Wisconsin CORE Waiver for Autism: A Complete Guide

If your child has autism and you live in Wisconsin, you have likely heard of the CORE waiver. But understanding exactly what it is, who qualifies, and how to apply can feel overwhelming. This comprehensive guide will walk you through everything you need to know about Wisconsin's CORE waiver for autism, including how it can help cover needed therapies like ABA. And remember, Get ABA Therapy is a free service that can match your family with vetted, BCBA-led providers who accept the CORE waiver and other insurance.

What Is the Wisconsin CORE Waiver?

The CORE waiver stands for "Community Options for Residential Environments" and is one of several Home and Community-Based Services (HCBS) waivers offered under Wisconsin's Children's Long-Term Support (CLTS) program. It is funded through the state's Medicaid system (BadgerCare Plus) and provides a range of services to children with developmental disabilities-including autism spectrum disorder-who need support to remain living at home and participating in their community.

Unlike standard Medicaid, waivers like CORE allow states to use federal Medicaid funds to cover services that are not typically provided through a state plan, such as respite care, personal assistance, and specialized therapies like applied behavior analysis (ABA). The goal is to keep children out of institutional settings by giving families the resources they need at home.

🔗 Related reading: Hyperfocus in Autism: ABA vs Medication · Local ABA Therapy

Who Qualifies for the CORE Waiver?

Eligibility for the CORE waiver is determined by several factors. Your child must:

• Be under 18 years old (some transitions may occur at age 18, but the waiver primarily serves children).
• Have a qualifying diagnosis-autism spectrum disorder is explicitly listed. Other diagnoses like intellectual disability or cerebral palsy may also qualify.
• Demonstrate a need for home and community-based services according to a state-approved functional needs assessment. This evaluation looks at areas such as self-care, communication, social skills, and behavior.
• Meet financial criteria for Medicaid. The CORE waiver is a Medicaid program, so your family's income and assets are considered. However, Wisconsin has special provisions for children with disabilities that allow higher income thresholds.

It is important to note that eligibility is not automatic just because a child has an autism diagnosis. You will need to go through an assessment process through your county human services department to document the level of support needed.

What Services Does the CORE Waiver Cover?

The CORE waiver covers a broad array of services tailored to each child's needs. The most commonly sought service for families of children with autism is ABA therapy, but the waiver can include many other supports.

ABA Therapy

Applied behavior analysis (ABA) is an evidence-based therapy for individuals with autism that focuses on increasing positive behaviors and teaching new skills. Under the CORE waiver, ABA can be provided by a Board Certified Behavior Analyst (BCBA) and qualified behavior technicians. The waiver covers assessments, one-on-one therapy sessions, parent training, and supervision. BCBA-led ABA is often the centerpiece of a child's waiver plan.

Respite Care

Caregivers can get a break through respite services. The waiver pays for trained providers to supervise your child so you can attend to other responsibilities or simply rest.

Personal Care and Support

Children who need help with daily living activities such as dressing, eating, or bathing can receive personal care assistance in the home.

Community Integration

Services that help your child participate in community activities-like camps, clubs, or recreation-are covered. This can include staff support to ensure safe inclusion.

Other Therapies

Depending on the child's needs, the waiver may also cover speech therapy, occupational therapy, physical therapy, and mental health counseling. However, these must be authorized as part of the individualized plan.

🔗 Related reading: Starting ABA Therapy Before an Official Diagnosis · Local ABA Therapy

How to Apply for the CORE Waiver

The application process for the CORE waiver is managed by each county's human services department. Here are the typical steps:

1. Contact Your County Human Services Department - Find the department for the county where you live. They will assign a support and service coordinator to your family.
2. Request an Assessment - The coordinator will schedule a comprehensive assessment (often called the CLTS functional screen) to evaluate your child's needs. This assessment is the basis for determining waiver eligibility.
3. Submit Required Documentation - You will need to provide proof of diagnosis (e.g., a diagnostic report from a psychologist or physician), financial information for Medicaid eligibility, and any relevant medical records.
4. Wait for Determination - Once the county reviews your application, they will notify you whether your child is eligible and whether a waiver slot is available. Due to funding caps, there may be a waitlist. If a slot is available, you will work with your coordinator to develop an Individualized Service Plan (ISP) that lists the specific services your child will receive.
5. Choose Providers - After the ISP is approved, you can select providers who are enrolled with the CORE waiver. This is where Get ABA Therapy can help-we match families with BCBA-led ABA providers who accept the waiver, saving you time and stress.

Costs and Insurance: What Families Pay

Because the CORE waiver is part of Wisconsin's Medicaid program, families typically pay little to nothing for covered services. Some families may have a small income-based premium or cost-sharing, but these are generally minimal. The waiver covers the majority of costs, including the full cost of ABA therapy, as long as the services are included in the ISP.

It is important to understand that the CORE waiver is not an insurance plan-it is a funding source that pays for specific services that are not otherwise covered by BadgerCare Plus. While your child does need to be eligible for Medicaid, the waiver itself handles the service costs.

If your child does not qualify for the CORE waiver, or if you prefer to use private insurance, ABA therapy and other supports are still accessible. Many commercial plans in Wisconsin cover ABA, and our free matching service can help you find providers who accept your plan.

Practical Tips for Families

Navigating the CORE waiver can be complex. Here are some tips to make the process smoother:

• Start early. The assessment and application can take several months. If you suspect your child may need waiver services, begin gathering documentation now.
• Keep copies of everything. Maintain a file with diagnostic reports, assessment results, correspondence with the county, and your child's ISP.
• Ask about waitlists. Some counties have waitlists for the CORE waiver. Inquire about the current status and whether there are alternative services available while you wait.
• Use a support coordinator. Your assigned coordinator is your best resource. They know the local system and can advocate for your child's needs.
• Consider combining waivers. Some children might be eligible for more than one CLTS waiver. Talk to your coordinator about whether a different waiver (like the Include, Respect, I Self-Direct (IRIS) waiver) could be a better fit for your situation.
• Look ahead to transition. As your child approaches age 18, services may shift to adult waivers. Start planning early with your coordinator to ensure continuity of care.

Common Mistakes to Avoid

Families often make a few missteps during the CORE waiver process. Being aware of them can save you frustration:

• Waiting too long to apply. The CORE waiver is not an emergency service. If your child needs immediate therapy, explore other options (private insurance, private pay) while the waiver application is pending. Our free service can help find providers who work with various funding sources.
• Not providing enough documentation. A thorough diagnostic report is critical. Submit a comprehensive evaluation that clearly states the autism diagnosis and describes functional limitations.
• Assuming the waiver covers everything. Only services included in the ISP are covered. Work closely with your coordinator to list all desired services, including ABA therapy.
• Ignoring changes in your child's needs. The ISP can be updated annually or when circumstances change. Request a review if your child requires new supports.
• Not asking for provider help. Finding a BCBA-led ABA provider who accepts the CORE waiver can be challenging. Let Get ABA Therapy do the legwork-we connect you with vetted providers in Wisconsin, so you can focus on your child's care.

Get Matched with an ABA Provider Who Accepts the CORE Waiver

At Get ABA Therapy, we understand that navigating the CORE waiver is just one part of a larger journey. Our role is to simplify finding a qualified BCBA-led ABA provider that works with the waiver and your family's needs-all at no cost to you. We work with clinics across Wisconsin that are experienced in serving children with autism and familiar with Medicaid waivers.

If you have a CORE waiver approval or are in the process of applying, complete our quick online form. We will review your child's needs, consider your location and preferences, and connect you with providers who have availability. It is that simple.

You do not have to navigate this alone. Let Get ABA Therapy be your free partner in finding the right ABA therapy provider for your child under the Wisconsin CORE waiver.