RESIDENTIAL CARE SERVICES PROVIDER IN WISCONSIN

OFFERING SUPPORTIVE, COMMUNITY-BASED HOUSING OPTIONS FOR INDIVIDUALS WHO NEED ASSISTANCE WITH DAILY LIVING WHILE PRESERVING AUTONOMY AND DIGNITY

Residential Care Services in Wisconsin provide housing and daily support for individuals with disabilities, chronic health conditions, or functional limitations who are unable to live independently but do not require institutional care. These services promote long-term stability, community integration, and quality of life. Wisconsin offers several licensed residential care models, which may be funded through Family Care, IRIS, or Children’s Long-Term Support (CLTS) waivers. Services must align with the participant’s Individual Service Plan (ISP) or Long-Term Care Functional Screen (LTCFS) and comply with licensing and Medicaid standards.

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1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)

Role: Regulates residential facility licensure and monitors provider compliance.

Agency: Division of Quality Assurance (DQA)

Role: Issues licenses and conducts surveys for Adult Family Homes (AFHs), Community-Based Residential Facilities (CBRFs), and Residential Care Apartment Complexes (RCACs).

Agency: IRIS Consultant Agencies / Managed Care Organizations (MCOs)

Role: Authorize funding and oversee care planning for waiver participants in residential settings.

2. TYPES OF RESIDENTIAL CARE SETTINGS

Adult Family Homes (AFH)

• Serve 1–4 residents

• Provide assistance with ADLs, meals, medication, and social activities

• Require DHS licensure

Community-Based Residential Facilities (CBRF)

• Serve 5+ residents

• Offer personal care, supervision, and supportive services

• Must meet staffing and facility requirements based on capacity and resident needs

Residential Care Apartment Complexes (RCAC)

• Independent apartments with optional support services

• Regulated under a separate certification process

• Can serve elderly adults or people with disabilities

3. SERVICES PROVIDED IN RESIDENTIAL CARE

Residential settings offer 24/7 supervision and a blend of personal care and habilitation supports:

• Assistance with bathing, dressing, and hygiene

• Meal preparation and dietary accommodations

• Medication assistance or administration

• Health monitoring and emergency response

• Socialization, recreation, and life skills training

• Transportation coordination

• Behavior support (if applicable)

All services must be delivered in a person-centered, home-like environment and aligned with the resident’s individualized plan.

4. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Wisconsin Department of Financial Institutions (DFI)

• Obtain Federal EIN and Type 2 NPI (if billing Medicaid)

• Submit facility floor plans and program statements to DQA

• Complete background checks, fire safety inspection, and sanitation review

• Obtain facility licensure as AFH, CBRF, or RCAC

• Enroll as an IRIS or Family Care provider (if serving waiver participants)

• Create a Residential Care Services Policy & Procedure Manual

5. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register business and secure EIN/NPI

Step 2: Choose a residential model (AFH, CBRF, or RCAC) and apply to DQA

Step 3: Undergo DHS-required inspections and staff clearance

Step 4: Apply to serve IRIS or Family Care participants through local MCOs or ICAs

Step 5: Submit P&P Manual, program statement, and staffing plan

Step 6: Begin services upon licensure and participant placement

6. REQUIRED DOCUMENTATION

• DHS license certificate and floor plans

• NPI registration and Medicaid/Fiscal Employer Agent agreement

• Residential Care P&P Manual, including:

  • Admission, discharge, and transfer procedures

  • Medication handling and incident reporting

  • Fire safety, emergency preparedness, and infection control

  • Staff credentialing, supervision, and shift coverage

  • Daily care logs and activity schedules

  • Participant rights and grievance protocols

  • Billing documentation and service verification

7. STAFFING REQUIREMENTS

Role: Administrator / Facility Manager

Requirements: Experience in residential care, background check, and compliance training

Role: Direct Care Staff / Resident Assistant

Requirements:

• 18+ years old with a caregiver background check

• First Aid and CPR certification

• Personal care and habilitation training

• Crisis response training (for behavioral support homes)

All staff must complete:

• HIPAA and confidentiality training

• Person-centered care and resident rights

• Abuse, neglect, and exploitation prevention

• Annual skills refreshers and supervision

8. WAIVER PROGRAMS THAT COVER RESIDENTIAL SERVICES

• Family Care / Family Care Partnership – Residential costs and services funded through MCOs

• IRIS (Include, Respect, I Self-Direct) – Participants choose residential supports through Fiscal Employer Agents (FEAs)

• Children’s Long-Term Support (CLTS) Waiver – May cover child-specific group homes or out-of-home respite

Note: Room and board is often funded privately or via SSI/SSDI, while support services are paid through waiver programs.

9. TIMELINE TO LAUNCH

Phase: Business Registration & Facility Planning

Timeline: 1–2 months

Phase: DQA Licensing & Staff Credentialing

Timeline: 2–4 months

Phase: Medicaid/MCO Enrollment & Readiness Review

Timeline: 30–60 days

Phase: Opening and Participant Admission

Timeline: Begins once the license is granted and resident funding is authorized

10. CONTACT INFORMATION

DHS Division of Quality Assurance – Residential Licensing

Website: https://www.dhs.wisconsin.gov/regulations/residential/index.htm

DHS Long-Term Care Programs

Website: https://www.dhs.wisconsin.gov/long-term-care-support.htm

ForwardHealth Medicaid Portal

Website: https://www.forwardhealth.wi.gov

Wisconsin Department of Financial Institutions (DFI)

Website: https://www.wdfi.org

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN RESIDENTIAL CARE PROVIDER

WCG helps providers open licensed residential homes with comprehensive support for licensing, staffing, Medicaid enrollment, and daily care documentation.

Scope of Work:

• DHS licensing and IRIS/MCO enrollment

• Residential Care P&P Manual development

• Floor plan and program statement preparation

• Staff credentialing logs and emergency plans

• Resident care documentation, shift notes, and incident forms

• Billing tools and compliance tracking templates

Continue To Our Client Portal To Get Started

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