HCBS Settings Rule: Heightened Scrutiny

The Wisconsin Department of Health Services (DHS) looks at certain residential settings more closely. The goal is to see if they can get paid by Medicaid for waiver-funded services. We call this process heightened scrutiny review.

A setting can get paid by Medicaid if it is a home and community-based setting. The federal home and community-based services (HCBS) settings rule sets guidelines. Guidelines say a setting is not home and community-based if it:

• Is located in a publicly or privately owned facility providing inpatient treatment (including skilled nursing facilities).
• Is on the grounds of, or next to, a public institution.
• Keeps people away from the broader community of people who do not get Medicaid HCBS waiver services.

When a provider requests to receive Medicaid funding, and if any of these are true, the setting needs a heightened scrutiny review to see if it is home and community-based. DHS reviews materials submitted by these providers and visits each setting. During each visit, DHS talks to staff and residents.

DHS has found enough evidence to show that the new settings it reviewed met the HCBS settings rule and are not institutional. The evidence from these heightened scrutiny reviews is documented in each setting’s evidentiary summary below.

We want your input 

DHS has found enough evidence to show that the 2025 settings listed in the 2025 HCBS heightened scrutiny evidentiary summaries (PDF) meet the HCBS settings rule and aren’t institutional. View the 2025 evidentiary summaries below.

We are sharing the submitted documentation and onsite visits for public comment. Public comment is a time to share your thoughts with us. Submit your comments by January 2, 2026. You can:

• Email your comments to DHS at: DHSHCBSHeightenedScrutiny@dhs.wisconsin.gov
• Mail your written comments to:
  Division of Medicaid Services
  Bureau of Programs and Policy
  Attn: Public Comments–Wisconsin Medicaid HCBS Heightened Scrutiny
  PO Box 309
  Madison, WI 53703-0309

You can get paper copies of the evidentiary packages mailed to you. Call 877-498-9525.

Evidentiary summaries

The evidentiary summaries include a list of the settings DHS reviewed and their supporting documentation. The public comment summaries provide an overview of the public comments DHS collected.

Contact information

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