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

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 HCBS waiver available to elderly and disabled Wisconsin residents that provides a variety of services and supports for long term care outside of a skilled nursing facility. 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, their legal guardian, or their power of attorney is responsible for self-directing their care instead of having the state act solely on their behalf.

A qualified participant, working with a case manager, determines their desired "outcomes" from long term care. They decide what sort of living arrangements and later life care 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 that the participant controls and is free to spend on anything outlined in the Plan. The individuals select from whom to purchase goods and services including their personal care service.

 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.

Please note 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 is not yet available statewide. In the counties where IRIS is not available, the alternative CIP and COP Waivers may be offered. However, make note, the CIP and COP Waivers are in the process of transitioning to Family Care, with all counties expected to make the transition by the beginning of 2018. (All counties that offer Family Care also offer 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 need assistance to perform the activities of daily living. During enrollment and periodically, thereafter, participants are assessed to identify their level of need.

When it comes to financial eligibility, Wisconsin Medicaid considers both the applicant's income and financial resources. The 2017 income limit is $2,205 per month. An individual cannot have more than $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, the state only looks at the income in the name of the applicant—their spouse’s income is not relevant. Also, the spouse of an applicant may retain savings and retirement account of up to $120,900. And this is not including the value of their home where they live and one car.

Also, individuals are entitled to convert a life insurance policy or purchase an irrevocable funeral trust. Funds placed in a funeral trust are restricted for memorial or funeral services only and are exempt from consideration by the Medicaid office.

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

 

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 that 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 expanding to include Adams, Danes, Florence, Forest, Oneida, Taylor, and Vilas. State officials anticipate that the program will be available in currently un-served counties in the state by the end of 2017, with the exception of Dane county. IRIS is expected to expand to Dane county by the beginning of 2018. For a map of currently 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 here. One can learn more about the program on the IRIS website or by calling 1-888-515-IRIS (4747).