The Wisconsin Department of Health Services has released new private-pay nursing home rates that take effect January 1, 2026. The update comes through Operations Memo 25-20, published November 17, 2025, and will influence long-term care planning, Medicaid eligibility reviews, and waiver determinations across the state.
New benchmark rates for 2026
The memo establishes two updated private-pay cost figures used in Medicaid policy and eligibility calculations:
A daily average private-pay nursing home rate of $352.06
A monthly average private-pay nursing home rate of $10,708.49
These benchmarks play a central role in several financial and eligibility determinations. They are used when calculating divestment penalty periods for individuals who transfer assets below fair market value. They also help determine eligibility for Wisconsin’s Home and Community-Based Waiver Group B Plus program.
Implications for agencies and planning teams
Long-term care providers, financial planners, and Medicaid specialists should update their tools and workflows before the January 2026 effective date. Eligibility assessments that rely on institutional cost deductions will now reference the updated monthly rate of $10,708.49.
For individuals with intellectual or developmental disabilities served in state centers, a different cost-of-care rate applies. However, for most applicants the private-pay rate remains the primary benchmark used in eligibility calculations.
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