1. Program Definition and Services

Personal Care Services (PCS) in Wisconsin provide medically necessary, hands-on assistance with Activities of Daily Living (ADLs) for individuals with functional or medical limitations. Services are delivered in the client's residence or community across two core approaches:

• Hourly Assistance with ADLs/IADLs: Dedicated daily support covering bathing, grooming, dressing, toileting, transfers, mobility, and light housekeeping directly related to the participant's care needs
• Medically Monitored Care Coordination: Non-skilled physical support coupled with verbal medication reminders, complex skin care, and nutritional intake assistance, completely directed by a specialized clinical roadmap

2. Regulations

Wisconsin Administrative Code DHS 105.17 sets strict provider certification, administrative staffing criteria, and financial accounting mandates for personal care providers.

Wisconsin Administrative Code DHS 107.112 defines Medicaid-covered services, physician prescription parameters, and detailed nursing supervision requirements.

3. Licensing or Certification

Operating entities do not require a separate medical facility license for standard home-delivered personal care. However, they must secure formal Medicaid provider certification through ForwardHealth. The agency must remain under the direction of a qualified administrator who is at least 21 years old and possesses an health-related degree or equivalent healthcare management experience.

4. Responsible State Agencies

Three structural entities co-manage program criteria:

• Wisconsin Department of Health Services (DHS)
• ForwardHealth
• MCOs & IRIS Consultant Agencies (ICAs)

5. Application Process

Applicants complete business registration through the Department of Financial Institutions (DFI) and acquire an organizational Type 2 NPI. The agency then submits a Medicaid provider enrollment application to ForwardHealth. Once Medicaid-certified, the agency establishes contractual relationships with regional MCO networks or IRIS Fiscal Employer Agents (FEAs) to receive authorization for client referrals.

6. Required Documentation

• DFI corporate registration certificate and an organizational Type 2 NPI mapped to a personal care or home health taxonomy
• Documented proof of liquid resources sufficient to cover at least 60 days of business operating expenses
• Personal Care Operations Policy Manual defining
• Background Information Disclosure (BID) forms and cleared background check logs 
• Staff personnel files containing signed written certifications

7. Timeline for Approval

Corporate organization, DFI registration, and financial cache setup takes 2 to 4 weeks. Review of the ForwardHealth Medicaid enrollment application and credential verification takes 1 to 2 months. Setting up local MCO or IRIS panel contracts requires an additional 30 to 45 days.

8. Pre-Application Process

Before initiating the ForwardHealth enrollment process, prospective providers must finalize their commercial legal foundation. This requires securing an active corporate EIN via the IRS, hiring or contracting an eligible Registered Nurse (RN) Supervisor, and obtaining comprehensive commercial liability and malpractice insurance.

9. Pre-Application Training

Personal Care Workers (PCWs) must complete competency-based training before delivering care independently. The supervising RN must verify and document each worker's successful performance of every assigned skill. Mandatory orientation modules must cover agency policies, client rights, ethics, universal precautions, and reporting protocols under the Wisconsin Caregiver Misconduct Law.

10. Additional Notes

• All personal care services must be ordered by a physician or advanced practice nurse prescriber, written medical orders must be formally renewed every 3 months unless an annual extension is clinically justified
• The provision of services must be strictly supervised by an RN, who must execute required in-home supervisory visits to evaluate staff performance and update the clinical Plan of Care
• Daily service logs must track specific assigned tasks completed, structural visit timestamps, and detailed clinical observations to clear state post-payment documentation audits

Why Choose Waiver Consulting Group?

Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any state.

With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.

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