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According to the latest Genworth Cost of Care Survey, the median cost of in-home care in Wisconsin is $5,529 per month, while home health care costs an average of $5,720 each month. Your cost could vary based on the level and quality of care you need and where you reside in the state.
In-home care consists of companion services such as helping someone with personal care tasks, assisting them with their housework and providing transportation services. Home health care involves skilled nursing care that’s directed by a licensed registered nurse or doctor.
The cost in in-home care services and home health care in Wisconsin is greater than the national average, but rather competitive compared with surrounding states. Home health care is significantly cheaper than in Minnesota, where the median cost is $6,912 per month, but Illinois and Iowa offer care that’s slightly cheaper. The national average for in-home care is $4,957 per month, and home health care costs on average $5,148 per month, making Wisconsin one of the more expensive places in the United States to obtain these types of services.
|In-Home Care||Home Health Care|
Receiving care at home can save you approximately $3,500 per month compared with semiprivate nursing home care. However, transitioning to an assisted living facility will save you about $1,000 monthly than continuing to receive health care at home. The most cost effective type of care is adult day care at $1,723 per month.
Wisconsin offers coverage for home care services through multiple waiver programs. To qualify for assistance through a waiver program, you must meet the requirements to receive Medicaid in Wisconsin. Medicaid coverage pays for direct medical care such as emergency services, medical appointments and prescription medication, but doesn’t cover the cost of room and board at a nursing facility.
Four waiver programs in Wisconsin can help low-income families afford in-home services and home health care. For more information, contact your local aging and disability resource center (ADRC).
|Contact||Area Served||Services Provided|
|Family Care Partnership Program||Local ADRC||Select counties||The Family Care Partnership program may cover in-home and home health care services, including the cost of medical care, doctor’s visits, medical transportation and prescription medications. It’s available only in select counties, and you must qualify for Medicaid to enroll. To find out whether you’re eligible, contact your local aging and disability resource center.|
|Program of All-Inclusive Care for the Elderly||Local ADRC||Kenosha, Milwaukee, Racine and Waukesha Counties||The PACE program offers comprehensive benefits that include dental and vision care, medical care, prescription drug coverage, home health care and emergency care. To qualify, you must be eligible for Medicaid, over the age of 55 and a resident of one of the four counties in which the program is available.|
|Family Care||Local ADRC||Entire state||The Family Care program, which is an extension of the Family Care Partnership program, combines all the benefits seniors need into a single program. It was designed specifically for long-term care, which includes in-home health services and home health care. The program coordinates care with local aging and disability resource centers and managed care organizations.|
|IRIS||Online||Entire state||The Include, Respect, I Self-Direct (IRIS) program provides a set budget that seniors can use as they wish for long-term care services. A counselor and agent to help participants decide how to manage their care within their set budget. Each person’s budget is determined by their health condition and medical needs. You must qualify for Medicaid before enrolling.|
To qualify for Medicaid in Wisconsin, you must not have substantial sellable assets, and your income must remain under a threshold that’s determined by the size of your household.
|Income Limits*||Asset Limits|
|Two-Person Household with one applicant||$30,276 for applicant||$2,000 for applicant, $137,400 for spouse|
|Two-Person Household with two applicants||$60,552||$4,000|
You must also meet the following requirements:
You can apply for Medicaid through the health insurance marketplace at healthcare.gov or online through the Wisconsin Department of Health Services.
What Information You Will Need
How to Get Help Applying for Medicaid
Applying for benefits can be a confusing process and you may have questions. Making sure that you fill in the information correctly is important because your benefits may be delayed if there are errors on your application. You can find help when applying for Medicaid in Wisconsin at the following resources.
|Contact||Area Served||Services Provided|
|State Health Insurance Assistance Program||Online or 800-242-1060||Entire state||The SHIP program helps seniors determine what insurance coverage options are best for their needs. Counselors can help you fill out applications for Medicare and Medicaid and help you find additional assistance.|
|ACCESS Wisconsin||Online||Entire state||ACCESS Wisconsin helps state residents qualify for benefits when they can’t afford the cost of health care. The agency can help you apply for Medicaid and determine your eligibility for other community programs.|
|Benefits.gov||Online or 800-362-3002||Entire state||Benefits.gov helps seniors apply for Medicaid programs online, offers a helpline, and can connect you to your local ADRC.|
Medicare doesn’t pay for non-medical home care, but it can cover the cost of the medical version of home care, called “Home Healthcare” in some situations. In order to be eligible, you need to be homebound and have a referral from your doctor for the specific type of medical care that is needed. There are also other restrictions that apply.
Below is an overview of some of the services typically covered by Medicare for those who are eligible:
As mentioned above, home care is distinctly different from home healthcare, but there is some overlap – so while Medicare doesn’t cover non-medical home care, there are personal care services that may be covered in special circumstances – such as an occupational therapist helping with eating or dressing.
Read our guide to Medicare and Home Care Coverage for more information.
While the above programs can be a great way to make home care affordable for many people, they are not the right solution for everyone. Thankfully, there are other ways to make home care more affordable for you and your family. For more information about your other options, read our section on Other Ways to Pay for this guide.
Your local aging and disability resource center (ADRC) is a great place to start if you’re looking for additional assistance. The state of Wisconsin also offers programs for seniors in need of material support, legal services, help paying for medications and ways to remain active in the community.
|Contact||Area Served||Services Provided|
|Qualified Disabled and Working Individual Program||Online||Entire state||The QDWI program helps seniors who are still working cover the cost of Medicare Part A. To qualify, you must be a senior with a disability who’s required to maintain a job to cover your cost of living.|
|SeniorCare Prescription Drug Assistance Program||Online||Entire state||Wisconsin residents over the age of 65 qualify for SeniorCare, which is a prescription drug program that helps seniors pay for their medications.|
|Housing Support Services||Online||Entire state||The Wisconsin Department of Health offers this program to help seniors facing homelessness find affordable, subsidized housing.|
|Adult Protective Services||608-266-1865||Entire state||Adult Protective Services provides legal services for seniors and their family members if there’s reason to suspect a loved one is being mistreated, neglected or financially exploited.|
|Greater Wisconsin Agency on Aging Resources||608-243-5670||Entire state||This nonprofit organization helps seniors find programs and aid. With some programs only offered in select counties, this organization helps alleviate some of the confusion involved with determining which programs you qualify for.|
|Wisconsin Family Caregiver Support Program||Online||Entire state||The Family Caregiver Program compensates those caring for someone with Alzheimer’s disease or dementia. This can help reduce the financial burden of being a caregiver.|
Wisconsin currently has a vaccine mandate for in-home and home health care workers. In addition to receiving both doses of the COVID-19 vaccine, home health care workers need to follow protocols regarding the use of personal protection equipment and masks to prevent the spread of the virus. These mandates may change, so it’s important to contact your local area agency on aging to receive the most current protocols.
Some service providers go beyond the minimum requirements set forth by the state and federal governments to help contain the spread of the virus among the elderly population. Your in-home care or home health service provider may have special protocols in place.
The Wisconsin Department of Health Services oversees all rules and regulations pertaining to home care in the state. Statute 50.49 of the health code highlights the rules that home care agencies must follow.
|What Types of Care Can Be Provided?||Home care is defined in the state health code as services that include physical therapy, speech pathology, skilled nursing care and social services that are conducted with the coordination of a licensed physician or nurse practitioner. To be registered as a home care agency, an organization must primarily provide nursing care.|
|Are Care Plans Required?||Before service can be provided, home care agencies must provide a treatment plan that highlights where and how service will be given, how much services will cost and the process required to amend the treatment plan. This treatment plan must be shared with the patient’s physician and receive proper approval.|
|Can Home Care Providers Assist with Medication Management?||In-home aides may help patients manage their medications.|
|Are There Special Requirements for Screening Home Care Aides?||Staff members must be screened in advance for illnesses such as tuberculosis and need to pass a criminal background check before they’re allowed to work with patients.|
|Are Home Care Aides Required to Undergo Special Training?||Anyone providing medical care must do so under the direct supervision of a licensed medical practitioner, such as a doctor or registered nurse. Those providing companion services may assist patients with tasks such as getting dressed, cleaning, walking, bathing and other personal care. They may not provide medical assistance without being licensed to do so.|
|Does Medicaid Cover Home Care in Wisconsin?||Wisconsin’s Medicaid program doesn’t cover the cost of home care directly, but multiple waiver programs throughout the state may cover part or all of the cost of long-term care at home.|
|How Do I Report Abuse of Myself or a Loved One?||Contact Adult Protective Services or the Long-Term Care Ombudsman if you suspect your loved one is the victim of abuse. The Ombudsman’s office can be reached at 800-815-0015.|
Whether you are looking for yourself or a loved one, finding a quality home care provider can be a stressful process. To help you overcome this challenge, we’ve created a helpful checklist below that can help guide you through the process of both determining your needs, and finding a home care agency that will be the best fit for you and your family.