Home and Community-Based Services (HCBS) Settings Rule

This webpage shares key information related to the Centers for Medicare & Medicaid Services (CMS) settings rule for Medicaid home and community-based services (HCBS) waivers.

How the federal settings rule affects HCBS waivers

HCBS waivers provide opportunities for Medicaid beneficiaries to receive services in their own home or community rather than in institutions or other isolated settings.

CMS requires all states that operate HCBS waivers to comply with the federal settings rule. The settings rule establishes requirements for residential and nonresidential service settings in Medicaid waiver programs. The purpose of the settings rule is to ensure that people receiving services through HCBS waiver programs have access to the benefits of community living and are able to receive services in the most integrated settings. The settings rule creates a more outcome-oriented definition of home and community-based settings rather than one based solely on a setting's location, geography, or physical characteristics.

Since the Wisconsin Department of Health Services (DHS) operates several programs under Medicaid HCBS waivers, DHS is required to implement the new rule. Over 80,000 people in Wisconsin receive services under 1915(c) waiver programs.

The HCBS rule applies to the following state Medicaid waiver programs:

• Family Care and Family Care Partnership
• IRIS (Include, Respect, I Self-Direct)
• Children's Long-Term Support Waiver

More information about the federal rule and HCBS settings rule requirements can be found on the CMS website.

Statewide transition plan

The HCBS settings rule requires states to develop a transition plan for reaching and maintaining compliance. Wisconsin's plan for meeting the rule's requirements is described in the Statewide Transition Plan for Compliance with Medicaid Home and Community-Based Setting Requirements, P-01839 (PDF).

Contact information

If you cannot find the answer to your question, send an email to DHSHCBSSettings@dhs.wisconsin.gov or call 877-498-9525.

Adult Long-term Care Provider Management Project—Encourage providers to enroll early

Adult long-term care waiver services providers and vendors must enroll with Wisconsin Medicaid through the ForwardHealth Portal by January 1, 2026. We need your help to get providers and vendors moving ahead this spring so they don’t fall behind later this year. Here are some key resources:

• Check out the New Provider Enrollment System for Adult Long-term Care Portal page. You’ll find recorded trainings about how to enroll and information on how to get started.
• Find a toolkit for managed care organizations, a toolkit for IRIS fiscal employer agencies, a toolkit for IRIS consultant agencies, and a toolkit for IRIS participants to help spread the word to providers.
• Stay updated by signing up for the Adult LTC Waiver Provider email list to get news and resources.

Please note:

• This requirement does not affect individual self-directed support or participant-hired workers.
• Currently, supportive home care organizations or providers with a unique EVV provider agency ID cannot apply because their provider type is not yet available in the application. We will post here when that changes later this summer.