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—enrollment now open!

As of September 16, 2024, adult long-term care waiver services providers must enroll with Wisconsin Medicaid through the ForwardHealth Portal. The Portal centralized enrollment system complies with federal requirements and standardizes, streamlines, and automates the process. Please note, this change does not affect individual self-directed support and participant-hired workers.

Here’s how to get started:

• Find information about the enrollment process in the Family Care, Family Care Partnership, PACE, and IRIS program areas of the ForwardHealth Online Handbook.
• Attend a live virtual training on Zoom to understand how to enroll. Check out the Live Training Schedule (PDF).
• Sign up for the Adult LTC Waiver Provider email subscription list to get training registration links by email.
• Find training recordings on the Trainings page of the Portal under the Adult Long-Term Care Programs menu.
• Visit the New Provider Enrollment System for Adult Long-term Care Portal page for more information.