Assisted Living Wisconsin

Single Applicant

$17,131

$2,000

Two-Person Household

(Only One Person Applying)

$23,169

$2,000 for applicant

$137,400 for non-applicant

Two-Person Household
(Both People Applying)

$23,169

$3,000 for regular Medicaid

$4,000 for a Medicaid waiver

Ombudsman Program 

(800) 815-0015

The local Long-Term Care Ombudsman Program serves as an impartial third party regarding denied Medicaid applications or claims for prescription drug coverage. It can help you determine why Medicaid denied you coverage and how you should reapply. Individuals can contact the ombudsman if Medicaid refuses to cover necessary medications.

Wisconsin Medicaid

(800) 362-3002

The Wisconsin Medicaid site has all the details for everything you need to know about applying for Medicaid or the Family Care Waiver in Wisconsin. You'll find details and contact information on all 11 different Medicaid plans available in Wisconsin.

Covering Wisconsin

(608) 261-1455

Covering Wisconsin, a federally certified and state-licensed entity, offers free expert help with health insurance questions in Wisconsin. This includes questions about how to enroll in Healthcare.gov or Medicaid in Wisconsin. If you have questions, you can call one of Covering Wisconsin's navigators for assistance.

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 Assisted Living.

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 Assisted Living. 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 Assisted Living. 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 Assisted Living will not typically be eligible to sign up for a LTC insurance policy.

Aging and Disability Resource Centers

(608) 266-1865

You'll find free, unbiased and accurate answers to many of your questions at the local Aging and Disability Resource Center (ADRC), including nursing and housing options, transportation, Medicare, Medicaid and home-delivered meals programs.

Wisconsin Department of Veterans Affairs

(608) 266-1311

Wisconsin offers assisted living for senior veterans and their spouses in three veterans' homes throughout the state. These homes provide assisted living within a broader community and include help with ADLs, medication administration and skilled nursing care if needed.

Long-Term Care Ombudsman

(800) 815-0015

In Wisconsin, long-term care ombudsmen are specially trained volunteers who advocate for seniors in conflicts with assisted living facilities. When an ombudsman receives an alleged complaint of neglect or abuse from a senior or caregiver, they investigate the allegation. When their investigation is complete, they attempt to resolve the conflict between the senior and the facility. Ombudsmen also advise seniors on billing issues, questions about Medicaid or Medicare and where they can find resources in their community. They also act to educate the broader community about the rights of seniors in long-term care facilities.

Legal Assistance for Older Adults

(608) 266-1865

If you live in Wisconsin, are aged 60 or older and need information, advice, or legal representation, contact an elder benefit specialist at your local ADRC. Benefit specialists give free, confidential counseling and advocacy on a wide range of services, including Medicare, Medicaid, senior care, Supplemental Security Income (SSI), debt collection, housing and utilities, evictions, tenant rights, and financial assistance programs.

State Health Insurance Assistance Program (SHIP)

(608) 266-1865

Seniors often have questions about applying for Medicare. The trained volunteers of Wisconsin's SHIP program can answer these questions. They provide free, confidential advice on all of Medicare's programs, including Original Medicare, Medicare Advantage, Medigap, Part D Prescription Plans and Long-Term Care Insurance. They work with seniors or their caregivers. Appointments with SHIP counselors can happen in person or over the phone, and they do not work for any commercial health care company.

Are loved ones allowed to visit to provide emotional support?

Are relatives allowed to visit for end-of-life care?

Are residents required to quarantine after visiting with a loved one?

Are visitors required to wear PPE (including masks) in order to visit residents?

Are non-medical contractors (such as hairdressers and entertainers) allowed in senior living facilities?

Are visitors checked for elevated temperatures?

Are visitors required to answer questions about health, travel, and potential virus contact?

Are residents allowed to leave (errands, visiting family, etc.) for non-medical reasons?

Are residents who leave required to quarantine when they return?

Are senior living communities required to cancel all group outings?

Are residents allowed to eat meals together in a common area?

Are residents allowed to gather in common areas for group activites?

Are staff members regularly required to do a temperature check?

Are staff members regularly tested for COVID-19?

Are staff members members regularly required to do a health and safety screening, including questions about travel, contact with positive cases, etc?

Are residents regularly screened for COVID-19 symptoms?

Are residents regularly checked for elevated temperatures?

Are residents regularly tested for COVID-19?

Assisted Living Service Plan Requirements

All prospective residents in a CBRF are assessed for their physical and mental conditions and abilities before admission.

The facility must then develop a temporary service plan to address the resident's immediate needs and a comprehensive plan within 30 days of admission. Reassessments are performed annually or anytime a resident has a change in condition.

RCACs perform similar evaluations.

Assisted living admission requirements

CBRFs are licensed to accept terminally ill residents or those who may have dementia, developmental or physical disabilities, brain injuries, AIDS, a history of drug abuse or alcohol abuse or mental health issues. CBRFs can only admit four residents at a time who require three or more hours of weekly nursing care. They cannot accept seniors who have needs that the facility cannot meet or are a danger to themselves.

RCACs can admit more independent seniors. However, a senior who wishes to live alone cannot be determined by a court to be incompetent, subject to guardianship or incapable of recognizing danger or summoning help.

Assisted living scope of care

CBRFs are required to provide:

• Leisure activities
• Supervision information and referral services
• Transportation
• Health monitoring
• Dementia activities
  
  
• ADL care
• Independent living skills
• Medication assistance and administration
• Behavior management

RCACs must provide at a minimum:

• Housekeeping
• Personal services, including assistance with ADLs
• Health monitoring
• Nursing services, if needed
• Medication administration

RCAC must also provide 24-hour emergency services.

Assisted Living Medicaid Policy

Wisconsin's Medicaid program provides waiver options for seniors who qualify for nursing care but don't require the intensive care setting it provides. Waiver participants can't be charged more than the current Social Security Insurance federal benefit rate and SSI-E disbursement for room and board.

Wisconsin allows family supplementation for room and board fees, private rooms and additional services.

Not all facilities accept Medicaid as a form of payment. Contact your prospective assisted living facility for its policy.

Assisted Living Facility Requirements

All assisted-living facilities in Wisconsin have minimal faculty requirements concerning occupancy, showers, bathrooms and sinks.

CBRFs can offer private or double-occupancy rooms with a shared bathroom. Smaller and medium facilities must have one bathroom and shower for every eight residents. Larger facilities must have at least one toilet, bath and shower for every eight residents of each gender.

RCAC apartments must be independent of all other units and have lockable doors. Only a resident's spouse or a roommate of their choosing can live with them in the apartment. The apartments must have a separate kitchen that includes a microwave or stove. Units also require a sleeping and living area, although they don't need different rooms. Every department needs a bathroom with a door, toilet, sink and shower or tub.

Medication Management Regulations

Residents of CBRFs found capable by their physicians can self-administer medications. Trained staff members may administer medication for other residents under the supervision of a registered nurse, a nurse practitioner or a pharmacist.

Residents of RCACs will administer their medications or have them administered by trained staff who are supervised by a registered nurse or pharmacist.

Staffing Requirements

There is no minimal staff to resident ratio in a CBRF in Wisconsin, but the facility must employ enough personnel to meet residents' needs over 24 hours. The facilities need to have at least one qualified staff member on duty whenever residents are present. One staff member needs to be awake and on duty overnight whenever any resident has intermittent care needs or cannot evacuate the facility within four minutes.

RCACs need to have enough staff to meet all planned and unplanned needs of the residents. They also need a service manager to ensure that each resident's needs are met.

Staff Training Requirements

Wisconsin requires each CBRF facility to provide orientation training to every employee before hiring. This training includes their job responsibilities, facility policies, medication management for residents, residents' rights, dealing with changing behaviors and reporting abuse.

Direct care staff must be trained in assessing the needs of each resident, how to develop a service plan and how to provide personal care. CBRF administrators must receive 15 hours of relevant continuing education each year.

RCAC staff need to be trained in fire safety, first-aid, resident's rights and the emergency plan for the facility.

Direct care staff need to be trained in the characteristics of aging within the RCAC's population, their assigned responsibilities and the philosophy and purpose of assisted living.

Background Checks for Assisted Living Staff in Wisconsin

CBRFs need to conduct background checks on all employees before hiring and every four years after that. They cannot employ anyone convicted of certain crimes. RCACs must perform a background check on all employees or caregivers directly in contact with residents. They need to use the Wisconsin Department of Justice and state registries.

Requirement for reporting abuse

If you believe a facility has not lived up to its responsibilities, contact the Long-Term Care Consumers Board or the Long-Term Care Ombudsman.

If you or someone you love has been abused, call Wisconsin's Victim Resource Center at (800) 446-6564. If that abuser is a caregiver, contact the office of caregiver quality at (608) 261-8319.