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.

$8684

Wisconsin

$7756

The United States

$11026

Minnesota

$8973

Michigan

$6570

Iowa

$6235

Illinois

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.

$7756

Eau Claire

$7902

Fond du Lac

$8144

La Crosse

$8502

Appleton

$8851

Wausau

$9429

Milwaukee

$9612

Janesville

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.

$8684

Nursing Home Semiprivate Room

$9429

Nursing Home Private Room

$1322

Adult Day Care

$4400

Assisted Living Facility

$4957

Home Care

$4957

Home Health Care

Financial Assistance for Nursing Home Care in Wisconsin

Most people do not pay for skilled nursing care entirely out-of-pocket. Rather, they utilize financial assistance programs to help cover the cost of nursing care. Of public financial assistance programs, Medicaid provides the most comprehensive coverage of nursing home care. But, not all seniors are eligible for Medicaid. And because each state operates its own Medicaid program within federal guidelines, eligibility and benefits vary from state to state. Below, we provide more information on Medicaid in Wisconsin.

Wisconsin’s Medicaid Program

Wisconsin currently has 1,144,492 people enrolled in Medicaid and CHIP, according to statistics from August 2020. In 2017, only 8.4% of the elderly, blind and disabled Medicaid enrollees used their benefits to pay for nursing home care. This low percentage is due to the state’s emphasis on using the services to pay for home-based care when possible. Wisconsin currently has 355 nursing homes serving the needs of its seniors, and many of those accept Medicaid to pay for care.

Understanding coverage options for nursing home care can get confusing because the state has multiple Medicaid programs for seniors. Family Care provides families access to financial assistance to pay for skilled nursing care at home, with options for nursing home care as well, while IRIS assists seniors who need long-term care and want to manage their own services. PACE provides long-term care coverage for seniors in the state’s largest three counties.

Medicaid Eligibility in Wisconsin

The state has numerous Medicaid programs for its seniors, including Family Care, IRIS and PACE. Each has its own income limits and qualification rules. For Medicaid coverage for nursing home care, residents must make no more than $2,349 a month and have no more than $2,000 in personal assets. In addition, seniors must be Wisconsin residents and U.S. citizens or legal immigrants. Finally, they must show on the Wisconsin Adult Long-Term Care Functional Screen that they require skilled nursing care. Seniors can check eligibility and apply for benefits on the Department of Health Services website.

Alternative Financial Assistance Options

  • Medicare: Medicare will cover the cost of one’s care in a skilled nursing facility for the first 20 days of their stay, and a portion of the costs up until day 100. After 100 days, the individual is responsible for all costs. Seniors must also have a “qualifying hospital stay” of at least 3 days prior to their admission to a nursing home in order to qualify for Medicare coverage.
  • Aid and Attendance: 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: 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. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.
  • Long-Term Care Insurance: Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy.

Free and Low-Cost Resources for Seniors in Wisconsin

Through several state and private organizations, seniors in Wisconsin have access to support, counseling and services they need to thrive. Adults living in nursing homes can take advantage of these services to ensure their rights are being fully protected and supported, even while they are in care. Families of nursing home residents can find advocacy, education and financial assistance through these groups. These services are offered at minimal cost or with no cost at all.

ResourceContactService
Aging and Disability Resource Centers(608) 266-1865Wisconsin has several ADRC locations throughout the state where older adults can get assistance in a variety of ways. Seniors in nursing homes and their families can turn to the ADRC for help understanding Medicare, Medicaid and Social Security benefits. They can also get help to purchase adaptive equipment from these centers. If an elderly adult prefers to receive skilled nursing at home, they can get information about this possibility at the ADRC’s long-term care options counseling service.
Wisconsin Music and Memory Program(608) 266-1865The Wisconsin Music & Memory Program is offered in over 300 nursing homes in the state. This program uses personalized music to help seniors with dementia unlock memories and communicate more effectively.
Area Agencies on Aging(866) 813-0974Wisconsin has three Area Agencies on Aging, the Dane County AAA, Milwaukee County AAA and Greater Wisconsin Agency on Aging Resources. These agencies work to assess the needs of elderly people within their communities, provide contact information to help seniors get the services and programs they qualify to receive and provide advocacy for seniors and their families.
Wisconsin Chapter of the Alzheimer’s Association(800) 272-3900With over 120,000 people in Wisconsin dealing with Alzheimer’s and dementia, the Wisconsin Chapter of The Alzheimer’s Association provides needed support to families. In addition to offering education about these memory conditions, the Alzheimer’s Association raises funds for research and advocates for affected families.
SeniorCare Prescription Drug Assistance(800) 657-2038Seniors who are U.S. citizens or qualified immigrants, reside in Wisconsin and are aged 65 and older can get help paying for prescription medications through Wisconsin SeniorCare. This prescription drug assistance program costs $30 a year and helps pay the out-of-pocket expenses for prescription medications.
Wisconsin Long-Term Care Ombudsman(800) 815-0015If a resident of a Wisconsin long-term care facility has a complaint about their treatment, the Long-Term Care Ombudsman investigates. The Ombudsman assists with problem resolution, helps residents and their families understand their rights, enforces laws about nursing home care and helps protect residents against abuse and neglect. The Ombudsman also assists families in understanding their options for care, how to pay for care and how to find appropriate services for elderly loved ones.
Family Care(608) 267-7286Family Care provides options for frail seniors in Wisconsin who need nursing services but wish to remain in their homes. Family Care is a Medicaid-based long-term care program that allows older adults to get services at home, with the flexibility to transition to nursing home care if needed. Family Care can be used to pay for home modifications, home-delivered meals, adult day care and supportive home care, as well as health care services.

Nursing Home Laws and Regulations in Wisconsin

Licensing RequirementsNursing 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 RequirementsWisconsin 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 RequirementsBefore 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 RestrictionsNursing 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 RequirementsNursing 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 RequirementsSNFs 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 ServicesAll 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 ServicesNursing 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 RequirementsWisconsin 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 RequirementsThe 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 CoverageWisconsin 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.