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.

Adult Long-term Care Provider Management Project: all providers should enroll now to avoid disruptions in 2026

All adult long-term care waiver services providers and vendors must enroll with Wisconsin Medicaid through the ForwardHealth Portal by January 1, 2026. As of August:

• Supportive home care agencies can now start a provider enrollment application.
• Supportive home care agencies with an electronic visit verification (EVV)-only provider Medicaid ID can convert their EVV-only enrollment to full Medicaid enrollment (revalidate).

Time is running out to process provider enrollment applications before the new year. We need your help to get providers and vendors enrolled—here are some key resources:

• Check out 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.
• 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.