Medicaid self-directed care
IRIS (Include, Respect, I Self-Direct)
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- Who qualifies
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Adults 18 or older in Wisconsin who are older adults or adults with a disability, are enrolled in Medicaid, live in a home, apartment, adult family home or residential care apartment complex, and are functionally eligible on the Long-Term Care Functional Screen. You, or your legal decision maker, choose services within a budget and hire and manage your own providers.
IRIS has no cost to join, but some people pay a monthly cost share based on income. An IRIS consultant agency and a fiscal employer agent help you.
Source: IRIS (Include, Respect, I Self-Direct) (Wisconsin Department of Health Services)Checked
- Can a family member be paid
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Yes. Yes. The IRIS program permits family members, guardians and legal representatives to be paid caregivers for the services the waiver allows.
Under the waiver, relatives may be paid for personal care or similar services only as part of supportive home care, respite, individual supported employment, nursing services and 1-2 bed adult family home services, when the service is in your plan.
Source: IRIS Policy Manual, P-00708 (Wisconsin DHS, 06/2026)Checked
- Can a spouse be paid
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Depends. Only for care beyond ordinary spousal caregiving. A spouse may be paid for personal care or similar services, as part of supportive home care, respite, individual supported employment, nursing services or 1-2 bed adult family home services, when the service is identified as necessary in the service plan, the participant prefers the spouse, the spouse meets the provider qualifications and has a provider agreement with the fiscal employer agent, and the care exceeds the normal caregiving responsibilities of a spouse who does not have a disability.
A spouse is never given decision-making authority over the selection of waiver service providers.
Source: IRIS 1915(c) waiver application WI.0484.R04.00, effective January 1, 2026 (Wisconsin DHS, dated 12/08/2025)Checked
- Can a legal guardian be paid
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Depends. Yes, for certain services. Guardians and active health care powers of attorney may be paid as participant-hired workers for respite care, supported employment, nursing services, 1-2 bed adult family home, customized goods and services, specialized transportation and supportive home care. When a guardian is both a paid caregiver and making budget decisions, the IRIS consultant reviews it for conflicts of interest.
Source: IRIS Policy Manual, P-00708 (Wisconsin DHS, 06/2026)Checked