Wisconsin - Transitional Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Wisconsin, Transitional Assistance Services are formally administered under the state's 1915(c) Medicaid waivers as "Relocation Services" within the Family Care, Family Care Partnership, and IRIS (Include, Respect, I Self-Direct) programs. This service provides critical, one-time financial assistance and coordination to cover setup expenses—such as security deposits, moving costs, and basic furnishings—for Medicaid members transitioning from institutional settings like nursing homes or Intermediate Care Facilities (ICF/IIDs) into their own community-based homes.

The single biggest structural barrier to entry for this service in Wisconsin is the state's mandatory managed care and self-directed waiver architecture. Wisconsin does not operate a fee-for-service (FFS) model for adult home and community-based services. Therefore, simply enrolling as a Medicaid provider through the state does not grant the ability to bill for services. To receive any payment, a provider must first complete the ForwardHealth Adult Long-Term Care enrollment, and then successfully secure a network contract with a regional Managed Care Organization (MCO) or be explicitly selected by a participant and authorized by an IRIS Consultant Agency (ICA).

1. Service Definition and Scope

Wisconsin defines this service category as Relocation Services within its adult long-term care waivers. The service is strictly limited to one-time, essential expenses required to establish a basic household when a member is moving from an institution to a private residence or a community-based residential facility (CBRF).

The scope of the service is highly regulated to prevent the use of Medicaid funds for ongoing living expenses or non-essential items. All expenditures must be directly tied to the member's transition plan and approved in advance by the member's care team.

• Covered Expense: Security deposits and up to the first month's rent required to secure a lease.
• Covered Expense: Essential household furnishings, including a bed, dining table, chairs, and basic kitchen utensils.
• Covered Expense: Professional moving company fees and transportation of personal belongings.
• Covered Expense: Initial set-up fees or deposits for essential utilities, including electricity, water, and heating.
• Excluded Expense: Ongoing monthly rental or mortgage payments beyond the initial transition period.
• Excluded Expense: Recreational items, televisions, cable service setup, or luxury furnishings.

2. Regulatory and Oversight Agencies

The Wisconsin Department of Health Services (DHS) oversees all Medicaid HCBS programs through its Division of Medicaid Services (DMS). Because Relocation Services do not involve direct medical care or the operation of a residential facility, providers are not licensed by the Division of Quality Assurance (DQA).

Instead, oversight is decentralized and managed contractually. Providers are monitored by the regional Managed Care Organizations (MCOs) or IRIS Consultant Agencies (ICAs) that authorize the specific transition funds.

• Wisconsin Department of Health Services (DHS): The overarching state agency administering Medicaid and HCBS waivers (https://www.dhs.wisconsin.gov).
• Division of Medicaid Services (DMS): The specific DHS division that manages the Family Care and IRIS programs (https://www.dhs.wisconsin.gov/dms/index.htm).
• ForwardHealth: The state's Medicaid Management Information System (MMIS) and provider enrollment portal operator (https://www.forwardhealth.wi.gov).
• Aging and Disability Resource Centers (ADRCs): County or regional entities that conduct initial functional eligibility and options counseling for members (https://www.dhs.wisconsin.gov/adrc/index.htm).
• Managed Care Organizations (MCOs): Regional entities, such as My Choice Wisconsin, that contract with providers for Family Care service delivery (https://mychoicewi.org).

3. Gatekeeping Prerequisites: Who Can Even Apply

The most critical gatekeeping prerequisite in Wisconsin is the managed care and self-directed structure of the adult long-term care system. There is no open fee-for-service enrollment pathway that guarantees a provider the right to bill for Relocation Services.

Providers must navigate a multi-tiered approval process, starting with state Medicaid enrollment and ending with localized network contracting or participant selection. Without an MCO contract or an IRIS participant authorization, a provider cannot operate or bill in this space.

• MCO Network Contracting: Providers must successfully negotiate and sign a credentialing contract with a regional Family Care MCO (e.g., Community Care, Inclusa) to receive referrals.
• IRIS Participant Selection: For the IRIS program, providers must be actively selected by a participant and have the specific transition service approved on the participant's Individual Support and Service Plan (ISSP).
• ForwardHealth LTC Enrollment: Providers must complete the Adult Long-Term Care Provider Enrollment process through the ForwardHealth Portal before any MCO or IRIS Fiscal Employer Agent (FEA) will issue payment.
• ADRC Referral Pathway: Members must be transitioned through the local ADRC; providers cannot self-generate Medicaid-funded transitions without ADRC and MCO/ICA approval.
• No Standalone Licensure: Because Wisconsin does not issue a specific "Transitional Assistance" license, providers must qualify under general business requirements and meet the specific credentialing standards of the contracting MCO.

4. Licensure and Certification Requirements

Wisconsin does not license or cover this service under a distinct statutory authority or facility license. There is no "Relocation Services License" issued by the state.

Instead, providers operate as standard commercial businesses—such as moving companies, retail furniture stores, or independent transition coordinators. They are approved based on standard business registration, commercial insurance, and adherence to MCO credentialing requirements.

• Business Registration: The agency must be registered as a legal entity (LLC, Corporation, etc.) with the Wisconsin Department of Financial Institutions (DFI) (https://wdfi.org).
• Tax Identification: The business must possess a valid Federal Employer Identification Number (EIN) from the IRS.
• Commercial Liability Insurance: MCO contracts typically require general liability insurance, often mandating a minimum of $1 million per occurrence.
• Division of Quality Assurance (DQA) Exemption: This service does not require DQA certification, as it does not involve direct personal care or residential facility operation.
• Local Business Licenses: Providers must hold any applicable municipal licenses required for retail or moving operations in their specific city or county.

5. Medicaid Provider Enrollment

All HCBS providers, including those providing Relocation Services, must enroll via the ForwardHealth Portal. This process generates a unique Medicaid Provider ID, which is a strict prerequisite for MCOs and IRIS FEAs to process claims.

Providers must ensure that their legal business name, tax identification, and physical address match exactly across all submitted documents to avoid immediate application rejection.

• Enrollment System: Applications must be submitted through the ForwardHealth Portal (https://www.forwardhealth.wi.gov/WIPortal/cms/public/ltc/provider_enrollment.htm).
• Provider Type: Applicants must select the "Adult Long-Term Care" provider type during the online enrollment process.
• Processing Time: ForwardHealth applications can take up to 60 days to process from the date of submission.
• Location Requirement: Providers must enroll and receive a unique Medicaid ID for each physical business location they operate.
• Required Form: Applicants must submit a completed IRS W-9 form matching the exact legal name and EIN on the ForwardHealth application.

6. Staffing, Training and Background Checks

Because Relocation Services often involve entering a vulnerable person's home or handling their transition funds, background checks are strictly enforced by state law. Training requirements are generally dictated by the contracting MCO rather than state statute.

Agencies must maintain a roster of cleared employees and ensure that no staff member with a disqualifying offense has direct, unsupervised contact with waiver participants.

• Caregiver Background Check: Required via the Wisconsin Department of Justice (DOJ) for any staff with direct, unsupervised contact with members.
• Misconduct Registry: Staff must be cleared through the Wisconsin DHS Caregiver Misconduct Registry prior to employment.
• OIG Exclusion List: Agencies must verify that staff are not on the federal HHS Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE).
• MCO-Specific Training: Staff may be required to complete MCO-mandated training modules on incident reporting, member rights, and the HCBS Settings Rule.
• Financial Handlers: Staff handling member funds for security deposits or utility setups must often be bonded or meet specific MCO financial security requirements.

7. Documentation, Policies and Records

Providers must maintain rigorous documentation to prove that waiver funds were spent exclusively on approved transition items. Receipts and invoices serve as the primary clinical and financial record for this service.

Failure to produce itemized receipts during an MCO or state audit will result in immediate recoupment of funds.

• Itemized Receipts: Providers must retain original, itemized receipts for all purchased furnishings, deposits, and moving expenses.
• Service Authorization: The agency must keep a copy of the MCO or IRIS service authorization detailing the exact approved budget and items for the transition.
• Record Retention: Wisconsin Medicaid requires all financial and service records to be retained for a minimum of five years.
• Incident Reporting Policy: Agencies must have a written policy for reporting critical incidents (e.g., abuse, neglect, exploitation) to the authorizing MCO and DHS.
• Participant Signatures: The delivery of goods (such as furniture) must be documented with a delivery receipt signed and dated by the waiver participant.

8. Billing, Rates and Claims

Providers do not bill the state MMIS (ForwardHealth) directly for Relocation Services. Instead, claims and invoices are submitted to the authorizing MCO or the IRIS Fiscal Employer Agent (FEA).

This service is not reimbursed on a standard fee schedule; rather, it is reimbursed at actual cost up to the maximum authorized limit established on the member's individual care plan.

• Billing Entity (Family Care): Claims are submitted directly to the contracted MCO's claims clearinghouse (e.g., WPS Health Solutions) or internal MCO portal.
• Billing Entity (IRIS): Invoices are submitted to the participant's chosen Fiscal Employer Agent (FEA), such as Premier FMS (https://premier-fms.com) or GT Independence.
• Rate Structure: Reimbursed at actual cost up to the authorized limit; providers cannot mark up the cost of retail goods or deposits.
• Prior Authorization: 100% of transitional expenses must be prior-authorized; retroactive billing for unapproved items is strictly prohibited.
• Timely Filing: MCO contracts typically require claims to be submitted within 90 to 120 days of the date of service or purchase.

9. Approval Sequence and Timeline

Becoming a fully paid provider requires sequential approvals from the state and the managed care entities. Providers cannot skip steps or apply to an MCO without first securing a ForwardHealth Medicaid ID.

The entire process, from initial business setup to receiving the first authorized member referral, typically takes three to five months.

• Step 1: Register the business entity with the Wisconsin DFI and obtain an EIN from the IRS (1-2 weeks).
• Step 2: Submit the Adult LTC Provider Enrollment application via the ForwardHealth Portal (up to 60 days).
• Step 3: Receive the Notice of Enrollment Decision and unique Medicaid ID from ForwardHealth.
• Step 4: Apply for network inclusion with regional Family Care MCOs or register as a vendor with IRIS FEAs (30-90 days).
• Step 5: Receive a specific member Service Authorization from the MCO or IRIS Consultant Agency before purchasing any goods or initiating a move.

10. Common Denials and Survey Findings

Because this service is heavily audited for financial compliance, most denials stem from purchasing unapproved items or failing to secure prior authorization before spending funds.

Providers must strictly adhere to the line items approved on the service authorization; substituting items without written MCO approval will result in non-payment.

• Denial Reason: Purchasing items not explicitly listed on the MCO or IRIS service authorization (e.g., buying a television when only a bed was authorized).
• Denial Reason: Submitting claims directly to ForwardHealth FFS instead of the authorizing MCO or IRIS FEA.
• Audit Finding: Failure to maintain original, itemized receipts for purchased goods, leading to fund recoupment.
• Audit Finding: Using waiver funds for ongoing rent or mortgage payments, which violates the one-time setup rule of the waiver.
• Enrollment Denial: The legal name on the ForwardHealth application does not exactly match the IRS W-9 or DFI registration.

11. Key Contacts and Resources

Providers should rely on the ForwardHealth Portal for state enrollment issues and contact regional MCOs or IRIS agencies directly for contracting, authorization, and billing inquiries.

Maintaining open communication with the member's MCO Care Manager or IRIS Consultant is essential for smooth service delivery and payment.

• ForwardHealth Provider Services: 1-800-947-9627 for enrollment and portal assistance (https://www.forwardhealth.wi.gov).
• Wisconsin DHS Family Care Information: Overview of the managed care program and MCO contacts (https://www.dhs.wisconsin.gov/familycare/index.htm).
• Wisconsin IRIS Program: Self-directed waiver information and ICA/FEA contacts (https://www.dhs.wisconsin.gov/iris/index.htm).
• Wisconsin Department of Financial Institutions (DFI): For business entity registration (https://wdfi.org).
• Wisconsin Caregiver Background Check Program: For mandatory staff background screenings (https://www.doj.state.wi.us/dles/cib/background-check-criminal-history-information).

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