Wisconsin Medicaid: Include, Respect, I Self-Direct (IRIS) Program
Overview of the IRIS Program
IRIS is a Medicaid program offered to qualified, elderly and disabled Wisconsin residents that provides a variety of services and supports for long term care. The program is based on the Cash and Counseling model, also referred to as consumer or participant direction. In this model of program, the enrolled individual or their legal guardian is responsible for self-directing their care instead of having the state perform that activity on their behalf.
The program works as follows. The participant, working with a case manager, determines their desired “outcomes” from long term care; meaning they decide what sort of life they hope to achieve. Then they identify the care services, goods and other supports necessary to achieve those outcomes; this is collectively referred to as their “Service and Support Plan”. A budget is allocated for the Plan which the participant controls and is free to spend on anything outlined in the Plan. The individuals select from whom to purchase goods and from whom to receive care.
One particularly attractive component of the IRIS program is that individuals can hire family and friends as their caregivers. Family members including spouses and the adult children of aging parents can be paid for providing personal care services. Caregivers are subject to background checks, must be qualified to provide the care and must pay taxes on the wages they receive.
This program is not limited to individuals living at home. Those residing in adult family homes, group homes and even some assisted living communities are eligible to participate in this program. However, they may be eligible for a broader range of services and supports if they live at home.
Wisconsin offers several other options for long term care of which the reader should be aware. IRIS is offered as an alternative Family Care and Family Care Partnership
and to the Medicaid CIP and COP waivers
To help avoid confusion it is worth mentioning that the IRIS Program is referred to by a variety of different names including Wisconsin’s Self-Directed Supports Program, Include, Respect, I Self-Direct, IRIS-SDPC and formerly the SDS Waiver.
IRIS Eligibility Guidelines
IRIS is a Medicaid program and as such, participants must meet the criteria for Medicaid. Both the applicant's functional ability and their financial resources are factors in determining IRIS eligibility.
Functionally, applicants must be in need of assistance to perform the activities of daily living. During enrollment and periodically thereafter participants are assessed to identify their level of need.
Financially, Wisconsin Medicaid considers both the applicant's income and financial resources. The 2013 income limit is $2,130 / month and $2,000 in total countable assets. However, there are many exceptions to these limits. For example, when only one spouse of a married couple is seeking benefits, they are permitted a higher income allowance and up to $115,920 in countable resources. These do not include the value of their home.
Wisconsin also offers Medically Needy Medicaid for higher income / high medical costs state residents. There are also professional Medicaid planners that focus on helping families to structure their resources so they qualify. Find Medicaid planning assistance here
Benefits / Services Covered by the IRIS Program
Each participant has a customized Service and Support Plan and a budget. This Plan outlines the services, goods and supports on which they can spend the budget. What can be included in the Plan is broadly defined as anything which helps the individual to maintain their independence provided the cost does not exceed the cost for the same item or service provided under other Medicaid programs.
More specifically, what follows are many commonly included items and services. It is worth noting that this is not an exhaustive list.
-Adult Day Care
-Counseling and Therapeutic Resources
-Customized Goods and Services
-Daily Living Skills Training
-Home Delivered Meals
-Personal Emergency Response System
-Personal Care Services
-Specialized Medical Equipment and Supplies
-Supportive Home Care
How to Apply for the IRIS Program
Page Reviewed / Updated - Feb. 2013