erica Wright.
“If we don’t try our best to move with that demand, we’re not going to be able to see as many people, and there’s going to be a lot of folks falling through the cracks,” she said.
Wright oversees all three Bread of Healing locations. While the clinics have some room to take on more patients right now, she wants to significantly increase their capacity over the next year — adding money and volunteers to serve a possible “monsoon” of demand.
“We’re never going to be able to serve everybody, we know that,” Wright said. “But I don’t want it to be where our phones are ringing off the hook and we just can’t meet at least a good chunk of the demand.”
Executive Director Erica Wright is shown at the Bread of Healing Clinic in Milwaukee, Nov. 24, 2025. (Jonathan Aguilar / Milwaukee Neighborhood News Service / CatchLight Local)
Higher premiums and shrinking options
Ashley Bratz paid about $545 a month for a low-deductible marketplace plan this year. That same plan cost over $700 when she went to sign up for 2026.
Even with her job at Open Arms Free Clinic in Walworth County covering a portion of her health care costs, the only option in Bratz’s price range had deductibles higher than what she expects to spend.
“It’s supposed to be reasonable, and this is not reasonable,” Bratz said.
The names of clinic volunteers are shown on a board at Open Arms Free Clinic in Elkhorn, Wis., Dec. 2, 2025. (Addie Costello / WPR and Wisconsin Watch)
Bratz, who works as the nurse clinic coordinator, said she did not receive enhanced marketplace subsidies this year. Those who did will face a particular shock as the tax credit expires — while also confronting rising prices and shrinking options.
The income-based tax credits have lowered some marketplace enrollees’ monthly premium payments since they became available in 2014.
In 2021, the federal government expanded those subsidies, further bringing costs down for lower-income enrollees and extending smaller subsidies to people making over four times the federal poverty level — $62,600 a year for one person in 2025.
Without an extension, monthly premiums are expected to more than double on average nationally for subsidized enrollees, according to KFF, an independent source for health policy research.
A quarter of enrollees surveyed by KFF said they were “very likely” to go without insurance if their premiums doubled.
The U.S. Senate on Thursday rejected a Democratic plan to extend marketplace subsidies. Republicans, who have long criticized the Affordable Care Act (ACA), have instead called for a broader overhaul. The Senate also rejected a Republican plan that would have expanded access to high-deductible insurance plans and deposit $1,000 to $1,500 in enrollees’ health savings accounts — without renewing enhanced subsidies.
Sara Nichols, Open Arms Free Clinic executive director, is shown Dec. 2, 2025, in Elkhorn, Wis. (Addie Costello / WPR and Wisconsin Watch)
Sara Nichols, Open Arms Clinic executive director, is forging ahead regardless. When Bratz told her about her shrinking affordable coverage options, Nichols started working with an insurance broker to find a new plan for the clinic’s small team of paid staff.
“We cannot have health care workers not have health insurance,” Nichols said.
The move left Bratz relieved. Now she’s preparing to help more clients who can’t afford coverage or just need help navigating the complicated system.
They face challenges beyond lost subsidies and premium hikes. President Donald Trump’s “big” bill-turned law included additional changes to Medicaid funding and the ACA that are expected to increase the number of people without insurance by 10 million over the next decade, according to the Congressional Budget Office.
“We always take what is thrown at us and we figure out how to handle it,” Bratz said. “Do I think we could also use more help? Yes.”
Resources needed to meet demand
Open Arms Free Clinic is already seeing higher demand, Nichols said.
It operates a dental clinic five days a week, and she’s considering whether further demand would require opening its medical clinic for an additional day.
That would take more volunteers and money.
While the Legislature sent state dollars to free clinics in its latest budget, private grants and donations have been harder to secure this year, Nichols said. She expects the clinic will have to get even leaner next year.
But she won’t start turning patients away.
The clinic provides dental, medical and behavioral health to low-income people who live and work in Walworth County. Its 250 volunteers help with things like translating, nursing, greeting patients and connecting people to the clinic. They also provide vision and pharmacy services.
“I know that we have enough smart people and kind people that we’re going to come up with a solution to anything that comes up,” Nichols said.
Steven Thompson counts out a patient’s medication at the Bread of Healing Clinic, Nov. 24, 2025, in Milwaukee. (Jonathan Aguilar / Milwaukee Neighborhood News Service / CatchLight Local)
This is far from the first time Wisconsin’s free clinics have faced big changes, said Dennis Skrajewski, the executive director of the Wisconsin Association of Free and Charitable Clinics.
Free clinics adapted to the COVID-19 pandemic, operating with fewer volunteers and switching to telehealth services and opening vaccine programs, Skrajewski said. Then clinics prepped for increased demand in 2023 after Medicaid unwinding.
“We’re used to waking up and the world changed yesterday, so we’ll adjust,” Skrajewski said.
Wisconsin’s free and charitable clinic association is collaborating with other safety net health providers as part of the Wisconsin Owns Wellbeing initiative, which will host statewide planning meetings to strengthen the state’s safety net services.
Clinic co-founder: ‘I just wish it weren’t needed’
Rick Cesar started working as a parish nurse at Cross Lutheran Church in the 1990s. He took people’s blood pressure at a weekly food pantry and ran an HIV testing site and needle exchange out of the church’s basement.
He helped co-found the Bread of Healing Clinic in 2000, a decade before the ACA passed.
“There were so many people that had no coverage,” Cesar said.
An exam room is shown at the Bread of Healing Clinic in Milwaukee, Nov. 24, 2025. (Jonathan Aguilar / Milwaukee Neighborhood News Service / CatchLight Local)
Brochures sit on shelves at the Bread of Healing Clinic in Milwaukee, Nov. 24, 2025. (Jonathan Aguilar / Milwaukee Neighborhood News Service / CatchLight Local)
Demand for free services persisted even after more people enrolled in marketplace plans. The clinic expanded to two other locations and hired paid staff. Cesar retired from nursing in 2019 but still regularly volunteers. He feels proud watching the clinic grow.
“I just wish it weren’t needed,” he said.
The clinic is adaptable, Cesar said, whether it’s responding to a pandemic with vaccine drives or helping clients navigate ACA changes.
“We’re going to be here and do as much as we can,” Cesar said. “But those resources, you never know how long they are going to last when the demand is so great.”
Looking for a free clinic?
Find a map of free or charitable clinics near you at wafcclinics.org.
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