Wisconsin Medicaid: Include, Respect, I Self-Direct (IRIS) Program

Page Reviewed / Updated - Mar. 2014

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers" which are also called Home and Community Based Services (HCBS Waivers) or Waiver Funded Services.

Waiver Description

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.

 In IRIS, one's family can be hired and paid to provide personal care services.

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.

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.   Also worth mentioning is IRIS is not available statewide.  In the counties in which IRIS is not available, the alternative CIP and COP Waivers are offered. 

 

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 2014 income limit is $2,163 / 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 $117,240 in countable resources. These do not include the value of their home.

Persons exceeding these limits have a few options.  Wisconsin offers Medically Needy Medicaid for higher income / high medical costs residents.   There are also professional Medicaid planners that focus on helping families to structure their resources so they qualify.   Learn more.

 

Benefits and Services

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.

  • Adaptive Aids
  • Adult Day Care
  • Communication Aids
  • Counseling and Therapeutic Resources
  • Customized Goods and Services
  • Daily Living Skills Training
  • Home Delivered Meals
  • Home Modification
  • Nursing Services
  • Personal Emergency Response System
  • Personal Care Services
  • Relocation Services
  • Respite Care
  • Specialized Medical Equipment and Supplies
  • Supportive Home Care
  • Transportation

 

How to Apply / Learn More

Although the IRIS Program is not yet available statewide, it is rapidly expanding. For a map of participating counties, click here.  The application process begins by applying for Medicaid with one’s local Aging and Disability Resource Center (ADRC). A complete list of county by county ADRC contacts is available as a downloadable PDF.   One can learn more about the program on the IRIS website or by calling 1-888-515-IRIS (4747).