Medicaid Nursing Home Rates by State

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Wisconsin

Medicaid nursing facility payment · Hybrid · researched October 2026

Wisconsin’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.

At a glance

Rate method

Hybrid

Case-mix level

Resident-level

Classification

PDPM

Rate updates

Once a year

Managed care (LTC)

Yes

Quality program

None

Paid outside the rate

Small

Bed hold

Hospital and leave

Published rates

Rates only

Assisted living

Covered

Personal needs allowance

$55 / month

Overview

• Each home gets its own rate built from five parts: direct care, support services, property, property tax, and add-on incentives.
• Direct care nursing is the home's own case-mix-neutral cost, capped at 125% of the statewide median x a regional labor factor; direct care 'other' and support services are flat prices (support = 125% of the median cost).
• Direct care is then multiplied by each resident's own PDPM nursing and NTA weights from the HIPPS code on the claim, so every resident in a home is paid a different rate.
• A 'support services reduction' takes back any amount by which the home's case-mix-neutral rate (before incentives) exceeds its own inflated costs.
• For SFY2027 (7/1/2026) the caps are $159.69 (nursing) and $196.33 (support); across 312 homes in the interim MCO rate file the median non-direct-care allowance is $221.48/day and the median rate at a case-mix weight of 1.0 is $369.11 (range $243.02-$484.18).

What matters in Wisconsin

• Each resident is paid differently: the claim's PDPM nursing and NTA codes set the direct care part, from about $80 to $500/day at the median home.
• Support services became a flat price at 125% of the median in 7/2023, a 75.9% jump ($89.65 to $157.73); it is $196.33 for SFY2027.
• Direct care nursing is capped at 125% of the median: $159.69/day for SFY2027 x labor factor (0.865-1.183).
• Family Care MCOs pay nursing homes the same FFS rates; DHS posts MCO rate sheets by PDPM group for 313 homes.
• The $170/bed/month bed tax is roughly returned through a flat $9.65/day Medicaid Access Incentive; there is no Medicaid-day discount.
• County homes share up to $39.1M a year in add-ons (19 of 35 got one for SFY2027, median $47.99/day); private homes cannot.

Frequently asked

Does Wisconsin Medicaid pay one daily rate per nursing home?

No. Since 1/1/2022 each claim carries the resident's PDPM HIPPS code. The home's nursing allowance is multiplied by that resident's nursing weight and the $17.37 other-direct-care price by the NTA weight, so rates vary by resident.

How did Wisconsin's 2023-25 budget change nursing home Medicaid rates?

2023 Act 19 made support services a priced rate at 125% of median cost, raising it 75.9% from $89.65 to $157.73/day for SFY2024 ($146.4M over two years). It also raised the ventilator rate from $726 to $926.

What do Family Care plans pay Wisconsin nursing homes?

The same rates as fee-for-service. DHS directs MCOs to use each home's FFS rates for dates of service from July 1, and Myers and Stauffer posts per-home rate tables by PDPM group for MCOs.

How much is paid outside the posted rate in Wisconsin?

Small: county-home add-ons (up to $39.1M a year) are about 4% of base nursing home Medicaid spending.

What does Wisconsin Medicaid pay on Medicare coinsurance days?

Full payment of Part A SNF coinsurance per the 2025 MACPAC compendium citing ForwardHealth; not confirmed in the handbook itself.

Does Wisconsin require a minimum share of spending on care?

No staff-spending floor; a profit limit cuts support services if the rate exceeds the home's own costs.

How is the Wisconsin nursing home provider tax charged?

$170 per licensed bed per month, flat; VA homes exempt; returned through a $9.65/day Medicaid Access Incentive.

How the rate is set

How the method got here

Verified October 11, 2026

Cost basis

Uses cost reports

Yes

Cost report

Wisconsin Medicaid Nursing Home Cost Report (F-01812), filed through Myers and Stauffer's WINHRS system; an independent CPA financial audit has also been required each year since the SFY2025 cycle (for SFY2026 rate setting).

Base year and rebasing

Rebased every year. Rates for a July 1 rate year use the cost report for the provider's fiscal year ending in the prior calendar year (SFY2026 rates = 2024 cost reports). Interim rates come from unaudited reports, then final rates after desk review or audit (about 1/3 of homes get a full DHS audit each year). From SFY2027 the direct care nursing and support services medians come from the most recent AUDITED costs (2024 reports) instead of the newest unaudited ones (2025), per the 8/28/2026 DHS slides.

Components

Component	Method	Notes
direct care nursing	Home's own inflated nursing cost per day / its all-resident PDPM nursing CMI = case-mix-neutral cost; allowance = lesser of that or the Nursing Services Target (125% of the median x labor region factor). The allowance is multiplied on each claim by the resident's PDPM nursing (NPG) weight.	Base $155.03 SFY2026 (Methods 2.10); $159.69 SFY2027 (median $127.75 + 25%, 8/2026 slides). Labor factors 0.865 (Oshkosh) to 1.183 (Minneapolis counties). 125%-of-median standard since 7/1/2022. Covers RN, NP, LPN, QIDP, CNA, feeding assistant, nurse aide training.
direct care other supplies and services	Flat price x each resident's PDPM NTA weight.	$17.37 SFY2026 and in the SFY2027 interim MCO file. Covers ward clerks, non-billable therapy/lab/radiology/pharmacy, social service and activity staff, medical supplies, OTC drugs.
support services	Flat price at 125% of the median inflated support cost per day (since 7/1/2023, 2023 Act 19), less the per-home 'support services reduction' if the home's CMI=1 rate (excluding incentives) exceeds its own inflated costs.	$157.73 SFY2024, $171.26 SFY2025, $193.45 SFY2026, $196.33 SFY2027. Covers dietary, housekeeping, laundry, maintenance, admin, utilities. Was $57.50 (SFY2022) and $89.65 (SFY2023).
property	Based on appraised equalized value (CoreLogic BVS depreciated replacement cost). Allowable property expense capped at 15% of EV; target 7.5% of EV; above target the home gets 20% of the excess. Intent: no more than 9% of EV. Maximum decrease $3.50/day per year.	Replacement cost per-bed cap: $75,900 through SFY2023, $96,735 SFY2024, $110,278 SFY2025, $119,872 SFY2026, $130,181 SFY2027.
property tax	Prior calendar year's tax bill (or municipal service fees for tax-exempt homes) x 1.007, per day.	Methods 5.10-5.40.
provider incentives	Per-day add-ons: Exceptional Medicaid Utilization Incentive (non-government homes, $0.75-$5.97 at 50-100% Medicaid days), Private Room Incentive (x $1.50), Innovative Area, Bariatric Equipment (50% of purchase cost per day), Behavioral/Cognitive Impairment (access $7.27 and improvement $0.69 bases in SFY2025), Medicaid Access Incentive $9.65 (NF), Small Facility Incentive $17.74 (50 or fewer beds).	Excluded from the support services reduction since SFY2024 (2023 Act 19, $31.2M).

Inflation

State-set factors by cost-report end quarter and cost category, published in the Methods. For SFY2027 (2025 reports): direct care wages 4.6%/4.3%/2.8%/2.1%, fringe 11.5%/10.6%/4.3%/3.5%, support services 6.4%/5.7%/4.0%/3.4% for Q1-Q4 year ends. Property tax +0.7%.

Verified October 11, 2026

Case mix

System

PDPM

Applied at

Resident-level

How it works

Methods 2.10/2.30: 'The PDPM reimbursement system is resident specific'; the nursing allowance is multiplied by the NPG weight (3rd HIPPS character) and the other-direct-care price by the NTA weight (4th character) on each resident's claim line.

Classification

Medicare SNF PPS PDPM weights for the nursing (25 groups) and NTA (6 groups) components; no variable per diem (durational) factor; PT/OT and SLP components not used. Fixed weights for special classes (SFY2026): non-DD bedhold 0.30/0.21, DD 2.36/1.71, DD bedhold 1.30/0.94, ventilator 3.84/3.06, hospice room and board 1.37/0.99. Default HIPPS ZZZZZ = lowest weights (PA1, NTA F).

Applies to

Direct care nursing (NPG weight) and direct care other supplies/services (NTA weight). Support services, property, property tax and incentives are not case-mix adjusted.

Acuity measured from

Claim-level for payment. A separate all-resident average PDPM nursing and NTA CMI over the cost-report period (data as of June 30) is used only to neutralize each home's nursing cost when setting its allowance. HIPPS from the active MDS (OBRA or PPS 5-day/IPA) applies from the ARD; assessments over 92 days old, late admission assessments (beyond 14 days) and stays discharged before an assessment bill ZZZZZ. MA-plan-only assessments cannot be used.

Updated

Each claim, with every new assessment; the weight table follows Medicare's PDPM weights (DHS adjusts bases for CMS parity cuts, e.g. 2.74% nursing / 2.47% NTA for 10/1/2023).

Move to PDPM

Moved from RUG-III 48-group index-maximizer facility-average Medicaid CMI (updated quarterly) to resident-specific PDPM billing for dates of service from 1/1/2022 (Myers and Stauffer PDPM billing guidance, effective 1/1/2022).

Verified October 11, 2026

Low-acuity residents

None. Wisconsin has no reduced or flat rate for low case-mix groups. Low-acuity residents (e.g. PA1, the lowest nursing group, paid about $80/day for nursing at the median home in the SFY2027 interim table) are paid less only through the PDPM nursing and NTA weights; the support, property and incentive parts are paid in full. Residents must still meet the nursing home level of care (Limited Nursing Care, Wis. Admin. Code DHS 132.13). Checked: Methods SFY2026 2.10-2.33; SFY2027 MCO rate workbook.

Verified October 11, 2026

Capital

Property allowance from appraised equalized value (depreciated replacement cost, per-bed cap $119,872 SFY2026 / $130,181 SFY2027): expense capped at 15% of EV, target 7.5% of EV, plus 20% of expense above target; maximum year-over-year drop $3.50/day. Plus a separate property tax pass-through. A new owner's asset basis is capped by CPI/Dodge-index rules and 108% of EV.

Verified October 11, 2026

Budget adjustment factor

No across-the-board factor. Limits work through (1) the 125%-of-median caps on direct care nursing and the support services price; (2) the per-home support services reduction (profit limit): if the CMI=1 sum of all components except incentives exceeds the home's own inflated costs, the excess comes off support services; (3) penalty cuts of 25%-100% of the rate for late cost reports, audits, appraiser payments or bed-assessment balances (Methods 1.30); (4) 2025 Act 15 included an unspecified $127M/yr all-funds Medicaid cost-to-continue reduction not tied to nursing homes.

Verified October 11, 2026

Add-ons and money outside the rate

Paid outside the posted rate

Level

small

Estimate

About 3-4% of base. The county/municipal add-on is capped at $39.1M a year against about $1.07B in base nursing home Medicaid spending ($715.1M FFS in 2023-24 + $353.9M Family Care institutional in CY2023). CPE excess payments were $0 in 2021-22 through 2023-24. Since 4/2024 the county money is paid as a per-diem add-on shown in the MCO rate file.

Components

County/municipal deficit add-on: up to $39.1M/yr (35 eligible, 19 paid for SFY2027). CPE excess distribution: $0 recently. No MCO directed payments or quality pools.

Source

https://docs.legis.wisconsin.gov/misc/lfb/informational_paper…

Verified October 11, 2026

Payments by owner type

Applies

yes

Detail

(1) Homes operated by local units of government (county/municipal; 35 flagged NSGO for SFY2027) share up to $39.1M a year as per-diem add-ons equal to their Medicaid deficits (19 received one for SFY2027, median $47.99/day, up to $299.89). (2) They also get any CPE federal match above the budgeted amount (none since 2020-21). (3) State veterans homes and tribal homes are paid the Medicare rate at their Medicaid case mix, with no ceilings. (4) VA homes are exempt from the bed assessment. (5) Conversely, the Exceptional Medicaid Utilization Incentive ($0.75-$5.97/day) is only for homes NOT operated by a government entity.

Funding

Local governments certify their expenditures as eligible for federal match (42 CFR 433.51(b) affidavit; CPE program). A home sold to a private owner keeps the add-on only for days the government operated it; a home bought by a local government during the year gets no award.

Source

https://www.forwardhealth.wi.gov/WIPortal/Tab/42/icscontent/p…

Verified October 11, 2026

Quality program

Active

No

Notes

No quality or pay-for-performance payment in the SFY2026 Methods or the 2023-2026 DHS rate meetings. The Behavioral/Cognitive Impairment 'Improvement' score (base $0.69/day SFY2025) is the only outcome-linked add-on, and it is acuity-based, not a quality program.

Verified October 11, 2026

Provider tax

Charged

per bed

Standard amount

$170 per licensed bed per month (statutory maximum 'not to exceed $170' since SFY2010-11), based on licensed beds as of the 15th of the prior month (DHS 15.04(2)(a)). Paid monthly.

Tiers

Who	Test	Amount
Nursing homes operated by the Wisconsin Department of Veterans Affairs	public	exempt
ICFs-IID	other	$910 per licensed bed per month

Lower for high-Medicaid homes

no

Returned in the rate

Not as a pass-through. The Medicaid Access Incentive ($9.65/day for every NF Medicaid day) is meant to repay, in aggregate, about what homes pay in the assessment (LFB Paper 46). Homes pay on all licensed beds (empty or private-pay), so high-vacancy or low-Medicaid homes are net payers. Since 1/1/2025 DHS reduces rates for delinquent assessments and refers balances over 120 days to the Department of Revenue.

Source

https://docs.legis.wisconsin.gov/statutes/statutes/50/i/14

Verified October 11, 2026

Provider tax notes

Licensed bed assessment (Wis. Stat. 50.14): $170 per licensed bed per month for nursing homes ($910 for ICFs-IID), deposited to the Medical Assistance trust fund; $55.0M collected in 2023-24. Returned in aggregate through the $9.65/day Medicaid Access Incentive. The assessment is not an allowable cost, but it is counted as expense in the support services reduction test.

Verified October 11, 2026

Supplemental payments

(1) Add-ons for nursing homes operated by local units of government (Methods 7.20; Wis. Stat. 49.45): up to $39.1M a year (all funds), limited by the Medicare upper limit, paid since 4/1/2024 as a prospective per-diem add-on equal to each home's Medicaid deficit from its unaudited cost report (FFS, MCO and hospice days). 30 homes qualified in 2023-24 (average $184.33/day), 34 in 2024-25 (average $79.41/day); the SFY2027 interim file flags 35 NSGO homes, 19 with an add-on (median $47.99/day, range $5.72-$299.89). The county certifies local expenditures eligible for FFP (42 CFR 433.51(b)). (2) Nursing home Certified Public Expenditure program: federal match on county/municipal homes' unreimbursed costs; any excess over the budgeted amount is paid out to those homes the next year; none paid in 2021-22 through 2023-24 ($0.7M CPE revenue in 2023-24). (3) State veterans homes and tribal homes are paid the Medicare rate. (4) Appraisal fee reimbursement. No MCO directed payment for nursing homes found.

Verified October 11, 2026

Other add-ons

(1) Medicaid Access Incentive $9.65/day (NF), $33.24 (ICF-IID). (2) Exceptional Medicaid Utilization Incentive, non-government homes only: $0.75 (50-59% Medicaid days incl. MCO and hospice), $1.49, $2.61, $4.10, $5.97 (90-100%). (3) Small Facility Incentive $17.74/day for 50 or fewer beds on the same or contiguous property. (4) Private Room Incentive: (private-bed % minus non-Medicaid day %) / Medicaid day % x $1.50, if no private room surcharge. (5) Behavioral/Cognitive Impairment access and improvement incentives (MDS + CDPS diagnosis scores). (6) Bariatric equipment: 50% of purchase cost per day. (7) Innovative Area Incentive (by approval, does not transfer on CHOW). (8) Specialized Psychiatric Rehabilitative Services $25.49/day SFY2026, $26.02 SFY2027 (PASRR Level II residents). (9) Isolation room add-on up to $35/day with prior authorization. (10) County-home per-diem add-on (see supplemental_payments).

Verified October 11, 2026

Units paid separately

(1) Ventilator-dependent residents (prior authorized, approved program): all-inclusive $972.88/day SFY2026, $993.12 SFY2027 (was $726 before 7/1/2023). (2) Traumatic brain injury rehab (prior authorized, approved program): all-inclusive $1,032.18 SFY2026, $1,053.65 SFY2027; no bed hold. (3) DD residents in NFs and ICFs-IID: DD rate class with fixed weights. (4) State and tribal-owned NFs (veterans homes): Medicare payment rate based on the home's Medicaid case mix; state ICFs-IID at actual cost. (5) Out-of-state NFs: standard rate for up to three months, then may be negotiated. (6) Hospice room and board paid to hospice at 95% of the rate from weights 1.37/0.99.

Verified October 11, 2026

Payment rules

Managed care for long-term care

Status

yes

Detail

Family Care (1915(b)/(c), statewide since 7/2018, mandatory for the benefit), Family Care Partnership and PACE MCOs include nursing home care in the benefit with no day limit. Capitation has separate nursing-home-level-of-care and non-nursing-home rate cells. About 1.12M of 3.54M projected SFY2026 Medicaid NH days are MCO days.

Verified October 11, 2026

Who pays

mixed: fee-for-service for most Medicaid nursing home days, plus Family Care, Family Care Partnership and PACE managed LTC organizations (statewide since July 2018), which pay nursing homes for their enrolled members. DHS projected SFY2026 days of 2,414,344 FFS non-DD vs 1,123,906 MCO (about 32% MCO). FFS nursing home payments were $715.1M in 2023-24; Family Care spent $353.9M on institutional care (NH/ICF-IID) in CY2023.

Verified October 11, 2026

Managed care rate floor

Yes, in practice: MCOs pay the FFS rates. DHS public meeting slides (8/2025, 8/2026): 'MCOs will be directed to use these rates for DOS 7/1/26 onward.' LFB Informational Paper 46 (Jan 2025): 'The rates paid to nursing homes to cover the costs of services provided to these individuals are equal to the Medicaid fee-for-service reimbursement rates, and are included in the capitation payments.' DHS posts 'Family Care MCO Rates by PDPM Category' workbooks for this purpose. The contract clause itself was not read. Sources: https://www.dhs.wisconsin.gov/nh-rates/nursing-payment-meetin… ; https://www.dhs.wisconsin.gov/familycare/mcos/nh-resources.htm

Verified October 11, 2026

Included in the daily rate

The daily rate covers nursing, non-billable therapy, lab, radiology, pharmacy and respiratory services provided to the home as a whole, covered OTC drugs, routine DME and disposable medical supplies, and supplies for ventilator residents. Billed separately: medical transportation by the home ($43/trip + $1.90/mile, Methods 7.40), ancillary services such as oxygen, lab and X-ray when billed by the provider (Wis. Stat. 49.45(6m)(b)), prescription drugs, physician and hospital services. Negative pressure wound therapy pumps moved into the daily rate (DHS memo, date not captured).

Verified October 11, 2026

Bed hold

Hospital stays

Paid at the Non-DD Bedhold rate (direct care at weights 0.30 nursing / 0.21 NTA plus the full non-direct-care allowance; median $264.53/day in the SFY2027 interim file). Maximum 15 consecutive days per hospitalization.

Leave days

Paid at the same Non-DD Bedhold rate; the Methods give no annual day limit (see open_questions).

Occupancy rule

Billable only if the home's occupancy was 94.0% or more in the prior calendar month (restricted-use and out-of-service beds excluded; prior-month bed hold days count as occupied). Homes closing or reducing beds may get an exemption.

Notes

Ventilator residents' bed holds pay the bedhold rate; TBI residents and Medicare Part A residents cannot be billed for bed hold. Residents or third parties may not be charged for covered bed hold days the home cannot bill.

Source

https://www.forwardhealth.wi.gov/WIPortal/Tab/42/icscontent/p…

Verified October 11, 2026

Personal needs allowance

Per month

55

Effective

2024-07-01

Notes

Raised from $45 by 2023 Act 19. Not indexed (handbook: 'Updated Annually? No'). Community waiver members keep a much larger basic needs allowance ($1,192/month from 5/1/2026).

Source

http://www.emhandbooks.wisconsin.gov/meh-ebd/policy_files/39/…

Verified October 11, 2026

Medicare coinsurance days

Method

full

Rule

Wisconsin's state plan (Attachment 4.19-B page 17, 'Payment of Title XVIII Part A and Part B Deductible/Coinsurance', TN 93-039, effective 10/16/1993) checks 'full amount' for the Part A deductible and Part A coinsurance for all three groups (Medicare-Medicaid, Medicare-Medicaid/QMB and QMB-only). Only the Part B coinsurance is 'limited to State plan rates' (4.19-B item 14: Medicaid maximum fee less the Medicare payment). This matches the ForwardHealth Online Handbook Topic #686 quoted by MACPAC (2025): for nursing facilities, 'Medicare deductibles, coinsurance, and copayments are paid in full'. The handbook itself sits behind a CPT license click-through and was not read directly. Treatment of Medicare Advantage SNF cost-sharing was not found.

Effect

For a dual-eligible on Medicare Part A days 21-100, the home receives the full daily coinsurance ($209.50 in 2025) from Medicaid on top of Medicare's payment, if the full-payment rule is current.

Source

https://www.dhs.wisconsin.gov/mandatoryreports/mastateplan/4-…

Verified October 11, 2026

Required care spending

Applies

no

Rule

No rule requires homes to spend a share of Medicaid revenue on staff or care, with recoupment. Related limits: (1) the direct care nursing allowance is the lesser of the home's own cost or the cap, so homes that spend less on nursing are paid less the next year; (2) the support services reduction cuts support services pay by any amount the CMI=1 rate (excluding incentives) exceeds the home's own inflated costs, a profit limit. 2019 Act 9 and 2021 Act 58 directed rate money 'to support staff ... who perform direct care' but set no spending test that was found.

Source

https://www.forwardhealth.wi.gov/WIPortal/Tab/42/icscontent/p…

Verified October 11, 2026

Occupancy rules

Applies

yes

Rule

(1) Bed hold days can be billed only if prior-month occupancy was 94.0% or more (Methods 7.80). (2) New homes in their first 12 months: property and property tax allowances spread over at least 50% occupancy of licensed beds (Methods 8.70). No occupancy floor applies to support services or direct care for existing homes, although statute allows DHS to set one (Wis. Stat. 49.45(6m)(ar)).

Source

https://www.forwardhealth.wi.gov/WIPortal/Tab/42/icscontent/p…

Verified October 11, 2026

MDS accuracy penalties

Methods 2.31: DHS reviews HIPPS codes and MDS data; 'Cases of over-coding acuity scores may be subject to claims recoupment or referral to the Office of the Inspector General.' Assessments older than 92 days, late admission assessments, and stays with no assessment are billed at default ZZZZZ (lowest weights). No fixed error threshold or percentage penalty was found.

Verified October 11, 2026

Published rates and changes

How often rates change

A home's rate changes

annual

When

July 1 each state fiscal year: interim rates from unaudited cost reports (set after July 1 and applied back to 7/1), then final rates after desk review/audit. Per-resident case mix changes the payment with every MDS assessment (HIPPS code on the claim). PDPM weight changes follow Medicare's October 1 updates when DHS adopts them.

Verified October 11, 2026

When rates change

July 1 rate year (e.g. 7/1/2026-6/30/2027). Interim SFY2027 rates were on file by 8/28/2026 with MCOs directed to apply them from 7/1/2026. Final rates come later after audit (rate letters on ForwardHealth / WINHRS). The SFY2027 Methods were to be submitted to CMS by 9/30/2026.

Verified October 11, 2026

Posted rates

Home-level rates published

Yes

Where

https://myersandstauffer.com/client-portal/wisconsin/ (Family Care MCO Rates by PDPM Category, linked from https://www.dhs.wisconsin.gov/familycare/mcos/nh-resources.htm); ForwardHealth public Nursing Home Rate Schedule lookup https://www.forwardhealth.wi.gov/WIPortal/Subsystem/Public/Nu…

Format

xlsx (one column per home: NSGO add-on, non-direct-care allowance, direct care nursing and other allowances at CMI=1, and the rate for each PDPM nursing group and NTA group, plus DD, bedhold and hospice rates); ForwardHealth lookup is an online form

Cadence

Annual rate year; the workbook is updated at least monthly as final rates are completed

History

Workbooks for SFY2023 through SFY2027 are posted on the Myers and Stauffer portal.

Home identifier

Medicaid 'PopID' (facility population ID) plus name and street address from the cost report; no CCN or NPI in the workbook.

Verified October 11, 2026

Rate build-ups

Published

No

Where

Full per-home rate calculations (cost per day, ceilings, CMIs, support services reduction) go to each provider through WINHRS rate letters, not posted. The public MCO workbook shows the component split per home.

What they show

Public workbook: NSGO add-on, non-direct-care allowance total, direct care nursing allowance at CMI=1 (after the cap), direct care other at CMI=1, and the resulting rate for every PDPM nursing and NTA group. Not shown: costs, medians, labor factor, property or incentive detail.

Format

xlsx

Example file

https://myersandstauffer.com/documents/WI/MCO%20Rates//1.%20S…

Verified October 11, 2026

Recent changes

Verified October 11, 2026

Assisted living

Medicaid assisted living

Covered

yes

Program

Family Care, Family Care Partnership and PACE (1915(b)/(c) managed LTC, statewide) pay residential services in community-based residential facilities (CBRFs), certified residential care apartment complexes (RCACs) and adult family homes. IRIS (self-directed, 1915(c)) cannot pay room and board.

What is paid

Care and supervision only. Room and board is paid by the member from income; providers must receive at least the member's room-and-board obligation. Family Care residential care spending was $1,104.2M in CY2023.

Rate

HCBS Minimum Fee Schedule, effective 10/1/2024 (minimum MCO payments, apparently per day): CBRF 5-8 members $141.35 / $158.65 / $168.31 (tiers 1-3); CBRF 9+ members $100.75 / $115.07 / $133.38; RCAC $67.41 (one rate); AFH 3-4 bed $203.50-$238.08. Tiers come from the Long-Term Care Functional Screen. MCOs must pay more when needed to secure care. Funded at about $258M/yr (2025 Act 15).

Limits

No waitlist for adults since February 2021; entitlement 36 months after county start. Requires nursing home (or non-nursing-home) functional eligibility via the Long-Term Care Functional Screen.

Source

https://www.forwardhealth.wi.gov/WIPortal/content/Managed%20C…

Verified October 11, 2026

Sources

1. Methods of Implementation for Wisconsin Medicaid Nursing Home Payment Rates, July 1, 2025 - June 30, 2026 (Attachment 4.19-D, TN 25-00XX) · state plan
2. Attachment 4.19-D posted on DHS state plan page (Methods for SFY2025, dated Dec 5, 2024) · state plan
3. DHS Nursing Home Payment Rates public meeting slides, Aug 28, 2026 (SFY2027) · agency page
4. DHS Nursing Home Payment Rates public meeting slides, Aug 7, 2025 (SFY2026) · agency page
5. DHS Nursing Home Payment Rates public meeting slides, Jul 19, 2024 (SFY2025) · agency page
6. DHS Nursing Home Payment Rates public meeting slides, Jul 24, 2023 (SFY2024; 2023-25 budget) · agency page
7. Wisconsin Medicaid Nursing Home PDPM Acuity Specific Billing Guidance (effective 1/1/2022, Myers and Stauffer) · agency page
8. SFY 2027 Family Care MCO Rates by PDPM Category (interim 7/1/2026, updated Aug 21, 2026) · rate file
9. DHS Family Care: Nursing Home Resources · agency page
10. DHS Nursing Home Reimbursement / Rate Setting pages · agency page
11. LFB Informational Paper 46 (Jan 2025): Medical Assistance and Related Programs, ch. 9 Nursing Home Services, ch. 10 Family Care · agency page
12. Wis. Stat. 50.14 Assessments on licensed beds · statute
13. Wis. Stat. 49.45(6m) nursing home payment system · statute
14. DHS Licensed Bed Assessment e-Payment page · agency page
15. LFB Summary of 2025 Act 15 (2025-27 budget), Health Services · statute
16. Medicaid Eligibility Handbook (EBD) 39.4 Deductions and Allowances · agency page
17. DHS HCBS Minimum Fee Schedule presentation (Sept 13, 2024; effective 10/1/2024) · agency page
18. MACPAC Compendium: State Medicaid Payment Policies for Medicare Cost Sharing (Aug 2025; cites ForwardHealth Topics #671/#686) · secondary

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