COVID-19: Testing Support for Shelters

The Wisconsin Department of Health Services is pleased to announce that Wisconsin shelters with shared living environments will be able to order rapid antigen tests for COVID-19 and/or lab-based follow-up PCR tests for free from the state of Wisconsin. This testing support is intended to complement COVID-19 prevention efforts.

All shelters with shared living environments are eligible to receive supplies. Organizations without shared living environments but who work with housing insecure populations may be eligible to receive testing supplies. Please contact WICOVIDTEST@wisconsin.gov (link sends e-mail) to learn how to apply.

Key definitions

Close contact: being within 6 feet of another person with confirmed or suspected COVID-19 for a cumulative total of 15 minutes or more over a 24-hour period.
Asymptomatic: a person who does not report or appear to have any symptoms or signs of illness.
Symptomatic: a person is exhibiting symptoms.
Quarantine: is used to keep someone who might have been exposed to the virus away from others.
Isolation: is used to separate people infected with COVID-19 from those who are not infected.
Molecular test: commonly called a PCR test, is a type of highly accurate diagnostic test that can detect an active COVID-19 infection. Samples for molecular diagnostic tests are typically collected with a nasal swab, or saliva collected by spitting into a tube. Samples are usually sent to a lab for processing.
Antigen test: commonly called a self-test or at-home test, is a type of diagnostic test that can detect an active COVID-19 infection. Samples for diagnostic tests are typically collected with a nasal swab. Results are available in 15-30 minutes. For symptomatic individuals who test negative or asymptomatic individuals who test positive, a confirmatory molecular test is recommended.
Up to date: A person has received all recommended doses in their primary series COVID-19 vaccine, and all booster dose(s) recommended for you.
Self-test: Self-tests for COVID-19 give rapid results and can be taken anywhere, regardless of your vaccination status or whether or not you have symptoms.

Key reasons to test in shelters

Testing in shelters is recommended by the CDC Testing in Homeless Shelters and Encampment. This includes diagnostic testing for symptomatic individuals and close contacts and/or regular screening testing for asymptomatic individuals such as weekly screenings.
People living in congregate settings are at a much higher risk for contracting and spreading COVID-19. The housing insecure population is part of this vulnerable group as they often live in close quarters, with rotating staff who have personal lives that create exposure risks in this setting.
Testing helps reduce community spread and keeps shelters operating safely. Testing individuals who are symptomatic and close contacts helps enable rapid detection of positive cases in shelters to reduce or prevent outbreaks. A routine screening testing program, which regularly tests people without symptoms or known exposures, is a tool to reduce “silent” spread of the virus and can help residents and staff. Testing regularly can prevent an outbreak, keeping residents and staff safe.
COVID-19 testing is free of charge. COVID-19 testing supplies, specimen transport, diagnostics and reporting are available to shelters.
COVID-19 testing is safe and accurate. Shelters can choose to offer laboratory-based testing or point-of-care antigen tests for residents and staff/volunteers. Both provide reliable results. If a shelter uses antigen tests and provides test results, they must first obtain a CLIA Waiver. If using a lab-based molecular test, all tests, transport, test results, and reporting are covered at no cost. Shelters may choose the type of tests they will use and develop a testing plan specific to their needs

Who is able to be tested?

Staff and residents are able to be tested.

When should testing be performed?

There are multiple options to consider when deciding on a testing strategy for residents and staff.

Provide screening tests upon intake.
Provide routine screening tests for asymptomatic residents and staff.
Test symptomatic individuals.
Test close contacts of someone who has tested positive for COVID-19.

Preparing for COVID-19 testing: step-by-step instructions

Determine the right test for your shelter.
Obtain a CLIA Certificate of Waiver (only for rapid point-of-care tests).
Partner with a clinician.
Submit a request for testing supplies.
Complete training.
Set up an account with the Wisconsin State Lab of Hygiene to report results.

1. Determine the right test for your shelter.

Testing supplies are available through the DHS COVID-19 testing supplies website. Shelters have the option to order and use testing supplies that best meet their needs for residents and staff, including highly accurate lab-based tests, rapid point-of-care tests, and antigen tests for use for self-testing.

Lab-based molecular tests (PCR)

Laboratory-based molecular tests, commonly referred to as PCR tests, are gold standard tests that are highly accurate. Conducted in a specialized environment by trained professionals, these tests are the most accurate tests available. These shelf-stable supplies must be return-shipped or couriered to a laboratory for resulting. Test results are usually available in 24-48 hours. The laboratory has all required certificates and handles reporting for the shelter.

Antigen tests, used for self-testing:

A COVID-19 self-test, also called an at-home test or over-the-counter test, is a type of COVID-19 test that you can take at home or anywhere. Self-tests are easy to use and produce rapid results.

COVID-19 Self-testing Information

Antigen point-of-care tests

Antigen point-of-care tests are available for use in shelters when proctored and reported under a CLIA Certificate of Waiver. This test can provide results in 15-20 minutes. Antigen point-of-care tests are the most accurate for individuals with symptoms. Confirmatory molecular testing is recommended (but not required) for asymptomatic individuals who test positive and symptomatic individuals who test negative.

To use rapid point-of-care tests, shelters must:

Obtain a Clinical Laboratory Improvement Amendment (CLIA) Certificate of Waiver. The CLIA certificate process is fast and easy.
Report results to state and federal authorities within 24 hours of result.
Facilitate access to confirmatory testing when needed. DHS will provide lab-based molecular testing supplies to shelters for confirmatory testing. More information about confirmatory testing is available.

2. Obtain a CLIA Certificate of Waiver (only for rapid point-of-care tests).

When ordering rapid antigen tests from DHS, you will need to submit your CLIA Certificate of Waiver number.
To obtain a CLIA Certificate of Waiver, you will need to submit a completed application to dhsdqaclia@dhs.wisconsin.gov.

3. Partner with a clinician.

All COVID-19 testing sponsored by this program needs to occur under the authority of a clinician with prescribing authority (MD, DO, PA, or NP). If you do not have a local clinician who manages your shelter's health services, you can complete the attestation form and submit to WICovidTest@Wisconsin.gov. This will allow you to conduct testing under the statewide standing order for COVID-19 tests prescribed by the Wisconsin DHS Chief Medical Officer.

4. Submit a request for testing supplies to the Wisconsin COVID-19 Collection Supplies Request Portal.

Order free DHS testing supplies.

Select “Other Organization”
- Provide a brief description in the “Testing Plan” section
- Select “Housing Compromised/Shelter” in the Facility Type
- Complete requested contact and shipping information
To order lab-based PCR testing supplies:
- Enter the name of the laboratory that your organization is paired with
- If your organization has not been paired with a lab, please indicate “need pairing”
- Click “Add Item” and select “Collection Supplies and Laboratory Services”
- Enter quantity of tests being requested
To order point-of-care antigen testing supplies:
- Enter quantity of tests being requested
- Provide organization’s CLIA Certificate of Waiver number if your organization is performing specimen collection, result interpretation, and providing results to the patient.
To order self-test antigen supplies:
- Enter quantity of tests being requested
- A self-test does not involve specimen collection, observation, or test result interpretation by a third party and does not require a CLIA Certificate of Waiver.
- Enter “requesting self-test antigen supplies” in the “Notes” section
- Review and accept outlined terms

5. Complete training.

Any staff who will administer COVID-19 testing at your shelter must complete training to assure they are using the tests safely and effectively.

Performing and Reporting antigen self-tests in Shelters

If shelters provide antigen self-tests to individuals in their facilities, individuals using the test should follow the manufacturer’s instructions exactly to collect and perform the test.

Individuals who test are encouraged to report any positive results to a health care provider or local or tribal health department. If they think their positive test result may be incorrect, they should contact their health care provider to determine whether more testing is necessary.

Performing and Reporting antigen self-testing in Shelters

6. Set up an account with the Wisconsin State Lab of Hygiene to report results.

COVID-19 is a Category I reportable condition in Wisconsin. As such, test results must be reported to the State of Wisconsin and to federal authorities (HHS). To report results, set up an account.
If you have questions about ordering testing supplies or shelter testing in general, please email WICOVIDTEST@wisconsin.gov.

Frequently asked questions by category

Is it mandatory for shelters to test residents and staff? No. Providing testing in shelters is voluntary, but having routine testing is one way to prevent the spread of COVID-19.
Is biohazard waste disposal provided by the state? No. Biohazard waste disposal is not covered. Shelters are responsible for safely disposing of waste. Options include the use of biohazard bags for used resulting cards, hard-sided biohazard containers for used swabs, and/or the use of a medical biohazard disposal service. For additional information, see CDC Waste Management Guidelines for SARS-CoV-2 Point-of-Care Testing.

When does a shelter need a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver? For a shelter to conduct point-of-care tests, the shelter must apply for and receive a CLIA Certificate of Waiver. Shelters may not conduct testing until the certificate of waiver has been approved. A shelter does not need a certificate of waiver if they collaborate with another entity willing to conduct testing at the shelter under that entity’s CLIA Certificate of Waiver or if the shelter is not conducting point-of-care tests.
- All testing would occur under the external entity’s CLIA certificate. The shelter should verify that the external entity conducting the test has a valid CLIA Certificate of Waiver. To find out if an entity has a valid CLIA Certificate of Waiver, request the CLIA number from the testing partner and verify it by checking the CDC CLIA Laboratory Search website or emailing DHSDQACLIA@wi.gov. All entities ordering supplies from DHS are required to provide their CLIA number when placing their orders.
What responsibilities must a shelter fulfill as an organization with a CLIA waiver? Any organization with a CLIA Certificate of Waiver is responsible for the safety and effectiveness of services they provide. For shelters conducting COVID-19 point-of-care testing, this includes staff training, effective infection control practices, and reporting infectious disease test results to the state of Wisconsin and to the federal authorities (HHS). Guidance about how to set up an account and report COVID-19 point-of-care test results is available from the Wisconsin State Laboratory of Hygiene. If a shelter coordinates with a testing partner or is providing lab-based molecular tests (not point-of-care tests), then the laboratory will assume the responsibility for the safety and effectiveness of testing – including responsibility for reporting test results on the shelter’s behalf.
How does a shelter apply for a CLIA Certificate of Waiver? To apply to receive a CLIA Certificate of Waiver, the shelter must fill out the Center for Medicare and Medicaid Services (CMS) application form CMS-116 CLIA Application and submit it to the State of Wisconsin CLIA Section at DHSDQACLIA@wi.gov. Once approved, CMS will assign a CLIA number and send a letter or email of confirmation to the shelter. For more information on CLIA certification, reference the CMS Laboratory Quick Start Guide.
How long does it take to process the CLIA Certificate of Waiver? Once a shelter submits an accurate and complete application, CMS usually processes the Certificate of Waiver in one week or less. Once approved, the shelter will be assigned a Federal CLIA number and may begin testing. Provide the CLIA number to DHS when ordering testing supplies.
Is there a fee associated with applying for a CLIA Certificate of Waiver? Yes. An entity is required to pay $180.00 to CMS before the CLIA Certificate of Waiver is approved. CMS will send an invoice to the shelter, and you may submit payment to CMS directly or pay online at Pay.Gov.
Does the CLIA Certificate of Waiver expire? The CLIA Certificate of Waiver is good for two years. CMS will send a renewal invoice 6 months prior to the expiration date of the certificate.
The CLIA application asks to identify the "director" of the laboratory. Can this be anyone in the shelter? The shelter may list any employee as the director on the CLIA application. It is recommended that the director is an individual who is or who will become knowledgeable about the requirements of maintaining the CLIA Certificate of Waiver and the shelter’s testing operations, including testing and safety protocols, staff training, and reporting of test results.
What other information will the application request? The application requires the shelter to provide their tax ID number. The application also requires the shelter estimate the number of tests they plan to conduct. This can be a general estimate based on the number of staff and residents.
How can a shelter verify whether they already hold a CLIA certificate? To verify whether an entity has a valid CLIA Certificate of Waiver, check the CDC CLIA Laboratory Search website or email DHSDQACLIA@wi.gov.
Who do I contact if I have additional questions about the CLIA Certificate of Waiver process? For any questions about the CLIA Certificate of Waiver and process, email the State of Wisconsin Department of Health Services, Division of Quality Assurance at DHSDQACLIA@wi.gov.

Who at the shelter is allowed to collect the specimen for a COVID-19 test? Does it have to be a nurse? Any staff member who is properly trained is allowed to collect the specimen and test the specimen to obtain a result. Training may be accessed through many venues, including from a trained clinician (a health care provider) or through the test manufacturer’s materials. If you need assistance finding these vendor materials, email WICovidTest@Wisconsin.gov.
- Self-tests can be distributed directly to Unhoused individuals to conduct and result themselves.
Does a shelter need to have access to lab-based molecular tests? All shelters conducting point-of-care testing under the Wisconsin Department of Health Services (DHS) standing order statewide standing order must assure compliance with the DHS and CDC recommendation for providing follow-up testing to confirm some antigen results. Lab-based molecular tests are recommended for this follow-up testing. Shelters can order and provide these follow-up, confirmatory tests for residents and staff, or refer staff to follow-up:
- at a free community testing site that conducts molecular testing
- at the individual’s health care provider or a free or low-cost health clinic for those who do not have a health care home (verify if they are conducting COVID-19 molecular testing prior to referral).
Should shelters require a negative test result for residents to return to the general population and staff to return to work? No. It is not recommended to require a negative test before returning. There have been reports that an individual can continue to test positive long after they are considered to be contagious.
If staff or residents test positive, how long should they isolate and quarantine? A person who tests positive should follow CDC Quarantine and Isolation Guidance. For additional guidance on this topic, contact your local or tribal health department. They may offer specific guidance for shelters.
When should an individual be referred for follow-up lab-based molecular testing? Follow-up confirmatory molecular testing is recommended for individuals who are symptomatic and test negative using a point-of-care antigen test. Confirmatory testing should be conducted as soon as possible and within 48 hours. For a simple guide on when to retest, see COVID-19 Antigen Testing: When is it best to retest? Additional guidance for the use of antigen testing is located in a point-of-care antigen test memo.

Does a shelter providing testing need an order signed by a medical provider? Yes, COVID-19 testing needs to occur under the authority of a medical provider. A shelter may obtain a written order through a clinician with prescribing authority (MD, DO, PA, or NP), or opt to use a standing order issued by Dr. Ryan Westergaard, Chief Medical Officer for the Wisconsin Department of Health Services. If a shelter chooses to use Dr. Westergaard’s standing order, they must sign an attestation form agreeing to follow the requirements of the order.