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.

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.

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

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.

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.  

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.

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.  

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.

Visitation Policies

Outings & Social Activities

*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

Nursing Home Laws and Regulations in Wisconsin