Page Reviewed / Updated - Feb. 2016
IRIS is a Medicaid HCBS waiver offered to qualified, 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.
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 available statewide. In the counties where IRIS is not available, the alternative CIP and COP Waivers are offered.
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.
When it comes to financial eligibility, Wisconsin Medicaid considers both the applicant's income and financial resources. The 2016 income limit is $2,199 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, they are permitted a higher income allowance and up to a maximum of $119,220 in countable savings and liquid assets. These do not include the value of their home or 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 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.
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.
Although the IRIS Program is not yet available statewide, it is rapidly expanding. State officials anticipate that the program will be available in all of the eight currently un-served counties in the state, leaving only a handful of counties out of the IRIS program by the end of 2016. 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).