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 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
The settings rule does not change the funding for institutions, such as nursing homes and intermediate care facilities for individuals with intellectual disabilities. These institutions are funded through the Medicaid State Plan. Institutions have never been allowable settings for long-term residential care under 1915(c) authority.
Learn more about the federal rule and HCBS settings rule requirements
- Home & Community Based Services Final Regulation at the Medicaid.gov website.
- Watch the DHS video HCBS Settings Rule: Overview:
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, email DHSHCBSSettings@dhs.wisconsin.gov or call 877-498-9525.
Medicaid payments will end March 31 for adult long-term care providers who do not submit a provider application immediately
All adult long-term care waiver services providers needed to submit an application to enroll or revalidate with Wisconsin Medicaid through the ForwardHealth Portal by December 31, 2025. Providers who choose not to apply will not get reimbursed by Wisconsin Medicaid for dates of service on and after April 1, 2026.
Providers who did not apply but want to keep delivering home and community-based services under one of Wisconsin’s adult long-term care waiver programs must apply immediately. Applications must be approved and contracts and services must be authorized before providers can be paid by Wisconsin Medicaid. This can take several weeks. Providers may see a lapse in payment if their application is not approved by March 31, 2026.
Key resources:
- Providers—learn how to apply on the 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.
- Partners—use our toolkits to help spread the word to providers:
Please note: this requirement does not affect individual self-directed support or participant-hired workers.