Summary of Revisions to the Medicaid Home and Community-Based Services Waiver Manual for the Children’s Long-Term Support Waiver Program
The updates included in the most recent (April 2026) version of the Medicaid Home and Community-Based Services (HCBS) Waiver Manual for the CLTS Waiver Program, P-02256 (PDF), are summarized below.
Chapter 1–Overview and Administration
No changes
Chapter 2–Eligibility
No changes
Chapter 3–Financial Eligibility
No changes
Chapter 4–Provider Requirements and Allowable Services
- § 4.5.5: added new section “Authorization of Market Rate Services.”
- § 4.6.4.2: clarifications for identifying the maximum amount the children’s foster care service may contribute for a level 5 foster home - the highest amount for any individual Residential Care Center (RCC) that’s listed on the Department of Children and Family’s RCC daily rate schedule.
- § 4.6.13: clarifications to support consistent operationalization of the empowerment and self-determination supports service as a service that may be provided only by providers who do not meet the definition of a caregiver (a person who has regular, direct contact with the participant).
- § 4.6.14: clarifications to support consistent operationalization of the family/unpaid caregiver supports and services service as a service that may be provided only by providers who do not meet the definition of a caregiver (a person who has regular, direct contact with the participant).
- § 4.7.3: changes to outline a process change for completing a Wisconsin caregiver background check, using the Wisconsin Online Record Check System (WORCS).
Chapter 5–Use of Funding in Substitute Care
§ 5.2: clarifications for identifying the maximum amount the children’s foster care service may contribute for a level 5 foster home - the highest amount for any individual RCC that’s listed on the Department of Children and Family’s RCC daily rate schedule.
Chapter 6–Enrollment and Recertification
No changes
Chapter 7–Individual Service Plan
- § 7.1.1: clarifications of the roles and responsibilities of the participant and the support and service coordinator in the service planning process.
- § 7.4:
- New definition of “outcomes” (changed from “the participant’s goals and the results they would like to see” to “the specific steps that help participants meet their overall goals and the results they would like to see”).
- Clarification that a participant’s outcomes must be identified before authorizing CLTS Waiver Program supports and services.
- Clarifications of what the CWA must ensure to complete an individual service plan:
- Authorized CLTS Waiver Program supports and services directly address and help the participant meet their outcomes.
- Authorized CLTS Waiver Program supports and services are unique to the participant’s disability and may not be items or services that are typically the responsibility of individuals not enrolled in the CLTS Waiver Program or are general household expenses.
- Coordination of benefits requirements are met.
- Cost effectiveness principles are used in the process of determining authorization of CLTS Waiver Program supports and services, to ensure the responsible use of public funds, and adding cost effectiveness guiding principles that must be used to evaluate which functionally equivalent option is appropriate to authorize.
Chapter 8–Participant Rights and Appeal and Grievance Processes
No changes
Chapter 9–Health and Safety
No changes
Chapter 10–Transition
No changes
Appendix A
Updated