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

Include, Respect, I Self Direct (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. However, one exception is for a live-in caregiver, in which family members cannot be paid to provide this service. Caregivers are subject to background checks, must be qualified to provide the care, and must pay taxes on the wages they receive. Specifically for the IRIS program, this option is called Self Directed Personal Care (SDPC).

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. At the time of this writing, Dane county was in the process of transitioning to this program, and Adams county was still operating under the CIP and COP Waivers. However, the CIP and COP Waivers are in the process of transitioning to Family Care, with Dane’s county expected to make the transition in approximately June 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 require a level of care consistent to that which is provided in a nursing home or an intermediate care facility for persons with intellectual disabilities. For those between the ages of 18 to 64, they must be disabled. Those 65 years of age and older do not need to be disabled, but still must meet the level of care need. In addition, applicants must require 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 2018 income limit is $2,250 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 assets (savings and retirement accounts, etc.) of up to $123,600, while the applicant is still able to retain up to $2,000. This does not include the value of their home where they live (up to $858,000) 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, such as Medicaid compliant annuities. There are also professional Medicaid planners that focus on helping families to structure their resources so applicants can 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 / Vehicle Modifications (toilet risers, shower chairs, van lifts, etc.)
  • Adult Day Care (up to 8 hours / day)
  • Adult Family Home / Adult Foster Care
  • Assistive Technology / Communication Aids
  • Consultative Clinical and Therapeutic Services for Caregivers
  • Counseling and Therapeutic Resources for Caregivers
  • Customized Goods and Services
  • Daily Living Skills Training
  • Fiscal Employer Agent Services (for self-directed option)
  • Home Delivered Meals
  • Home Modification
  • Live-in Caregiver
  • Nursing Services
  • Personal Emergency Response System
  • Personal Care Services
  • Relocation Services
  • Respite Care (in-home and out-of-home)
  • Specialized Medical Equipment and Supplies
  • Supportive Home Care
  • Training for Unpaid Caregivers
  • Non-Medical Transportation


How to Apply / Learn More

Although the IRIS Program is not yet available statewide, it is currently expanding to Dane county and is expected to make the transition into Adams county in June of 2018. 

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).