Assisted Living in Madison, WI

Assisted Living Costs in Madison

According to the 2018 Genworth Cost of Care study, the average monthly cost of assisted living in Madison ($4,363) is about on par with the state average ($4,300) and less than $400 higher than the nationwide average rate of $4,000. Assisted living costs vary significantly in other areas of Wisconsin, ranging from a high of $5,000 per month in Oshkosh to a low of just $2,638 in La Crosse. Seniors pay close to the state average in Milwaukee ($4,264) and slightly less in Janesville ($4,068) and Green Bay ($4,075).

The Cost of Assisted Living in Surrounding Areas

Care Cost Comparison

Senior care costs are affected by factors beyond geographic location, such as the type and amount of care provided and the setting. Nursing homes and home health aide services provide skilled personalized care, so they’re the two most expensive options in the city. Nursing homes offer 24-hour care and other specialized services, which explains their $4,000 higher average cost.

Assisted living appears to be more expensive than homemaker services, but fees at these residential facilities generally include room and board. The monthly homemaker rate covers services only, so seniors still have to pay for food, utilities, maintenance and other regular household expenses.

Senior Care Cost Comparison Chart

Financial Assistance for Assisted Living in Madison

Medicaid in Wisconsin

The Wisconsin State Medicaid program provides health care services to low-income residents who meet specific eligibility requirements. Covered services can include case management, primary and preventive care, emergency, inpatient and outpatient hospital care, lab and X-ray services, medical supplies and equipment and long-term care in an intermediate or skilled nursing facility.

Medicaid coverage for long-term care is available to Madison residents who are U.S. citizens or qualified immigrants and:

• Aged 65 or older, or under age 64 and blind or disabled
• Have an income of less than $2,313 per month and total assets of $2,000 or less

While income from all sources counts toward the monthly limit, there are exceptions to the asset limit. Several assets are exempt, including one vehicle, personal belongings, burial plots, a principal home valued at less than $858,000 and household furnishings.

Wisconsin Medicaid offers seniors additional ways to qualify for coverage:

Medically needy: Those currently receiving or who meet the eligibility requirements for federal Supplemental Security Income benefits automatically qualify for Medicaid coverage for both health and long-term care services. 

Medicaid deductible: Seniors with income over the Medicaid limit and high medical expenses may qualify for coverage with a Medicaid deductible. This allows an applicant to receive six months of full coverage after they’ve spent their personal deductible on medical bills. 

Madison seniors can call (800) 362-3002 to learn more about the Wisconsin Medicaid program or apply online through Wisconsin Access.

Wisconsin Medicaid offers two waiver programs that provide vital services and supports to help Medicaid-eligible seniors and disabled adults stay in their homes or the community.

Include, Respect, I Self-Direct Waiver

The IRIS waiver program provides the means for seniors and disabled adults to direct their own care to better meet their needs. A case manager works with each program enrollee to formulate a personalized care plan and budget. The participant can then use their budgeted funds to pay for approved services and supports from providers of their own choosing. To qualify for the IRIS program, Wisconsin residents must:

• Be eligible for Medicaid
• Be aged 65 and older or aged 18 to 64 and disabled
• Be assessed as needing an intermediate or skilled nursing level of care
• Prefer to live in a private home, adult family home or approved residential care setting in the community

IRIS program enrollees can use their budgeted funds to pay for a variety of services and supports such as adult day care services, assistance with personal care, prepared meals, residential care, approved medical equipment and supplies, necessary nursing care and nonmedical transportation.

Family Care Waiver

The Family Care waiver provides enrollees with long-term managed care. An assigned managed care provider assesses each applicant’s needs and develops and implements a personalized service plan that’s delivered in the community setting the person chooses.

To qualify for the waiver, Madison residents must be aged 65 or older, or aged 18 to 64 and disabled, and assessed as at risk of nursing home placement if they don’t receive daily assistance.

The services and supports covered under this waiver program may include:

• Transition assistance
• Care coordination
• Assistance with personal care and activities of daily living
• Residential services
• Intermittent skilled nursing care
• Physical, speech and occupational therapy
• Durable medical equipment and necessary supplies
• Adaptive aids
• Medical transportation

Nursing home care is an entitlement with Wisconsin Medicaid, so eligible residents are guaranteed to receive services. The above waiver programs aren’t entitlements, so approved seniors may face a wait to receive services due to enrollment caps.  

To learn more about the IRIS and Family Care waiver programs or to apply, Madison seniors can contact the Aging and Disability Resource Center of Dane County at (608) 240-7400.

Other Financial Assistance Programs for Assisted Living

Bridge Loan

It’s not unusual for seniors to experience a cash shortage when they’re making a move to assisted living. Rather than waiting until long-term funding becomes available, such as government benefits or proceeds from the sale of a home, seniors can apply for a bridge loan from Elderlife Financial. Typically structured as a line of credit, an Elderlife bridge loan is available for a term of up to 12 months and has no application fee or other up-front costs. Up to six family members can apply to ease the approval process, and loan proceeds are often available within just one business day.

Interested seniors can call Elderlife Financial Services at (888) 228-4500 for more information or to apply by phone or complete an online application.

State Supplemental Payment

Madison residents receiving Supplemental Security Income from the federal government also qualify for a monthly cash top-up from the state, which can be used to pay for assisted living expenses not covered by Medicaid. The maximum state supplemental payment is $179.77, but the exact amount depends on an applicant’s living arrangement and income.

Seniors can apply for both federal SSI and Wisconsin state SSP benefits by calling the Social Security Administration at (800) 772-1213 or visiting the Madison SSA office located at 6011 Odana Rd.

Assisted Living Resources in Madison

Aging and Disability Resource Center

The ADRC of Dane County provides elderly Madison residents with valuable information on available resources and services. Seniors and their families can contact the ADRC for free guidance about options for long-term care, referrals to local programs and personalized elder benefits and disability counseling. The Center also provides screening assessments and application assistance for county and state benefits, including publicly funded long-term care programs.

ADRC of Dane County
2865 N. Sherman Ave., Madison, WI 53704
(855) 417-6892

Senior Centers

The Madison metropolitan area is home to several senior centers. Older residents are sure to find something that piques their fancy at their neighborhood center, whether it’s a relaxing game of mah-jongg, a shared interest club or a computer, craft or fitness class. Most centers offer congregate noontime meals, health and wellness programs, group outings and life-enriching special events such as art shows and summer concert series.

Senior Legal Aid

Legal Action of Wisconsin provides low-income elderly Madison residents with access to free legal assistance through the SeniorLAW project. Qualified individuals aged 60 and older can receive advice and representation for a wide range of civil legal issues such as long-term care, physical or financial elder abuse and neglect, public benefits such as Medicaid, SSI and Social Security and consumer law.

Legal Action of Wisconsin
744 Williamson St., Ste. 200, Madison, WI 53703
(608) 256-3304