Completing the registry is the first step in becoming a provider of HCBS waiver services. After completing the registry, please contact your county waiver agency (CWA). For more details, see Ch. IV of the HCBS Waiver Manual.
- Complete the online Wisconsin Medicaid Waiver Provider Registration process.
- Complete and sign the appropriate Medicaid Waiver Provider Agreement form. (If you are not sure which form you need, your CWA can help you to decide which form to fill out.)
- WI Medicaid Program Provider Agreement and Acknowledgement of Terms of Participation for Waiver Service Provider Agencies, F-00180 (Word) is for Medicaid waiver service provider organizations, such as personal care agencies, adult or child day care agencies, supportive home care agencies, transportation agencies, and other organizations or agencies that have been specifically identified as covered service providers.
- WI Medicaid Program Provider Agreement and Acknowledgement of Terms of Participation for Individual or Non-Traditional Providers, F-00180A (Word) is for providers who are individual, sole proprietors, unaffiliated with an agency or service organization. It is also to be used for a company that provides waiver-funded services not typically covered by Medicaid providers. Examples include carpenters and other skilled trades completing home modifications or specialty work such as vehicle modifications.
- WI Medicaid Program Provider Agreement and Acknowledgement of Terms of Participation for Waiver Service Provider Agencies or Individuals - Self-Directed Supports, F-00180B (Word) is used for provider agencies or individuals who are employed by the waiver participant under a self-directed support and service plan and paid through a fiscal agent or fiscal intermediary.
- Email the completed and signed form to the DHS Provider Registry.
Placement on the registry does not establish approval as a qualified provider.
Waiver Service Rates Initiative
The State of Wisconsin is creating a uniform rate-setting methodology for most waiver services. This may affect payment for providers. Please see the Waiver Service Rates Initiative page for more information.
Information for Counties
CWAs can find more information about their role in provider registration here.