How to start a private duty nursing agency in Wisconsin

Wisconsin requires a Home health agency license (Wis. Admin. Code DHS 133) with Medicare certification — or Medicaid enrollment as a nurse in independent practice from Wisconsin Department of Health Services (DQA license; ForwardHealth enrollment) to operate a private duty nursing agency.

License required

Yes

License

Home health agency license (Wis. Admin. Code DHS 133) with Medicare certification — or Medicaid enrollment as a nurse in independent practice

Issuing agency

Wisconsin Department of Health Services (DQA license; ForwardHealth enrollment)

Regulation

Wis. Admin. Code DHS 105.16 and 105.19; DHS 107.12; DHS 133

1. Agency route: obtain a DHS 133 home health agency license and Medicare certification, then enroll with Wisconsin Medicaid
2. Individual route: enroll as a nurse in independent practice (DHS 105.19)
3. Provide PDN only through RNs and LPNs (some services RN-only) with prior authorization

Staffing

• RNs and LPNs only; certain services limited to RNs

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.

Nursing care agencies (private duty nursing) — active organization NPIs (NPPES)

91 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

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

All Wisconsin Private duty nursing Medicaid rates, ranked →

• WI Children's Long-Term Support Waiver Program (1915(c))
• WI Family Care Waiver (1915(c))
• WI IRIS (Include, Respect, I Self-Direct) Waiver (1915(c))

Wisconsin waivers and waiting lists →