How to start a home health agency in Wisconsin

Wisconsin requires a Home health agency license from Wisconsin Department of Health Services, Division of Quality Assurance to operate a home health agency. Fee: $300. Processing time: DQA has up to 90 days to review a complete application before issuing a provisional license (3 months, extendable up to 3 times for 1 year total).

License required

Yes

License

Home health agency license

Issuing agency

Wisconsin Department of Health Services, Division of Quality Assurance

Fee

$300

Fee details

$300 nonrefundable application fee; background checks $15 per person.

Renewal

No license renewal: a regular license is valid indefinitely. An annual continuing fee equals 0.25% of patient fee revenue (minimum $500, maximum $2,500).

Processing time

DQA has up to 90 days to review a complete application before issuing a provisional license (3 months, extendable up to 3 times for 1 year total).

Accreditation

Simultaneous licensure and Medicare certification can go through a CMS-approved accreditor (ACHC, CHAP and others) or a state survey.

Medicare certification

Medicare certification is optional for licensure but required for Medicaid HHA certification. DQA recommends Medicare after its survey and CMS issues the number. Separately, CMS put a 6-month nationwide moratorium on new Medicare enrollment of home health agencies (including new branches and practice locations) into effect on May 13, 2026; it can be extended in 6-month increments, and CMS left any Medicaid/CHIP moratorium to each state.

Regulation

Wis. Stat. § 50.49; Wis. Admin. Code ch. DHS 133

1. Send a letter of intent with the administrator's and substitute administrator's credentials
2. Submit form F-62674 with the $300 fee, background checks, organizational chart, 90-day budget (F-62674A), financial references and IRS EIN letter
3. Submit the pre-licensure checklist F-62536 with numbered policies and procedures
4. DQA does a fit-and-qualified review, then a policy review
5. Operate under a provisional license and serve 10 skilled nursing clients (7 active)
6. Send 10 care plans to trigger an unannounced licensure survey
7. Receive the regular license after corrections

Staffing

• Administrator: physician, RN, or person with health care administration training and 1 year supervisory/administrative home health experience; substitute administrator also required

Program

Wisconsin Medicaid / BadgerCare Plus (ForwardHealth, Wisconsin Department of Health Services)

Enrollment portal

ForwardHealth Portal — Become a Provider / Provider Enrollment Information

Fiscal agent

Gainwell Technologies (supports ForwardHealth interChange as the state's fiscal agent)

Application fee

ForwardHealth's handbook says some provider types owe the federally mandated application fee, which can change each year and offsets screening costs. It may be due again at re-enrollment and, where applicable, at revalidation. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.

Fingerprinting

ForwardHealth assigns limited, moderate or high risk, mostly using CMS's levels, and screens at enrollment, re-enrollment and revalidation. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.

Site visit

Screening follows the assigned risk level at enrollment, re-enrollment and revalidation. For some provider types, such as supportive housing agencies, the DHS Office of Inspector General does a site visit before revalidation can be completed. Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections.

Revalidation

Wisconsin revalidates every enrolled provider every three years, more often than the federal 5-year minimum. ForwardHealth mails a Provider Revalidation Notice giving the revalidation date (also visible via 'Check My Revalidation Date' on the secure Portal). Revalidation cannot start before that date, and the application, plus any fee, is due within 30 days after it. Providers who miss the deadline are terminated and must re-enroll with new screening and possibly another fee. During revalidation the provider re-signs the Provider Agreement and Acknowledgement of Terms of Participation.

Full Wisconsin Medicaid enrollment guide →

CON program

Yes

Program

Approval of nursing home and ICF/IID projects under Wis. Stat. ch. 150 (not called certificate of need)

Agency

Wisconsin Department of Health Services

Services covered

• construction of new nursing homes
• nursing home bed capacity increases
• nursing home capital expenditures over $1,000,000 (excluding renovation or replacement)
• nursing home clinical equipment over $600,000 (excluding renovation or replacement)
• conversion between nursing home and facility primarily serving persons with developmental disabilities

Moratoria

The statute caps licensed nursing home beds statewide at 51,795 and beds in facilities primarily serving persons with developmental disabilities at 3,704. DHS may adjust the caps only as the statute allows and must recommend changes every two years (Wis. Stat. §150.31).

Wisconsin certificate of need details →

Model

hybrid

State vendor

Sandata

Services in scope

• personal care
• supportive home care
• home health

Alternate EVV allowed

Yes

Program

https://www.dhs.wisconsin.gov/evv/index.htm

Wisconsin EVV requirements →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

Rate pass-through

State law directs DHS to work with care management organizations and CMS to raise the direct care and services portion of Family Care capitation rates to address direct caregiver workforce shortages (subject to federal approval).

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Home health agencies — active organization NPIs (NPPES)

999 (as of Sep 13, 2026)

Medicare-certified home health agencies (CMS Care Compare)

87 (as of May 27, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,107,383 (as of Jun 1, 2026)

All Wisconsin Home health Medicaid rates, ranked →