Wisconsin Medicaid Home and Community-Based Services Heightened Scrutiny

We want your input. 

The Wisconsin Department of Health Services (DHS) looks at certain home and community-based services (HCBS) settings more closely. The goal is to see if they can get paid by Medicaid for waiver-funded services. We call this process heightened scrutiny review. DHS wants your input on our findings. That’s why we’re opening a 30-day public comment period.

A setting can get paid by Medicaid if it is a home and community-based setting. The federal HCBS settings rule sets the guidelines. Guidelines say a setting is not home and community-based if it is:

• In a publicly or privately owned facility providing inpatient treatment (including skilled nursing facilities).
• On the grounds of, or next to, a public institution.
• Keeps people away from others who don’t get Medicaid HCBS waiver services.

If any of these are true, then the setting needs a heightened scrutiny review to see if it is home and community-based.

DHS has found enough evidence to show that the new settings meet the HCBS settings rule and aren’t institutional. View the settings (PDF) under review and their supporting documentation. You can find more information on the Heightened Scrutiny webpage. 

Public comment is a time to share your thoughts on the submitted documentation and onsite visit.

Submit your comments by August 15, 2026. You can:

• Email your comments to DHS at DHSHCBSHeightenedScrutiny@dhs.wisconsin.gov.
• Mail your written comments to:
  Division of Medicaid Services
  Bureau of Programs and Policy
  Attn: Public Comments–Wisconsin Medicaid HCBS Heightened Scrutiny
  PO Box 309
  Madison, WI 53703-0309

You can get paper copies of the evidentiary summaries mailed to you. Call 877-498-9525.