Medicaid Standards for Certified 1-2 Bed Adult Family Homes

The Wisconsin Medicaid Standards for Certified 1-2 Bed Adult Family Homes (AFHs) help protect and promote the health, safety, and welfare of people living and getting support, services, and supervision in 1-2 bed AFHs.

These certification standards affect:

• Managed care organizations (MCOs) operating Family Care and Family Care Partnership
• The IRIS (Include, Respect, I Self-Direct) program
• County human service agencies that certify and serve as placing agencies for 1-2 bed AFHs

The standards apply to 1-2 bed AFH providers, operators, substitute or respite care providers, staff who work in an AFH, and the residents served in the AFH and their legal decision-makers.

Each 1-2 bed AFH must be certified by one MCO, county human service agency, or the IRIS program before serving residents in the AFH. An AFH can only be certified by one agency. Once the AFH has been certified, they may be eligible to admit residents from other MCOs, IRIS consultant agencies (ICAs), or county human service agencies.

How to get a 1-2 Bed Adult Family Home Certification

1. Review and comply with standards and benchmarks.

AFH applicants must:

• Review and comply with the Wisconsin Medicaid Standards for Certified 1-2 Bed Adult Family Homes, P-00638 (PDF)
• Review and comply with the Home and Community-Based Services (HCBS) Settings Rule Benchmarks: 1-2 Bed Adult Family Homes (AFH), P-02060 (PDF)

2. Contact and request certification from your preferred certifying agency.

For county programs, contact your County Human Service Agencies.

For Family Care and Family Care Partnership programs, see which MCOs are in your area using the Family Care Geographic Service Regions (GSR) map, P-01790 (PDF).

See current list of certified 1-2 bed adult family homes (Excel)

For IRIS, contact the Wisconsin Department of Health Services, Division of Medicaid Services—DHSIRISAFH@dhs.wisconsin.gov. 1-2 bed IRIS AFH providers must use the AFH provider portal to become certified. Learn more on the 1-2 bed AFH Certification for IRIS Providers: Using the AFH Provider Portal webpage.

3. Work with the certifying agency to do the review.

After agreeing to complete a certification review, the agency will supply the AFH applicant with the forms and instructions required by that agency for the completion of a certification review.

Free caregiver training available

The WisCaregiver Careers program now meets the caregiver training requirements for 1-2 bed AFHs.

Newly hired caregivers must complete at least 15 hours of training within the first 90 days. All caregiver staff must complete at least 15 hours of training annually. The Wisconsin Medicaid Standards for Certified 1-2 Bed AFHs, P-00638 (PDF), updated in August 2024, now include provisions related to V.H.1.a-l (initial training) and V.H.2.a-l (ongoing training).

The Certified Direct Care Professional (CDCP) program, along with two FREE supplemental trainings, meets all the required training standards and can be used for annual staff training. The free supplemental microcredential training courses include: Resident Rights in All HCBS Settings and Medication Administration. Learn more at WisCaregiverCDCP.com.

Free training for caregivers in 1-2 bed AFHs fact sheet, P-03683 (PDF)

Resources

• Wisconsin Medicaid Standards for Certified 1-2 Bed Adult Family Homes, P-00638 (PDF)
• Home and Community-Based Services (HCBS) Settings Rule Benchmarks: 1-2 Bed Adult Family Homes (AFH), P-02060 (PDF)
• Wisconsin 1-2 Bed Adult Family Home Change Reporting (F-03044) (Word)

Exceptions

A certifying agency or the placement agency responsible for placement of the resident into the AFH may apply for an exception to certain 1-2 bed AFH certification requirements on behalf of the AFH, resident, or legal decision-maker. This process is outlined in the Wisconsin Medicaid Standards for Certified 1-2 Bed Adult Family Homes. DHS will review and decide whether to grant exceptions to the requirements in these standards. If an exception is granted it may be unconditional or with conditions.

For certifying or placing agencies only: AFH Exceptions Request Form (F-02220)

DHS contacts

If you have questions about the standards, please call 608-261-6393 or email the appropriate program:

• Family Care: DHSDMSLTC@dhs.wisconsin.gov
• IRIS: DHSIRISAFH@dhs.wisconsin.gov

If you are interested in opening a 3-4 bed adult family home, you must be licensed. To find out more, go to the Division of Quality Assurance's Adult Family Home webpage.

Adult Long-term Care Provider Management Project: Medicaid payments to end for providers not self-enrolled through the ForwardHealth Portal

All adult long-term care waiver services providers must enroll with Wisconsin Medicaid through the ForwardHealth Portal right away. Medicaid payments for services delivered in homes or in the community will end in 2026, for providers who do not self-enroll now.

• Most providers should submit a new provider enrollment application on the ForwardHealth Portal to get a Medicaid-issued provider ID.
• Supportive home care agencies with electronic visit verification (EVV)-only provider Medicaid IDs have a quicker process. They’ll convert their EVV-only enrollment to full Medicaid enrollment. It’s called revalidation.

Key resources:

• Providers should visit 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 should use our toolkits to help spread the word to providers. We’ve created a:
  • Toolkit for managed care organizations
  • Toolkit for IRIS fiscal employer agencies
  • Toolkit for IRIS consultant agencies
  • Toolkit for IRIS participants

Please note: this requirement does not affect individual self-directed support or participant-hired workers.