Community Care Home   Community Care on Facebook  Community Care on LinkedIn   

Contact Us At:


Join Our Network

Community Care offers member-centered care to elders and adults with intellectual and physical disabilities in Eastern Wisconsin. We’re the only Wisconsin organization to offer all three long-term care programs of Family Care, Partnership and Program of All-Inclusive Care for the Elderly (PACE). We are always interested in adding providers to our network who share Community Care’s mission of delivering quality, cost-effective care to those we serve.

Interested in joining the Community Care provider network? Download an application below to get started. All applications are available in Adobe PDF and Microsoft Word formats.

Community Care highly recommends providers attend an Application Training Session. Dates and more information on trainings can be found in the Provider Education session, by clicking here. These trainings are required for any provider whose application has been denied and are looking to reapply. 

If you have questions or need confirmation as to which application you should complete, call 1-866-937-2783 and select option 2.

General Application  OOAFH ApplicationTransportation Application    Health Care Group Application

General Provider Application - PDF General Provider Application - MS Word OOAFH Application - Microsoft Word Format OOAFH Application - PDF Format Health Care Group Application - PDF Health Care Group Application - MS Word Transportation Provider Application - PDF Transportation Provider Application - MS Word

Please note:  Community Care is currently NOT accepting applications for 3 or 4 bed licensed adult family homes or 1 or 2 bed certified homes in Kenosha County. 

For Racine County and Milwaukee County, Community Care, Inc. is accepting pre- application documents from qualified providers of adult family homes.  Consideration will only be given to providers who have services that match the needs of specific members.

Current needs include homes that are:

  1. State approved for non-ambulatory residents and/or
  2. Capable of serving members with a background that includes any of these service specialties;
    • Drug and/or alcohol use
    • Correctional history
    • Sex offender history
    • Complex medical needs requiring RN oversight.

To be considered all of the following pre-application documents must be submitted:

  • Current Adult Family Home License with HCBS compliance or 1-2 Bed Certification’ Program Statement demonstrating programming capable of serving members with backgrounds described above,
  • Summary of management and direct staff expertise, experience and credentials related to the specific services being offered,
  • Summary of experience writing and adhering to Behavioral Support Plans including the submission of a sample BSP/ISP that has been de-identified, 
  • A written Training Plan including detailed training for the specific target groups identified above,
  • Credentials and experience of any specialty staff including Registered Nurses  if applicable,
  • Contact information, including name, phone and email

If, after review, your pre-application materials align with current member placement needs, you will receive an invitation to submit a full application. (updated 11/15/22)

Checklist of Materials to Send With Your Application

All required items (on the application checklist) must be submitted with general application, transportation application or OOAFH application to be considered. If all required items are not submitted at time of application, applications will be denied and providers will need to reapply at a future date.

Community Care requires all providers who have had an application denied attend an Application Training session prior to reapplying. More information on training sessions is found on our Provider Education page.

  • All licenses and/or certifications
  • Certificate of Insurance with Community Care, Inc. listed as the certificate holder (No Declaration Page or Insurance Application or Insurance Binder)
  • Attestation Form - (Word or PDF format) to be completed by all providers
  • W-9 Form (to be completed by all providers)
  • Residential Data Collection(to be completed by all corporate residential providers and submitted with the General Application)
  • Residential Summary - (Word or PDF format) to be completed by all residential providers
  • Direct Deposit Form - (Word or PDF format) with a cancelled or voided check
  • Program Statement required for all certified or licensed providers

Submit Your Completed Application To:

  Mail:  Community Care, Inc.
            ATTN: Provider Management
            1801 Dolphin Drive
            Waukesha, WI 53186

Email:  [email protected]

  Fax:  (262) 446-6707

Home   |   Who We Are   |   Members & Families   |   For Providers   |   Careers   |   Consulting Services   |   Contact Us

 Corporate Headquarters: 205 Bishops Way, Brookfield, WI 53005
Phone: (414) 231-4000 Toll Free: 1-866-992-6600 TTY: Call the Wisconsin Relay System at 711
Help in Other Languages
© 2014-2019, Community Care, Inc. - All Rights Reserved   |   Privacy Policy   |   Terms of Use