Medicaid Home and Community-Based Services

For use by Wisconsin HCBS Waiver Programs:

  • Children's Long-Term Support (CLTS)
  • Community Integration Program IA (CIP IA)
  • Community Integration Program IB (CIP IB)
  • Community Integration Program II (CIP II)
  • Community Options Program – Waiver (COP-W)

List of Chapters and Sections of the Revised Interim Manual

Chapter I – Overview and Administration (PDF) I-1
1.01 Long-Term Support in Wisconsin (PDF) I-1
1.02 State Medicaid Waiver Authority (PDF) I-2
1.03 The Medicaid Waiver Mandate (PDF) I-2
1.04 Exemptions from the Mandate (PDF) I-3
1.05 Registering Applicants on HSRS (PDF) I-4
1.06 Medicaid Waiver Program Wait Lists (PDF) I-5
Chapter II – Waiver Eligibility (PDF) II-1
2.01 Waiver Eligibility (PDF) II-1
2.02 Waiver Target Groups (PDF) II-1
2.03 Waiver Services for Persons with Severe & Persistent Mental Illness (PDF) II-6
2.04 Active Treatment/ No Active Treatment (NAT) Determination (PDF) II-6
2.05 Medicaid Non-Financial Eligibility Requirements (PDF) II-9
2.06 The Parental Payment Limit (PDF) II-12
2.07 Level of Care (LOC) (PDF) II-12
2.08 Eligible Living Situations (PDF) II-14
2.09 Waiver Participant Moves (PDF) II-16
2.10 Denial of Participation or Termination of Program Participation (PDF) II-22
2.11 COP Eligibility After Waiver Program Termination (PDF) II-26
Chapter III – Financial Eligibility (PDF) III-1
3.01 Medicaid Eligibility (PDF) III-1
3.02 Children Applying for the Waiver – Special Considerations (PDF) III-3
3.03 Medicaid Waiver Income Groups (PDF) III-4
3.04 Spousal Impoverishment (PDF) III-11
3.05 New Applicants Leaving an Institution (PDF) III-13
3.06 Payments, Prepayments or Repayments to Medicaid (PDF) III-13
3.07 Other Payments (PDF) III-13
Chapter IV – Allowable Services (PDF) IV-1
4.01 Introduction (PDF) IV-1
4.02 Ensuring Providers are Qualified (PDF) IV-1
4.03 Ensuring Access  - Provider Choice (PDF) IV-4
4.04 Conflict of Interest (PDF) IV-6
4.05 Provider Screening Requirements (PDF) IV-8
4.06 Medicaid Waivers: General Limitations (PDF) IV-12
4.07 Participant Contributions (PDF) IV-14
4.08 Reserved for future use (PDF) IV-14
4.09 Allowable Services Index (PDF) IV-15
Chapter V – Use of Funding in Substitute Care (PDF) V-1
5.01 Introduction (PDF) V-1
5.02 Determining Waiver Allowable Costs (PDF) V-1
5.03 Ability to Pay - Room and Board (PDF) V-2
5.04 Waiver Specific Requirements: CIP 1A/1B (PDF) V-4
5.05 Waiver Specific Requirements: CLTS (PDF) V-4
5.06 Waiver Specific Requirements: CIP II, COP-W, and COR (PDF) V-4
5.07 Purchasing Substitute Care Services (PDF) V-13
Chapter VI – The Waiver Application Packet (PDF) VI-1
6.01 Introduction: The Application (PDF) VI-1
6.02 The Content of the Waiver Application Packet (PDF) VI-1
6.03 Waiver Program Start Date (PDF) VI-15
6.04 Medicaid Waiver Application and Approval Process (PDF) VI-17
6.05 The Waiver Application Packet – Reference Guide (PDF) VI-21
Chapter VII – Recertification, Plan Review, and ISP Update (PDF) VII-1
7.01 Introduction (PDF) VII-1
7.02 Recertification: Program Specific Requirements (PDF) VII-3
7.03 Timeliness of Recertification and Documentation (PDF) VII-11
7.04 Individual Service Plan Review - Documentation (PDF) VII-12
7.05 Service Plan Updates (PDF) VII-13
Chapter VIII – Participant Rights and Appeal and Grievance Processes (PDF) VIII-1
8.01 Medicaid Waiver Applicant/Participant Rights (PDF) VIII-1
8.02 Responsibility for the Notification of Rights (PDF) VIII-1
8.03 Waiver Agency Actions Subject to Appeal or Grievance (PDF) VIII-4
8.04 General Notice and Notification Requirements Associated with Waiver Agency Actions (PDF) VIII-6
8.05 Participant Rights: Restrictive Measures (PDF) VIII-7
Chapter IX – Assuring the Health and Safety of Medicaid Waiver Participants (PDF) IX-1
9.01 Introduction (PDF) IX-1
9.02 Application of this Chapter to Individuals and Agencies (PDF) IX-2
9.03 Response Systems Required (PDF) IX-3
9.04 Investigation / Inquiry Expectations of Waiver Agencies (PDF) IX-5
9.05 Waiver Agency Response Options (PDF) IX-6
9.06 Incident Prevention, Management, Resolution, and Reporting (PDF) IX-7




Please continue to use current manual material on Reporting and Reimbursement until the revised manual material is available.

Appendix List

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Last Revised: May 23, 2018