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Nursing Homes in Wisconsin
The state of Wisconsin is known for its beer and cheese, but for those who call the state home, it is much more than that. Wisconsin has beautiful bluffs, dells and hills to explore, lakefront cities that take advantage of the waterfront and the excellent health care options of the University of Wisconsin hospital system, which is the state’s top-ranked hospital for senior care. These perks make it appealing for Wisconsin residents to retire in the state. The 2019 population estimate for Wisconsin is 5,822,434 people, and 17.5% of the population is aged 65 and older.
Nursing home care offers skilled nursing services at all times for medically frail seniors. The average cost for nursing home care in the state is $8,684 for a semiprivate room and $9,429 for a private room, according to the 2020 Genworth Cost of Care Survey. Wisconsin retirees who need nursing home care have 355 nursing homes to choose from. A Medicaid program that puts the choice of care in the hands of the senior and the senior’s family makes Wisconsin an appealing place to retire. This guide can help seniors understand those options and how to use Medicaid to pay for nursing care.
The Cost of Nursing Home Care in Wisconsin
The cost for nursing home care in Wisconsin is right in the center of the states around it. For services in a semiprivate room, Wisconsin residents pay an average of $8,684 a month, according to the 2020 Genworth Cost of Care Survey. This is significantly less than the cost in Minnesota of $11,026. It’s also less than Michigan’s cost of $8,973. However, Illinois, with a cost of $6,235 a month, and Iowa, with a cost of $6,570 a month, are both significantly lower than the Wisconsin average. The national average of $7,756 a month is less than the Wisconsin average.
Seniors will find that the cost of nursing home care varies within the state as well. Both the amenities of the community and its location can impact the cost of care. The state average of $8,684 is similar to the average in the Wausau area, which is $8,851 and La Crosse, which is $8,144. Janesville, near the Illinois state line, has the highest cost, at $9,612, while Eau Claire comes in lowest, at $7,756. Fond du Lac averages $7,902, while Milwaukee comes in much higher, at $9,429. In Appleton, seniors pay around $8,502 for nursing home care.
Eau Claire
$7756
Fond du Lac
$7902
La Crosse
$8144
Appleton
$8502
Wausau
$8851
Milwaukee
$9429
Janesville
$9612
Not all seniors who need assistance will choose nursing home care. The average cost for a semiprivate room in Wisconsin is $8,684, while seniors who prefer a private room pay about $800 more a month. The most affordable care option is adult day care, which averages $1,322 a month. Seniors who choose to get a little extra help in an assisted living facility can expect to pay around $4,400 a month. For both home care and home health care, the monthly state average is $4,957.
Nursing Home Semiprivate Room
$8684
Nursing Home Private Room
$9429
Adult Day Care
$1322
Assisted Living Facility
$4400
Home Care
$4957
Home Health Care
$4957
Does Medicaid Cover Nursing Home Care in Wisconsin?
In Wisconsin, the 1.288 million residents currently enrolled in Medicaid/CHIP includes 8,515 seniors ages 65 and older. Recipients who live in nursing homes have the cost of their room and board covered as well as their medical supplies, medicines, social services and medical care. Specific medical services provided by therapists or specialists are also included in Medicaid coverage.
A percentage of seniors living in each of the 348 nursing homes located throughout Wisconsin receive Medicaid assistance, along with 24/7 care and attention. Wisconsin’s Medicaid State Plan, administered by the Wisconsin Department of Health Services, provides coverage for care, including medically necessary supplies, prescriptions and transportation to other health care providers, such as dentists or ophthalmologists. Those seniors wanting to remain at home or in their communities while receiving skilled nursing may qualify for other Wisconsin Medicaid programs such as Family Care and the Program of All-Inclusive Care for the Elderly.
Medicaid Eligibility in Wisconsin
Qualifying for Medicaid requires meeting specific income and medical criteria. Applicants must provide details regarding all forms of income for themselves and their spouses, even if only one is seeking coverage. A financial assessment is included as part of the application process.
Limits for income and assets are fixed and dependent on whether one or both spouses are applying. For a single applicant, income is limited to $32,904 per year, with an asset limit of $2,000 during the same time period. In a two-person household where only one person is applying, the income limit is the same, as is the asset limit for the applicant. The non-applicant spouse, however, is able to retain up to $148,620 in assets through the Spousal Impoverishment Act. In cases where both spouses seek coverage, the income limit increases to $65,808 and the asset limit to $4,000.
2022 Medicaid Income Limits for Seniors in Wisconsin
| Household Size | Number of Applicants | Income Limits Per Year* | Asset Limits: Applicant(s) | Asset Limits: Non-Applicants |
|---|---|---|---|---|
| One Person | 1 | $32,904 | $2,000 | |
| Two Person | 1 | $32,904** | $2,000 | $148,620 |
| Two Person | 2 | $65,808 | $4,000 |
*Except for a $45/mo. personal needs allowance, Medicare premiums and possibly a spousal income allowance for a non-applicant spouse, all of a recipient's monthly income must be put toward the cost of nursing home care.
**Income limit is for applicant only.
Additional non-financial requirements include proof of U.S. citizenship and state residency.
How to Apply for Medicaid in Wisconsin
To submit a Medicaid application, seniors or caregivers can visit the ACCESS Wisconsin site, create an account and complete the online application. Other ways to apply include calling the local county agency, printing and mailing the application packet or going in person to the local agency, where a worker will help applicants complete a paper or virtual application. All paperwork needs to be prepared prior to starting the application. Once submitted, application results take 30 days. A follow-up pre-hearing conference is encouraged for any application where benefits are denied, reduced or ended.
Information You Will Need:
- State driver’s license, valid U.S. passport, Native American tribal enrollment document or other proof of identity
- Copy of birth certificate, adoption papers, or military, hospital or other record showing proof of U.S. birthplace
- Tribal enrollment card, tribal census or other document proving tribal membership or Native American / Alaska Native Descent
- Bank statements, financial records and all other documents showing total assets for 60 months before date of application
- Life insurance policies
- Deeds, contracts or titles
- Pension, Social Security and all other retirement income for previous 60 months
- Lease, rental agreement or mortgage receipt showing current address before date of application
- Final will, trust or power of attorney documents, if applicable
- Any other documentation applicant believes may support their claim
Additional Medicaid Support & Resources in Wisconsin
Below is a list of contact information and free resources that may help make the Medicaid application process easier to navigate and less convoluted for families.
| Resource | Contact | Service |
|---|---|---|
| Aging & Disability Resource Centers | Varies by County | Operating in every county across the state, Aging and Disability Resources Centers can help families apply for Medicaid both in person and over the phone. They provide information about long-term care, including specifics regarding Medicaid financial requirements, the lookback period and exclusion forward. |
| American Council on Aging | Online Only | In addition to covering all aspects of Medicaid planning, the American Council on Aging offers a prescreening eligibility test that tells families their projected eligibility status. A comprehensive question and answer section, detailed pages on state-specific eligibility and estate planning help are available to help families understand the process and plan ahead. |
| Benefits.gov | (800) 362-3002 | Providing basic information about Medicaid eligibility by state, Benefits.gov is a federal website that delivers general information about income limitations and eligibility requirements. Links are included to sites where additional information about Medicaid and the application can be found. |
Does Medicare Cover Nursing Home Care in Wisconsin?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it’s most valuable for those who are recovering from an injury, illness or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers a number of specific services, including:
- Meals
- A semiprivate room
- Medications
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn’t Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors’ day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Resources and Support in Wisconsin
A form of federal health insurance available to those 65 and older, Medicare cannot cover the cost of nursing home care. However, it can cover the cost of medical supplies or doctor services to seniors living in a nursing home. Medicare may also help pay for some aspects of medical care during the Medicaid application process and waiting period or while seniors are still living at home before locating a suitable nursing home. Trained support staff are available for each given resource to give information and advice specific to families’ unique circumstances.
| Resource | Contact | Service |
|---|---|---|
| SHIP | (800) 242-1060 | The State Health Insurance Assistance Program (SHIP) is a federally funded program that provides education and information about all aspects of Medicare, including eligibility, benefits and claims. Toll-free hotlines are available for general counseling. Families are given unbiased suggestions and advice for choosing the best health insurance options, with comparisons of Medicare, Medicaid and long-term care insurance available. |
| BenefitsCheckUp | (800) 794-6559 | A free service offered by the National Council on Aging, BenefitsCheckUp lets families learn whether their loved one qualifies for Medicare, Medicaid or other forms of health care assistance by completing a short series of questions. Results are tailored to meet specific needs, based on answers submitted, and applicants have access to a toll-free hotline for assistance answering questions or about results. |
| Medicare.gov | (800) 633-4227 | The official website for the federal health care program, Medicare.gov helps families navigate the Medicare application process. Ranging from basic information such as a cost overview and how to get started to more in-depth resources comparing health plans and providing support while filing claims, Medicare.gov offers round-the-clock information for families and elders. A live, 24/7 chat and toll-free number are available for questions about claims, logging in and other general assistance. |
Other Financial Assistance Options for Nursing Home Care in Wisconsin
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
| Name | How To Apply | How It Works |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov | If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be able to use it to pay for skilled nursing care. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not typically be eligible to sign up for a LTC insurance policy. |
Free and Low-Cost Resources for Seniors in Wisconsin
There are many resources in Wisconsin that assist seniors in their retirement. Caring.com has compiled information on local organizations, programs and agencies and categorized them into care types for easy reference.
Area Agency on Aging
Retirees can find support and advice on various senior-related issues from their local Area Agency on Aging. The agency provides advice on topics such as financial assistance programs, in-home care and long-term care planning. It also connects seniors and caregivers with community-based resources.
| Program Name | Phone Number | Description |
|---|---|---|
| Wisconsin Area Agencies on Aging | Wisconsin's Area Agencies on Aging handles medical and nonmedical needs for older adults. From Medicare counseling and elder nutrition programs that offer meal delivery to homes and senior dining centers where older adults can access meals Monday through Friday along with other health and nutrition support services, these programs help seniors age at home. AAA services also include caregiver assistance, prescription drug help and fall prevention programs to keep older adults in Wisconsin safe and healthy. |
Cash Assistance Programs
Cash assistance programs in Wisconsin provide financial support to help low-income retirees remain in their own homes for as long as possible. Seniors and caregivers can apply for tax rebates and reductions, discounts on vital services and help covering the cost of heating and cooling their home.
| Program Name | Phone Number | Description |
|---|---|---|
| Wisconsin Lifeline Program | 800-234-9473 | The LifeLine Program offers a discount on landline or mobile telephone service, ensuring that participants can stay in contact with loved ones. |
Food Assistance Programs
Local organizations help ensure elderly citizens have a balanced diet and receive essential vitamins and minerals to remain healthy. Through nutrition programs, congregate meals, home-delivered meals and food pantries, these programs help Wisconsin seniors afford the nutritious food they need.
| Program Name | Phone Number | Description |
|---|---|---|
| Wisconsin Meals on Wheels | Wisconsin Meals on Wheels supports seniors in communities statewide by offering nutritious meals, supportive services and safety checks. Seniors must be 60 or over or disabled to be eligible, and meals are provided in a congregate setting or via home delivery for those who aren't mobile. Pricing varies depending on circumstances, and some clients qualify for free meals. Seniors may also access varying support services, including emergency meal delivery during bad weather, pet food delivery and transportation to medical appointments. | |
| Wisconsin Elderly Nutrition Program | 608-266-3746 | The Wisconsin Elder Nutrition Program provides home-delivered meals and senior dining options for residents 60 and older. Hundreds of senior dining centers throughout the state offer qualifying Wisconsinites a space to eat, learn about nutrition and engage with other older adults. A locator allows residents to find the dining centers closest to them. To receive home-delivered meals, seniors undergo an evaluation via an at-home visit, and those who qualify can receive fresh or frozen entrees brought right to their doorsteps. |
| Wisconsin FoodShare | 800-362-3002 | The primary government assistance program in Wisconsin for nutritional needs is the Supplemental Nutrition Assistance Program (SNAP), called Food Share. It gives families in need of help the ability to purchase food at their neighborhood grocery stores and, in some cases, restaurants and convenience stores. |
Health Insurance & Prescription Drug Coverage for Seniors
Wisconsin seniors who meet certain income criteria can apply to local resources to help them pay for prescription drugs. Eligible residents can also receive assistance through health insurance and other programs to access free or discounted medical services.
| Program Name | Phone Number | Description |
|---|---|---|
| Wisconsin SeniorCare Prescription Drug Assistance Program | 800-657-2038 | SeniorCare subsidizes prescription drug costs for qualifying Wisconsin seniors, covering most medically necessary drugs with only a $5 copay. For coverage, a drug manufacturer must make a rebate agreement with the SeniorCare program. It may require you to use a generic drug rather than a brand name. If you want to make a special request for a brand-name drug, you may appeal for an exception. More that 95% of Wisconsin's pharmacies accept the SeniorCare card. |
Legal Resources
Many organizations offer free or low-cost legal services to Wisconsin seniors. Older adults can access advice on issues such as estate planning, living wills and power of attorney. Some firms also act as long-term care ombudsmen, advocating for the rights of seniors in senior living communities.
| Program Name | Phone Number | Description |
|---|---|---|
| Wisconsin Long Term Care Ombudsman Program | 800-815-0015 | The long-term care ombudsman advocates for Stoughton seniors in memory care facilities and helps to ensure that they get the scope of care they're entitled to under state rules. Individuals can contact the ombudsman for help with researching memory care facilities in Stoughton and finding ways to pay for services. The ombudsman can also help facilities identify solutions for gaps in residents' care resulting from challenges related to dementia. |
Senior Engagement
Senior engagement resources and programs in Wisconsin help older adults remain active and ensure they contribute to the community. Resources include wellness programs, volunteer opportunities, support groups and organizations that help residents connect with the community to live fulfilling lives.
| Program Name | Phone Number | Description |
|---|---|---|
| Wisconsin Senior Employment Program (WISE) | The Wisconsin Senior Employment Program, also known as the Senior Community Services Employment Program, is available to legal residents aged 55 or older. It offers part-time (subsidized) work to seniors who fall within a specific income range and are currently unemployed. Work placements are often in not-for-profit or government agencies. While the added income is a perk, seniors can also form new friendships and gain skills. Residents can apply via their respective counties. | |
| Alzheimer's and Dementia Alliance of Wisconsin (ADAW) | 888-308-6251 | The Alzheimer's & Dementia Alliance of Wisconsin offers education, personal services and family support for individuals impacted by memory loss. The nonprofit can provide care consultations, resource referrals and educational programs. It also hosts social programs and peer support groups for individuals diagnosed with Alzheimer's. |
| Alzheimer's Association Wisconsin Chapter | 800-272-3900 | The Wisconsin chapter of the Alzheimer's Association provides in-home options counseling to help seniors and families navigate the system and make informed decisions regarding residential memory care services. The chapter has in-person and virtual support groups and early-stage engagement activities to help individuals build social connections and gain practical advice. |
| Wisconsin Memory Screening | 608-266-2536 | Provided by Wisconsin's Department of Health Services, memory screening is available in communities throughout the state to improve early diagnosis. Screening also gives families an opportunity to connect with community-based programs and supports and find early intervention programs. |
| Wisconsin Alzheimer's Institute | 414-219-5083 | The Wisconsin Alzheimer's Institute conducts research initiatives, educational programs and clinical care services to support individuals impacted by Alzheimer's and dementia. In addition to its public health programs and community engagement efforts, the organization sponsors the development of memory clinics across the state to ensure Wisconsinites have access to the care services they need. |
Medicaid Resources
Navigating the Medicaid system is often difficult and confusing. Several Wisconsin resources help older adults by providing advice on Medicaid options, waiver programs and eligibility criteria to help seniors receive the right health care benefits.
| Program Name | Phone Number | Description |
|---|---|---|
| Wisconsin Family Care | 608-266-1865 | Family Care is a home- and community-based waiver program that helps cover the costs of care services disabled adults need at home or in long-term care settings, such as Community-Based Residential Facilities. Two methods deliver services covered by Family Care: aging and disability resource centers throughout the state and managed Financial Assistance for Senior Living & Senior Care care organizations serving different counties and regions. The program intends to keep disabled seniors in their own homes or communities rather than in the state's licensed nursing facilities, improving outcomes and costs for everyone. |
| Wisconsin Include, Respect, I Self-Direct Program | 888-515-4747 | This program, known as IRIS, gives you the power to direct Medicaid funds toward your choice of care options received at home and in the community. You can use your budget to pay for the following services: • Adaptive and communication aid • Counseling and therapy • Daily living skills training • Emergency response systems • Home-delivered meals • Home modifications • Personal care services • Skilled nursing services • Transportation There is no cost to any of these services if your income is low enough unless you exceed your budget. If your income is high enough, the program may expect you to pay a cost-share for services, which it will include in a monthly bill. |
Social Security Offices
Social Security offices in Wisconsin help seniors and disabled people access the benefits they're entitled to. Older adults can contact their local office for information about receiving retirement benefits, disability allowance and Supplemental Security Income.
| Program Name | Phone Number | Description |
|---|---|---|
| Wisconsin Social Security | Social Security is a source of income available to retirees and people who can no longer work because of a disability. The money for Social Security comes from a payroll tax levied on employers, employees and self-employed individuals. When you retire, you'll receive monthly payments based on how much you earned when you were working. |
Tax Assistance
Seniors can apply for tax assistance from several Wisconsin resources. Elderly residents and those with disabilities could be eligible for tax exemptions on medical expenses, reductions on property tax and other tax assistance programs.
| Program Name | Phone Number | Description |
|---|---|---|
| Wisconsin Homestead Credit | 608-266-2486 | The Department of Revenue provides a property tax credit up to $1,168 for qualifying homeowners. The amount of your credit depends on your income and the number of dependents living in the home. |
Utility & Energy Bill Assistance
Low-income seniors who are struggling to meet the costs of maintaining their homes can find support from organizations that offer assistance with utility and energy bills. Wisconsin retirees could also qualify for emergency funding programs if they're in danger of losing utility services due to unpaid invoices.
| Program Name | Phone Number | Description |
|---|---|---|
| Wisconsin Home Energy Assistance Program (WHEAP) | 866-432-8947 | The Wisconsin Home Energy Assistance Program provides funds for low-income households in the state that need help paying their heating and cooling bills. It offers benefits on a long-term basis and in crisis situations. To qualify, households must earn 60% or less of the state median income. Meeting this income requirement doesn't guarantee the household will receive benefits as the program has limited funding. |
Veteran's Services
Wisconsin retirees who have served in the U.S. military can find support from local veteran services. These offices and organizations help vets access the benefits they're eligible for and provide advice and information on a variety of issues.
| Program Name | Phone Number | Description |
|---|---|---|
| Wisconsin VA Benefits and Health Care | The Wisconsin VA Benefits and Health Care options for veterans ages 65 and older are available at locations throughout the state, including medical centers in Madison, Milwaukee and Tomah and outpatient clinics, community-based programs and vet centers in many cities and rural areas. Seniors can access different types of assistance, such as the specially adapted housing program that helps older vets stay in their homes with modifications and additional monthly funding to pay for in-home care. | |
| Wisconsin Veterans Home at Union Grove | 800-947-8387 | Wisconsin Veterans Home in southeastern Wisconsin provides senior veterans with affordable residences and comprehensive nursing services. Its range of medical services includes doctors' visits, social worker care, medical transportation and skilled nursing. |
Nursing Home Laws and Regulations in Wisconsin
| Topic | Rule |
|---|---|
| Licensing Requirements | Nursing homes are licensed as skilled nursing facilities or intermediate care facilities through the Department of Health Services. Licenses are valid for one month, at which time the nursing home must submit a report to the DHS to renew the license. |
| Staffing Requirements | Wisconsin regulations indicate the total number of hours of nursing care each resident must receive. In a nursing home where skilled nursing care is needed, the facility must have enough nurses on staff to provide 2.5 total hours of care per resident. In intermediate nursing care facilities, the hours drop to 2.0. Of that care, 20% must come from licensed nurses.Nursing homes are required to employ a charge nurse who is a licensed practical nurse operating under a physician or professional nurse’s authority. The charge nurse can also be a professional nurse (RN). |
| Staff Training Requirements | Before starting their jobs, all new employees in nursing homes need to have orientation and safety training. All employees must receive residents' rights training before they reach 30 days of employment for the nursing home.All nursing homes must provide a nursing in-service from time to time to help their staff members gain important skills. Dietary in-service programs are also required on occasion. |
| Admission Restrictions | Nursing homes may not admit more residents than their maximum bed capacity. They also may not admit residents who need care greater than the care they are licensed to provide. If a resident needs services the facility cannot make available, that resident cannot be admitted. |
| Care Planning Requirements | Nursing home staff must create personal care plans presented in writing within the first four weeks of admission and must include assessments from all appropriate professionals and the orders from the patient’s physician. These plans have to be reviewed and updated as needed, but no set review timetable is required. |
| Dietary and Nutritional Services Requirements | SNFs in Wisconsin must provide food that is nourishing, palatable and well-balanced. Meals have to be planned with the help of a dietitian. The facility must also have a director of food services.Menus should provide a variety of foods to accommodate different tastes and eating habits. Meals must be served in a dining room at a table for all residents who can eat this way. Any resident confined to bed is required to have a covered pitcher of drinking water available at all times. |
| Specialized Rehabilitative Services | All specialized rehab services must be either provided on-site or arranged for with an outside facility. All rehabilitative treatment is reported to the resident’s physician within two weeks of the start of therapy. |
| Medication and Pharmaceutical Services | Nursing homes must have arrangements with a pharmacy to get medication for residents. In addition to the required daily medications, SNFs can have a contingency supply of medication for 10 days or less. Medications are labeled with the patient's name, dosage, expiration date and directions for use. |
| Activities Requirements | Wisconsin nursing homes are required to have activities programs designed to meet the interests and needs of residents, but the law doesn't define specific activities requirements. |
| Infection Control Requirements | The state requires its nursing homes to report suspected communicable diseases to their local health officer. All nursing homes must have a plan to manage residents who have communicable diseases based on the current best standards of practice. |
| Medicaid Coverage | Wisconsin offers Medicaid to residents who meet specific income requirements, and it may cover nursing home care. To qualify for Medicaid coverage for a nursing home, Wisconsin seniors must be eligible based on the Adult Long-Term Care Functional Screen. |
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