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.
The United States
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.
Fond du Lac
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
Nursing Home Private Room
Adult Day Care
Assisted Living Facility
Home Health Care
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 $30,267 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 $137,400 in assets through the Spousal Impoverishment Act. In cases where both spouses seek coverage, the income limit increases to $60,552 and the asset limit to $3,000.
2022 Medicaid Income Limits for Seniors in Wisconsin
Annual Income Limits
(Only One Person Applying)
$2,000 for applicant
$137,400 for non-applicant
(Both People Applying)
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.
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.
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.
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:
- A semiprivate room
- 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.
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.
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.
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.
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.
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
Finding appropriate nursing home care can be a challenging experience for many. To simplify the process and make the transition a smoother one, a number of free and subsidized resources exist in Wisconsin to help families.
For elders 65 and older, Senior Care Prescription Drug Assistance can help contribute to drug costs. Applicants must be Wisconsin residents and U.S. citizens or have a qualifying immigrant status. The program has three levels, each with its own income limitations. For example, to qualify for Level 1, individual applicants must earn no more than $21,744 per year. Seniors 65 and older can apply anytime, and recipients pay an annual $30 fee.
Staffed by specially-trained volunteers, Wisconsin’s Long-Term Care Ombudsman program advocates for seniors and their caregivers with nursing homes and community-based residential facilities, resolving complaints ranging from dietary needs and financial issues to denial of community services and physical abuse. Ombudsmen meet with elders and families to discuss their concerns, then work directly with facilities to resolve issues.
This Medicaid-waiver long-term care program for seniors who need skilled nursing provides care and support to help them live safely and with dignity at home. Family Care services may include skilled nursing, occupational / physical therapy and home-delivered meals.
The Respite Care Association of Wisconsin offers resources for caregivers, including training courses in caregiving. Grant programs, including the Caregiver Respite Grant Program and Supplemental Respite Grant Program, support caregivers financially with days off and direct financial assistance. To qualify, applicants must have either been denied supports or other programs or they must not have received a Long-Term Care Waiver within 30 days. Applications include a Eligibility Criteria Form, which requires supporting documentation from the applicant's local ADRC.
COVID-19 Rules for Nursing Homes in Wisconsin
The following information is based on research done on several government websites, including dhs.wisconsin.gov/covid-19. These rules apply to Independent Living Communities and other types of senior living facilities. We’ve most recently updated this data on 2/15/2022, but since COVID-19 is a rapidly evolving pandemic, contact your local senior living facility or Area Agency on Aging for more specific and up-to-date information.
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?
Outings & Social Activities
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?
*Note: This information was not available for this state, contact your local area agency on aging or senior living facility for more information.
COVID-19 Safety Measures for Staff and Residents
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?
Nursing Home Laws and Regulations in Wisconsin
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.
Nursing Homes Facilities in Wisconsin (82)
- Altoona, WI (3)
- Amery, WI (2)
- Appleton, WI (8)
- Ashland, WI (2)
- Beaver Dam, WI (3)
- Beloit, WI (3)
- Black River Falls, WI (2)
- Bloomer, WI (4)
- Brookfield, WI (4)
- Cedarburg, WI (2)
- Chippewa Falls, WI (3)
- Clintonville, WI (3)
- Delavan, WI (2)
- Dodgeville, WI (3)
- Eau Claire, WI (3)
- Elkhorn, WI (2)
- Fond Du Lac, WI (7)
- Glendale, WI (3)
- Green Bay, WI (9)
- Greendale, WI (2)
- Greenfield, WI (3)
- Hayward, WI (2)
- Hurley, WI (2)
- Janesville, WI (4)
- Kenosha, WI (8)
- La Crosse, WI (4)
- Ladysmith, WI (3)
- Lancaster, WI (2)
- Madison, WI (8)
- Manitowoc, WI (6)
- Marshfield, WI (3)
- Menomonee Falls, WI (3)
- Menomonie, WI (3)
- Merrill, WI (2)
- Middleton, WI (2)
- Milwaukee, WI (18)
- Monroe, WI (2)
- Muskego, WI (2)
- New Holstein, WI (2)
- New Richmond, WI (3)
- Oconomowoc, WI (2)
- Oconto Falls, WI (2)
- Oneida, WI (2)
- Oshkosh, WI (5)
- Osseo, WI (2)
- Peshtigo, WI (2)
- Platteville, WI (2)
- Plymouth, WI (3)
- Racine, WI (3)
- Reedsburg, WI (3)
- Rhinelander, WI (2)
- Rib Lake, WI (2)
- Rice Lake, WI (2)
- Richland Center, WI (2)
- Ripon, WI (3)
- River Falls, WI (2)
- Shawano, WI (5)
- Sheboygan, WI (7)
- South Milwaukee, WI (2)
- Sparta, WI (2)
- Spooner, WI (2)
- Stevens Point, WI (2)
- Stoughton, WI (2)
- Sturgeon Bay, WI (2)
- Sun Prairie, WI (3)
- Superior, WI (3)
- Tomahawk, WI (2)
- Union Grove, WI (2)
- Verona, WI (3)
- Viroqua, WI (2)
- Watertown, WI (2)
- Waukesha, WI (4)
- Waupaca, WI (2)
- Wausau, WI (4)
- Wauwatosa, WI (3)
- West Allis, WI (7)
- West Bend, WI (3)
- West Salem, WI (2)
- Weston, WI (2)
- Weyauwega, WI (2)
- Whitehall, WI (2)
- Wisconsin Rapids, WI (3)