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DEPARTMENT OF HEALTH SERVICES Division of Medicaid Services F03288 (06/2024) STATE OF WISCONSINHOME AND COMMUNITYBASED NONRESIDENTIAL SETTINGS ATTESTATION The Division of Medicaid Services home and
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How to fill out home and community based

01
Identify if you meet the eligibility criteria for home and community-based services.
02
Gather necessary documentation, such as proof of income, residency, and medical needs.
03
Contact your local Department of Health or Medicaid office to express your interest in home and community-based services.
04
Complete an application form provided by the agency, ensuring all information is accurate and up-to-date.
05
Schedule an assessment with a case manager who will evaluate your needs and determine the appropriate services.
06
Review and agree on the service plan developed by the case manager.
07
Sign any required consent forms and finalize the implementation of your services.

Who needs home and community based?

01
Individuals with disabilities or chronic illnesses requiring support.
02
Elderly persons who prefer to remain in their homes rather than moving to a nursing facility.
03
Caregivers seeking additional assistance in providing care for their loved ones.
04
People with mental health conditions needing support in daily living activities.

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Home and community based refers to services and support provided to individuals in their homes or local communities instead of institutional settings. This approach aims to enhance the quality of life for individuals who may need assistance with daily living activities.
Typically, individuals who receive home and community based services or funding from government programs are required to file home and community based forms. This might include caregivers and service providers as well.
Filling out home and community based forms usually involves providing personal information, service details, and financial information. It is important to follow the specific guidelines provided by the agency or program managing these services.
The purpose of home and community based services is to support individuals in living independently and participating in their communities while receiving necessary care and assistance tailored to their needs.
Required information typically includes personal identification details, information about the services being utilized, any income or funding sources, and documentation of need for services.
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