Financial Assistance, Costs and Payment Options for Eldercare in Wisconsin

Page Reviewed / Updated - February 18, 2020

This webpage will help residents of Wisconsin in understanding the costs associated with elderly care. The average cost of assisted living, in-home care, and adult day care throughout the state will be explored. Payment options and programs that provide financial assistance with the costs of senior care, whether it is in the home or in an assisted living facility, will also be covered.

While the programs covered on this page are inclusive of what the state of Wisconsin has to offer, it does not cover what is available on a national level. When seeking assistance with the cost of elderly care, it is important to consider all avenues of assistance. To help in your search for the best program for the given situation, make sure to use our free Resource Locator Tool.

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Wisconsin Elder Care Costs

Assisted Living / Memory Care

As of 2019, the average monthly rate for assisted living throughout the state of Wisconsin is $4,300. This amount is nearly 8% greater than the national average of $4,000 / mo. However, there is one area where the cost is considerably less expensive, which is the area of La Crosse. Here, the average monthly cost for assisted living is $2,638. Janesville and Green Bay have costs nearly equivalent to the national monthly average of $4,000, with average monthly costs between $4,068 and $4,075. The area of Milwaukee is slightly over the national monthly average at $4,264 / mo. It can also be helpful to know the areas of the state where assisted living is the most expensive, which includes Wausau ($4,644 / mo.), Sheboygan ($4,674 / mo.), Racine ($4,888 / mo.), and Oshkosh ($5,000 / mo.).

For those that require Alzheimer’s care, often referred to as memory care, there is an additional monthly fee due to the increased need for supervision and security. On average, this type of care is an additional $860 - $1,290 / mo.

Home Care

As with the cost of assisted living, the hourly cost of home care is over the national hourly average. As of 2019, the Wisconsin statewide average is $23.50, which is just over 10% more costly than the nationwide average of $21.00 / hr. Throughout the various regions of Wisconsin, the hourly price can fluctuate quite a bit, with the most affordable home care found in Sheboygan ($19.75 / hr.), Madison ($21.00 / hr.), Wausau ($21.50 / hr.), and Green Bay ($21.75 / hr.). The areas that have the costliest home care include Racine, La Crosse, Janesville, and Milwaukee. Here, the average hourly cost is $25.00.

For those that require minimal medical assistance in the home, home health care is also available. This type of care, provided by medical professionals, generally costs approximately $.50 / hour more statewide. However, there are two areas, Sheboygan and Madison, where the cost of home health care is significantly more expensive, and on average, costs $4.00 / hour more than does regular home care.

Adult Day Care

Adult day care is a great alternative for those who require daytime supervision, as it offers a significantly more affordable option. In Wisconsin, in 2019, the average daily rate is $65, which is just under the national average of $72 / day. The most affordable areas for adult day care in Wisconsin are Wausau ($35 / day), Racine ($60 / day), and Appleton ($62 / day). On par with the statewide average of $65 / day are Fond du Lac and Milwaukee.  There are three areas of the state that have a daily rate that is significantly higher than the rest of the state: Madison ($85), Eau Claire ($87), and Green Bay ($112).

Wisconsin Financial Assistance Programs

Medicaid Programs for the Elderly

Background Information
Medicaid is a health insurance program for low-income individuals throughout the United States. This program was created by the Federal government, but allows each state to make its own rules and administer the program within a given parameter. Through the state Medicaid plan, nursing home care is covered for elderly and disabled individuals.

In-home personal care is also provided via the Medicaid State Plan and is known as the Medical Assistance Personal Care (MAPC) program. Via this program, assistance with daily activities is provided. This includes assistance with dressing, grooming, preparing meals, shopping for groceries, and laundry. Assistance can be provided in one’s own home, a foster care home, or an assisted living facility.

Medicaid now also offers long-term care outside of nursing homes through Medicaid Waivers, often called Home and Community Based Services Waivers. Currently, the state of Wisconsin offers the following waivers.

Family Care and Family Care Partnership Programs
These long-term managed care programs are intended to help seniors continue to live in their homes, with the goal of preventing premature nursing home placements. These programs offer Self-Directed Supports (SDS), which means individuals are able to self-direct their care, including hiring select family members as caregivers. Via these programs, a variety of supportive services are available and include adult day care, personal care assistance, durable medical equipment, home modifications, and personal emergency response systems. The main distinction between these two programs is the Family Care program focuses on non-medical personal care, while the Family Care Partnership program also encompasses prescription medication and medical assistance. For support information and eligibility information, click here.

IRIS (Include, Respect, I Self-Direct) Program
This waiver provides long-term care supports to avoid and/or delay nursing home placement of elderly and disabled residents of Wisconsin. This program allows for consumer direction, enabling eligible applicants to self-direct their care. Together with a case manager, individuals come up with a care plan and a budget is allocated based on the plan. Through this program, family members can be hired to provide personal care services. Other supports via this wavier include specialized medical equipment, home modifications, adaptive aids, nursing services, among many others. For more information, click here.

Community Options Program Waiver (COP-W) and the Community Integration Program II (CIP-II)
While one may have heard of the Community Options Program Waiver (COP-W) and the Community Integration Program II (CIP-II), these programs were phased out and transitioned into the managed care program, Family Care, which is mentioned above. This transition was complete by the end of June, 2018.

Wisconsin Medicaid Eligibility
In order for seniors to be eligible for long-term care Medicaid, they must have a functional need for care. In addition, there are also income and asset limitations. While eligibility requirements may vary between the state plan and Medicaid waivers, generally speaking, as of 2019, a single individual’s monthly income cannot be in excess of $2,313. This amount is equivalent to 300% of the Federal Benefit Rate (FBR). The asset limit is set at $2,000. However, this does exclude certain assets, such as an individual’s home, given it is valued under $878,000 and it is the main residence of the applicant. Other exempt assets include furniture in the house, personal items, an automobile, and burial plots.

Being over the income and / or asset limit(s) does not mean one cannot qualify for Medicaid. For those over the income limit, there is a medically needy pathway. This is basically a “spend down” program in which applicants with high medical bills relative to their income spend their “excess” income on medical expenses. Once one has spent their income down to the medically needy income limit, they are able to receive Medicaid services for the remainder of the “spend down” period.

An option for those over the asset limit is to spend excess assets on non-countable assets. For instance, one can make home reparations, modifications, and additions, as well as pay off debt. That said, it is imperative that one does not give away assets in order to meet the asset limit. Gifting assets within 60-months prior to one’s application date violates Medicaid’s look back period, which can result in a period of Medicaid ineligibility.

Applying for Medicaid can be particularly complicated if one is over the income and / or asset limit(s). It is also more complicated if the applicant is married with a healthy (non-applicant) spouse, as there are different rules that govern this situation. In both these instances, it is strongly recommended that one consult with a Medicaid planning professional for assistance prior to applying for Medicaid.

State (Non-Medicaid) Assistance Programs

The state of Wisconsin has several non-Medicaid based programs offering services and financial assistance to seniors in need of long-term care and supports.

Wisconsin Supplemental Security Income (SSI) Exceptional Expense Supplement
This program provides a monthly subsidy for those who require at least 40 hours of supportive services or in-home care. Benefits can be sought in the individual’s home, a foster care home, or an assisted living facility. For additional information and eligibility requirements, click here.

Alzheimer’s Family & Caregiver Support Program (AFCSP)
This program offers support to those who have Alzheimer’s disease or a related dementia, as well as offers respite for family caregivers. Personal care, durable medical equipment, home modifications, transportation assistance, and adult day care are all benefits available via this program. To learn more, click here

SeniorCare Pharmaceutical Assistance Program
Via this program, seniors can purchase generic and brand name drugs with just a small co-payment. To participate in this program, there is a small annual fee. For additional information, click here

Community Options Program
This program was similar to the Wisconsin COP-Waiver program, but was specifically intended for those that were not on Medicaid. As with the COP-Waiver program, COP has transitioned into the managed care program, Family Care, as well as Family Care Partnership and IRIS. This transition was complete by June of 2018. Click here for more information.

Other Financial Options for Care

In addition to the state specific programs that assist in covering the cost of elderly care in Wisconsin, there are also federal and non-profit programs available. In order to find other programs that assist in paying for care or reduce your out-of-pocket cost, make sure to use our Resource Locator Tool.  This tool makes it easy to locate and consider all of your options and choose the program that best fits the circumstances. Eldercare loans and programs that aid veterans with assisted living are other available options.

Finding Affordable Care

To effectively find senior care that best fits your and your family’s budget, it is very important to know which type of care is best suited to the needs of your loved one. To assist you in accurately determining what type of care is needed, our organization has partnered with professionals who can assist you free of charge. They also assist in matching your needs with the most affordable, high quality care throughout Wisconsin. At no charge for this service, this is an invaluable tool for families who are looking for assistance. Get started now.

Top Cities for Senior Care in Wisconsin

For more information about the costs and resources available in Wisconsin cities, click on the links below.