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 (October 2025) 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
§ 1.1: change to clarify by replacing “legal guardian” with “legal representative” and adding definition of legal representative. (A legal representative is someone with court-ordered authority to act on behalf of the child to make major medical decisions and/or consent to CLTS Waiver Program enrollment and services; the county waiver agency, or CWA, must retain a copy of the court order.)
Chapter 2–Eligibility
- § 2.4.1: change to clarify by replacing “legal guardian” with “legal representative” and adding definition of legal representative. (A legal representative is someone with court-ordered authority to act on behalf of the child to make major medical decisions and/or consent to CLTS Waiver Program enrollment and services; the CWA must retain a copy of the court order.)
- § 2.8.1: change to clarify by adding definition of legal representative. (A legal representative is someone with court-ordered authority to act on behalf of the child to make major medical decisions and/or consent to CLTS Waiver Program enrollment and services; the CWA must retain a copy of the court order.)
Chapter 3–Financial Eligibility
No changes
Chapter 4–Provider Requirements and Allowable Services
- §§ 4.2.1, 4.3.2.1, 4.6.2.1, 4.6.3.2, 4.6.3.3, 4.6.3.5, 4.6.5.1, 4.6.8.1, 4.6.8.5, 4.6.11.5, 4.6.13.1, 4.6.13.2, 4.6.13.4, 4.6.14.3, 4.6.15.2, 4.6.20.5, 4.6.23.6, 4.6.24.3, 4.6.26.1, 4.6.27.4, and 4.6.30.1: change to clarify by replacing “legal guardian” or “authorized representative” with “legal representative” and adding definition of legal representative. (A legal representative is someone with court-ordered authority to act on behalf of the child to make major medical decisions and/or consent to CLTS Waiver Program enrollment and services; the CWA must retain a copy of the court order.)
- §§ 4.5.3.1 and 4.5.3.2: clarification of method to submit one time high-cost submissions by replacing “email to dhscltshighcost@dhs.wisconsin.gov” with “the CLTS High-Cost Request Processing Application in the ForwardHealth Portal.”
- § 4.6.15.1: clarification of the Financial Management Services service definition by
- Changing “Train caregivers on the requirements for providing financial management services” to “Train caregivers on the service requirements, limitations, and exclusions for the CLTS Waiver Program service(s) the caregiver will directly provide to the participant, as outlined in the applicable service description(s) in § 4.6"
- Specifying the frequency the Fiscal Agent should “complete screening activities for caregivers by conducting US Office of the Inspector General List of Excluded Individuals and Entities” by adding “when the caregiver is hired and at a minimum each time the FMS provider renews their CLTS Waiver Program Medicaid Waiver Provider Agreement and Acknowledgement of Terms of Participation (F-03344) with DHS”
Adding information about what the FMS provider needs to do to verify caregiver qualifications:
“For the specific CLTS service the caregiver will directly provide to the participant, the FMS provider must confirm and verify any required certification, license, education, or experience documentation is valid, current, and meets applicable service description requirements per § 4.6 in the CLTS Program Manual.CLTS Waiver Program funds may not pay for services provided by persons who have been denied a professional license, certification, or enrollment by the Department of Health Services, Department of Safety and Professional Services, Department of Children and Families, or Department of Workforce Development. In addition, services may not be provided by persons whose credentials have been suspended or revoked, or who have been denied the renewal of their professional license or certification.”
- § 4.6.29.5: clarification by updating the title of the DHS support and service coordinator training course to “CLTS Program Training for Support and Service Coordinators.”
Chapter 5–Use of Funding in Substitute Care
No changes
Chapter 6–Enrollment and Recertification
§§ 6.1 and 6.1.1.1: change to clarify by replacing “legal guardian” with “legal representative” and adding definition of legal representative. (A legal representative is someone with court-ordered authority to act on behalf of the child to make major medical decisions and/or consent to CLTS Waiver Program enrollment and services; the CWA must retain a copy of the court order.)
Chapter 7–Individual Service Plan
- §§ 7.1, 7.3,7.4, 7.4.2.1, and 7.5: change to clarify by replacing “legal guardian” with “legal representative” and adding definition of legal representative. (A legal representative is someone with court-ordered authority to act on behalf of the child to make major medical decisions and/or consent to CLTS Waiver Program enrollment and services; the CWA must retain a copy of the court order.)
- § 7.6: removed Authorized Representative Designation form (F-20987).
Chapter 8–Participant Rights and Appeal and Grievance Processes
§ 8.1: change to clarify by replacing “legal guardian” with “legal representative” and adding definition of legal representative. (A legal representative is someone with court-ordered authority to act on behalf of the child to make major medical decisions and/or consent to CLTS Waiver Program enrollment and services; the CWA must retain a copy of the court order.)
Chapter 9–Health and Safety
§ 9.1, 9.2.2, 9.3.3, 9.4.1, 9.4.4: change to clarify by replacing “legal guardian” with “legal representative” and adding definition of legal representative. (A legal representative is someone with court-ordered authority to act on behalf of the child to make major medical decisions and/or consent to CLTS Waiver Program enrollment and services; the CWA must retain a copy of the court order.)
Chapter 10–Transition
§ 10.1: added new resource, “The Children’s Long-Term Support and Adult Long-Term Care Programs,” to support participant transition from the CLTS Waiver Program to adult long-term care programs.
Appendix A
Updated