Starting a care business in Wisconsin

Wisconsin has no license called a family child care home. Caring for 4 or more children under age 7 for less than 24 hours a day requires a DCF license, and a home-based program is licensed as a family child care center. Since August 1, 2026, under 2025 Wisconsin Act 15, that license covers 4 to 12 children with no more than two providers caring for children at one time, and the group child care center license starts at 13 instead of 9. Both require free pre-licensing help before DCF hands you an application, and both start with a 6-month probationary license. If you will care for 1 to 3 unrelated children, you need no license; county or tribal certification is optional (DCF certifies in Milwaukee County). Two cautions: DCF's fee page still shows the old 4-to-8 range, and some local governments, including the City of Milwaukee and Kenosha County, limit family child care to 8 children.

There is no assisted living facility license either. Residential care for adults is a ladder set by the number of unrelated residents. One or two residents means a certified adult family home, approved by a county, a managed care organization (MCO) or the IRIS program rather than the state. Three or four residents need an adult family home license, which allows up to 7 hours of nursing care per resident per week. Five or more need a community-based residential facility (CBRF) license, where the nursing limit drops to 3 hours a week. Apartment-style buildings with private kitchens and baths serving 5 or more adults are residential care apartment complexes, which are registered or certified instead of licensed as CBRFs.

For a CBRF, the building and the neighborhood come before the application. Every building, including an existing house, goes through DHS plan review. A CBRF may not sit on land zoned commercial, industrial or manufacturing, and in cities a new one generally cannot open within 2,500 feet of another community living arrangement unless the city allows it. Public money comes through Family Care, which requires an MCO contract that DHS says is not guaranteed; IRIS does not pay for CBRF settings. Adult family homes face their own change: DHS is rewriting chapter DHS 88 (Clearinghouse Rule 26-026), which was not yet in effect on October 12, 2026.

A home health agency license is only for skilled nursing or therapy in clients' homes; DQA tells agencies that only help with daily living, housekeeping or appointments not to apply. Under DQA's process a new agency starts on a provisional license and has up to one year to serve 10 skilled patients before its licensure survey. Federal policy is the larger obstacle: CMS stopped Medicare enrollment of new home health agencies nationwide on May 13, 2026, for six months unless extended, and Wisconsin requires Medicare certification for Medicaid home health certification. A new agency can still get its state license, but while the freeze lasts it can serve only private-pay, commercial insurance and other non-Medicare payers.

Two business types need no state license. Adult day care centers can run on private pay without one; DQA certification is voluntary unless you plan to serve people whose care is paid for with county Medicaid waiver funds. DHS lists no state license for non-medical home care that private-pay clients buy. An agency that wants to bill Wisconsin Medicaid for personal care must be certified as a personal care agency under Wis. Admin. Code § DHS 105.17.