Nursing Homes in Wisconsin
More than 5.8 million people live in Wisconsin, and according to the U.S. Census, 17.9% of those residents are seniors. Many of these seniors have medical conditions that require 24-hour nursing care, making it difficult for them to remain in their own homes. Nursing facilities offer a practical solution for these seniors, offering the care they need and comfortable living arrangements where they can share meals and activities with their peers. There are 17,947 people living in Wisconsin's 344 nursing homes.
This guide explores the options seniors and their families have for covering the cost of nursing home care, including Medicare and Medicaid. It provides a list of useful resources and organizations seniors can turn to for help in understanding the Medicare and Medicaid systems. The guide also explains how nursing homes are regulated in Wisconsin and lays out some of the rules that nursing homes in the state are required to follow.
Cost of Wisconsin Nursing Homes
The average cost of nursing homes in Wisconsin is $247 per day. This is higher than the national average which is $228 per day.
Can You Use Medicaid to Pay for Nursing Home Care in Wisconsin?
Wisconsin Medicaid will pay for nursing home care for seniors who meet the financial and medical eligibility requirements. There are also Medicaid programs to support seniors who require nursing home levels of care but would prefer to remain in a community setting.
There are currently just over 1.4 million people enrolled in Wisconsin's Medicaid and CHIP programs. Medicaid can be used to cover the cost of a shared room in a nursing home and any essential medical care. It cannot be used to pay for nonessential items such as entertainment or confectionery, but seniors are allowed to retain a small amount of money each month from their income as a personal needs allowance.
Eligibility for Medicaid in Wisconsin
To qualify for Medicaid in Wisconsin, seniors must meet certain eligibility criteria. Individuals applying for Institutional/Nursing Home Medicaid can hold up to $2,000 in countable assets, while couples can have up to $4,000. The income limits are $32,904 per year for a sole applicant or $65,808 for a couple.
In addition to the above requirements, applicants must also meet the following eligibility criteria:
- Be a US citizen
- Reside in Wisconsin
- Pass a clinical needs assessment
Applying for Medicaid in Wisconsin
Seniors can apply for Medicaid online via the ACCESS Wisconsin website. They can also contact ForwardHealth Member Services by calling (800) 362-3002 or pay a visit to their local Income Maintenance and Tribal Agency office for in-person advice.
What Information You Will Need
Before starting the application process, it's a good idea to gather the following documents and information:
- Bank statements from all bank accounts
- Property deeds and titles
- Proof of Social Security Income
- Statements showing any earnings from investments or pensions
- Documents showing any VA pensions, benefits or other income
- Proof of identity (such as passport or birth certificate)
- Any relevant medical documentation
Additional Medicaid Support and Resources in Wisconsin
Seniors and their loved ones who require assistance with the Medicaid application process may find the following resources useful. These organizations offer information and advice for would-be Medicaid beneficiaries.
|Wisconsin Department of Health Services
|The Wisconsin Department of Health Services oversees a variety of health programs and provides information about Medicaid and its various forms on its website. It also provides a list of useful contact details for seniors who are struggling with the application process.
|Wisconsin Area Agencies on Aging
|See List for Local Contact Details
|Each county in Wisconsin has a dedicated area agency on aging. This organization provides help and support for the county's older adults, including assistance with Medicaid claims and long-term care planning.
|Seniors can manage their Medicaid claims and any services they're receiving via the Forward Health portal. Forward Health makes it easy for seniors to access care, including managing self-directed Medicaid programs through the IRIS program.
Can You Use Medicare to Pay for 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 Support and Resources in Wisconsin
Seniors who are unsure what Medicare coverage would suit them best or who need advice about enrollment periods may find the following resources helpful. These free resources help to ensure seniors claim the support they are entitled to, and can also protect them from fraud.
|Wisconsin Aging Advocacy Network
|The Wisconsin Aging Advocacy Network serves the state's older adults by advocating for them on policy issues. It also offers education services, including information about Medicare and its associated plans.
|Wisconsin Senior Medicare Patrol
|This volunteer-run organization provides free information and advice to seniors to help them avoid Medicare fraud. Volunteers answer questions about Medicare so seniors can feel confident they're claiming what they're entitled to form their Medicare plans.
|Wisconsin SHIP is the State Health Insurance Assistance Program. It provides free information about Medicare, including costs, enrollment, plan types and eligibility. It can also offer advice to seniors about programs they may be eligible for that could lower their Medicare costs.
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. 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 (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 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.
Nursing Home Laws and Regulations in Wisconsin
|The Wisconsin Department of Health Services oversees the licensing of skilled nursing facilities. Facilities must meet certain requirements regarding staffing, nutrition and safety, and are re-assessed regularly.
|Wisconsin nursing facilities must have sufficient nurses on staff to deliver 2.5 hours of care per resident, per day. At least 20% of that care must be delivered by licensed nurses. Facilities must also employ a charge nurse.
|Staff Training Requirements
|All employees are required to undergo orientation and safety training before starting work. They must also receive training in resident rights before they complete their first 30 days of employment. Ongoing in-service training must also be provided.
|Nursing homes are licensed to have a certain number of residents and are not permitted to exceed their capacity. They may not admit a resident who requires more care services than the facility is able to provide.
|Care Planning Requirements
|All newly admitted residents must be provided with a personal care plan within four weeks of admission. This plan must include assessments from all relevant medical professionals, including the resident's physician. Plans must be reviewed on a regular basis.
|Dietary and Nutritional Services Requirements
|Nursing homes must provide palatable and nutritious meals to all residents. These must be served in a dining room for those who are able to eat at a table. Residents who are bedbound must have drinking water available by their bedside at all times.
|Specialized Rehabilitative Services
|Residents who require specialized rehabilitative services must have their needs met either on-site or via an external provider. Any such treatment must be reported to the resident's primary physician within two weeks of commencement.
|Medication and Pharmaceutical Services
|Nursing homes must have an arrangement with a pharmacy to ensure residents have access to their daily medication. Contingency supplies for up to ten days can be kept on-site. All medications must be clearly labeled, including information about the resident and their prescription plan.
|Facilities are required to provide activities and programs that meet the needs, abilities and interests of residents. There are no specific requirements relating to the type of activities that must be provided.
|Infection Control Requirements
|All instances of communicable diseases must be reported to the local health officer. Nursing homes are required to have a plan in place to manage any residents who have a communicable disease.
|Seniors who meet the financial and medical eligibility criteria may qualify for Medicaid support to aid with their long-term care costs. This can cover many of the expenses associated with nursing home care.
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