Every answer was written and checked ahead of time, with the official document next to it. Nothing is made up on the spot.
Do I need a license to run a non-medical home care agency in Wisconsin?
No state license, but Medicaid work needs certification or enrollment.
Wisconsin licenses home health agencies, which primarily provide skilled nursing and therapy. The documents we hold show no license for non-medical or supportive home care agencies, and the Family Care waiver lists no license or certificate for them. To bill Medicaid personal care as a freestanding agency, you need DHS approval and Medicaid certification under DHS 105.17; DQA reviews and surveys you. To be paid by Family Care MCOs or IRIS, you must enroll with Wisconsin Medicaid.
Written and checked September 22, 2026
How does an agency become a Medicaid personal care agency?
Apply to DQA, pass its on-site survey, and DQA recommends Medicaid certification.
A freestanding personal care agency applies on DHS forms with a nonrefundable fee. DQA approves or denies the application within 90 days, and approval lasts 1 year. You must ask for an on-site survey within 9 months and show you have served at least 5 personal care clients. After the survey, DQA recommends (or does not recommend) certification to the DHS Division of Medicaid Services. You need an administrator who meets DHS 105.17 qualifications and at least one registered nurse (RN).
Written and checked September 22, 2026
What does a Wisconsin home health license cost?
$300 to apply, then 0.25% of patient fee revenue each year.
The application fee is $300 and is nonrefundable. The yearly fee is 0.25% of patient fee revenue, at least $500 and at most $2,500, paid with the annual report. DQA may first issue a 90-day provisional license; during it the agency must serve at least 10 patients needing skilled care before asking for the licensure survey.
Written and checked September 22, 2026
When is the personal care agency annual report due?
Every 12 months; in 2026, through the DQA Provider Portal by April 30.
DHS 105.17 requires an annual report and fee every 12 months, on a schedule DQA sets. In 2026, renewals opened in the portal on March 1 and were due April 30; no document we hold gives the 2027 date. DQA's training slides say an agency that does not renew and pay on time is closed automatically and Medicaid is told to end its contract. The rule itself says DQA sends a warning and may end certification 60 days after the due date (see "Where the official documents disagree").
Written and checked September 22, 2026
What must a personal care prior authorization request include?
Screening tool, addendum, plan of care and clinical records.
Since Update 2026-23 (September 2026), requests need the Personal Care Screening Tool (PCST, F-11133), the Personal Care Addendum (F-11136), a plan of care with orders from a prescribing provider, and clinical records dated within 12 months of the requested start date, including at least a yearly physical exam. Add the live-in worker form (F-02717) and proof of residence if a live-in worker is exempt from EVV. Incomplete requests will be modified or denied.
Written and checked September 22, 2026
Which EVV system do Wisconsin agencies use?
Sandata, free from DHS, or a connected alternate system.
EVV is required for personal care (T1019, T1020), supportive home care (S5125, S5126), RN supervisory visits (99509) and home health services. Claims without matching verified EVV visits are denied. Plan on at least two weeks to set up Sandata, or up to three months for an alternate system.
Written and checked September 22, 2026
Do live-in caregivers have to use EVV?
Not always for personal care; always for home health and 99509.
DHS lets live-in workers skip EVV for T1019, T1020, S5125 and S5126. For fee-for-service, send the Live-In Worker Identification form (F-02717) with the PA request and bill with the KX modifier. Live-ins must still use EVV for 99509 and for home health care. HMOs, MCOs and agencies can require live-ins to use EVV anyway.
Written and checked September 22, 2026
Which Family Care health plans (MCOs) are there?
Anthem, Community Care, Inclusa and iCare, Lakeland Care, My Choice Wisconsin.
The DHS contact list (June 2026) names these managed care organizations for Family Care, Family Care Partnership and PACE, and lists the counties each serves. Under the 2026 contract, MCOs may only use providers enrolled in Wisconsin Medicaid.
Written and checked September 22, 2026
Do supportive home care agencies have to enroll with Wisconsin Medicaid?
Yes, to be paid by MCOs or IRIS.
All adult long-term care waiver providers had to enroll or revalidate through the ForwardHealth Portal. Agencies not approved by March 31, 2026 could not be paid for services from April 1, 2026. After enrolling, you revalidate every 3 years; ForwardHealth mails notices 90, 45 and 15 days before your date.
Written and checked September 22, 2026
How often must caregiver background checks be redone?
At least every four years.
Agencies covered by the Caregiver Law must get a Background Information Disclosure (F-82064), a Department of Justice record check and a DHS status report for each caregiver when hired, and redo the check at least every four years. Home health and personal care agencies are covered. For Family Care, the MCO contract makes the MCO do the checks or require providers to do them.
Written and checked September 22, 2026