Page Reviewed / Updated - October 2019
Our guide to paying for senior care in Madison, Wisconsin, provides an overview of senior care costs throughout the state and the financial assistance available to those who qualify. This guide also includes information about public benefits programs and other resources available for low-income seniors, but it focuses on senior care in the Madison area.
In most senior care categories, the cost in Madison is higher than the state median. While assisted living costs are only $63 higher than the Wisconsin median, the difference is more significant for adult day care and nursing home care, where the costs are $434 and $487 higher, respectively. The only category which is lower is home care, where seniors in Madison pay $4,004 per month; $477 less than the Wisconsin median.
The cost of assisted living in Madison is close to the state median. Some large cities have lower costs, with seniors in Green Bay paying $288 less than those in Madison. Other large cities have higher costs, including Racine which is $525 a month higher than Madison. The highest assisted living in the state is found in the Oshkosh area, where the average is $5,000 per month, $637 higher than Madison. On the other end of the range is the La Crosse area, where assisted living costs an average $2,638 monthly, $1,725 less than Madison.
Home care costs in Madison are among the lowest in the state, at just $4,004 per month. The only city that's more affordable is Sheboygan, where seniors pay $3,766; $238 less than Madison's seniors. Other affordable cities include Wausau, with an average of $4,099 and Green Bay, which averages $4,147. Milwaukee, Racine and Janesville have the highest home care costs, with seniors in each city paying an average of $4,767. This is $763 less than the average in Madison.
Madison is one of Wisconsin's less affordable cities for adult day care. Seniors in the city pay $1,842 per month, $434 more than the state median. The most affordable city in the state is Wausau, where seniors pay just $758 per month, more than $1,000 less than Madison. Other affordable options include Appleton, Racine and Milwaukee. The least affordable adult day care in the state is in Green Bay, where seniors pay $2,427 per month, $585 more than those in Madison.
The cost of nursing home care in Madison is close to the state median. The average in Green Bay is $7,711, which is $1,110 lower than Madison. Eau Claire has the lowest nursing home care costs in Wisconsin at $7,422, $1,399 lower than Madison. On the other end of the scale, Racine and Janesville are less affordable than Madison. The Milwaukee area has the highest average cost of nursing home care at $9,555 per month, $734 more than Madison.
Wisconsin Medicaid provides health care and nursing home care to eligible seniors in Madison. It's an entitlement, so all eligible residents receive care.
People who have been living in a nursing home or similar medical institution for at least 30 days can receive Institutional Medicaid. Applicants must meet certain financial, residency, age and functional criteria to receive coverage. They must require a nursing home level of care, be a resident of Wisconsin and aged 65 or over. Applicants aged 18-64 must be assessed as disabled.
To be financially eligible, all applicants must meet income and asset limits. For single applicants, there is a monthly income limit of $2,313 and an asset limit of $2,000. For married applicants whose spouses aren't applying, the limits are the same, however, the non-applicant spouse can keep $126,420 of the couple's joint assets. If both spouses are applying they must have a monthly income of less than $4,626 and assets less than $4,000.
The Supplemental Security Income (SSI)-Related Medicaid provides health coverage to people aged 65 and over or to those who are blind or disabled. There are no functional requirements for SSI-Related Medicaid, but applicants do need to meet financial eligibility criteria. Income limits for SSI-Related Medicaid in Wisconsin include the income amount plus the Actual Shelter Allowance, (which is an amount that covers a portion of the applicant's housing expenses, including mortgage or rent payments, utilities and property taxes).
For married couples, the income limit is $903.38 plus an Actual Shelter Allowance of up to $358.67; this is the same whether one or both spouses are applying. Single applicants have an income limit of $597.78 per month plus an Actual Shelter Allowance of up to $257 and an asset limit of $2,000.
When determining the value of assets for Medicaid eligibility, certain assets are not counted. These include personal belongings, household items, burial trusts and IRA's and 401K's in payout status. If the applicant or their spouse is living in their own home, the home is also exempt as long as it's valued at less than $878,000.
The Medicaid State Plan in Madison also covers some personal care services under the Medical Assistance Personal Care. These services can include personal care such as grooming and bathing and some non-personal care activities such as laundry. Participants must be eligible for Medicaid and deemed medically needy.Seniors can apply for Medicaid on the ACCESS website, or applications can be downloaded from the Department of Health Services website.
Family Care and Family Care Partnership Programs
The Family Care and Family Care Partnership Programs provide an array of services that help participants continue living independently. They have similar benefits and eligibility requirements, although the Partnership Program is only available in selected counties, including Dane County.
Services available include adult day care, respite care, home modifications and assistance with activities of daily living. The Family Care Partnership Program also includes medical care and prescription drugs. It's a self-directed program which allows participants to hire their own caregivers, which can include family members, friends and neighbors.
Eligible participants must require assistance with activities of daily living. They must also be adults aged 65 or older, or if younger than 65, they must have a physical disability. Applicants must also meet the same financial requirements as in long-term Medicaid, although a cost-share arrangement may be available for people who don't meet these criteria. The Department of Human Services website has further information, and seniors can apply through their local Aging and Disability Resource Center.
Include, Respect, I Self-Direct (IRIS) Program
The IRIS Program offers assistance to older adults and individuals with disabilities. It is a self-directed program designed to enhance the independence and self-determination of participants. Through the program, participants create a plan based on their needs and goals and receive a budget based on that plan. Funding can be spent on anything in the plan, and participants are responsible for sourcing goods and services and acting as an employer for their caregivers. Friends and family members can be hired through the program.Applicants for this program must be adults aged 65 or older, or disabled if younger than 65. They must also be eligible for Institutional Medicaid and require a nursing home level of care. The services available on the plan are quite flexible and can include anything that encourages or maintains the independence of the participant. This can include adult day care, assistive technology and nursing services. Seniors can apply at the Aging and Disability Resource Center and can find more information on the IRIS website.
Wisconsin Supplemental Security Income Exceptional Expense Program
The SSI Exceptional Expense Program, or SSI-E, is available to eligible residents who receive Social Security Income. SSI members on the program receive a monthly cash benefit, which is currently up to $95.99 for singles and $345.36 for couples. The amount varies depending on the applicant's living arrangements.
Participants in the program must live at home, in adult foster care or an assisted living facility, and must require 40 or more hours of assistance each week. Single applicants have an income limit of $771 per month and assets less than $2,000, while married couples can have an income of up to $1,517 and assets up to $3,000. Seniors can apply through the Dane County Department of Human Services.
Alzheimer's Family and Caregiver Support Program
Families of people with Alzheimer's disease, dementia or other related memory disorders can receive support through the AFCSP. The program provides a range of services, including medical equipment, home modifications and respite care. Participants must be living in their own home or the home of a caregiver. All applicants must have a written diagnosis from a doctor that states they have a memory disorder.
Participants must be Wisconsin residents, and their annual household income must be under $48,000. Any expenses related to Alzheimer's disease and treating the participant can be deducted. Funding for this program is administered by counties, and they determine the services provided based on the needs of the applicant. In Dane County, seniors can apply through the Aging and Disability Resource Center, and further information can be found on the AFCSP website.
SeniorCare Pharmaceutical Assistance Program
Wisconsin residents aged 65 and over who don't receive Medicaid may be eligible for the SeniorCare Pharmaceutical Assistance Program. This program helps seniors pay for prescription medications by providing low co-pay amounts. The level of coverage available is determined by the applicant's annual income, and a small annual fee of $30 is charged to seniors in the program. More information is available on our SeniorCare page and the Department of Human Services website. Applications are made through the local Aging and Disability Resource Center.
|City of Madison DPCED Housing Authority||(608) 266-4675||The Housing Authority helps provide housing to low-income families, people with disabilities and those over 50 years old. It administers the Housing Choice Voucher Program and a number of public housing units in the city, including some designed especially for senior residents.|
|Home Chore Program||(608) 512-0000||This program helps seniors stay in their homes longer by providing free services in the home. Services are provided through volunteers and include cleaning floors, organizing items and performing minor home maintenance tasks such as changing light bulbs.|
|Wisconsin Home Energy Assistance Program||(866) 432-8947||WHEAP provides financial assistance to help eligible residents pay for heating or electricity bills. The amount available depends on the household income, the number of residents living in the household and the size of the home.|
|City of Madison Minor Home Repair Program||(608) 246-3737||This program provides low-cost home repairs to eligible homeowners in Madison. Repairs can include accessibility modifications such as the installation of wheelchair ramps and grab bars. Homeowners must meet certain financial and residential requirements to qualify for the program.|