Wisconsin Medicaid HCBS Waivers: Family Care & IRIS

Wisconsin Medicaid pays for home and community-based care primarily through two long-term care programs: Family Care and IRIS. Both serve older adults and adults with disabilities who need long-term care and meet Wisconsin's functional and financial rules, and both pay for that care at home or in the community rather than in a nursing home.1 Together they are the core of Wisconsin's Medicaid HCBS waivers, the home and community-based services (HCBS) side of Medicaid long-term care.

The difference between them comes down to who runs the show. Family Care coordinates your care for you through a care organization, while IRIS lets you hire and manage your own workers, and a qualified spouse, relative, or guardian may be paid to provide certain IRIS services.1

In This Guide

• What Wisconsin Medicaid HCBS Waivers Are
• Family Care and IRIS Compared
• Who Qualifies for Wisconsin Medicaid HCBS Waivers
• What HCBS Waivers Cover
• How Enrollment Works
• How to Apply for Family Care or IRIS

What Wisconsin Medicaid HCBS Waivers Are

Home and community-based services (HCBS) is the part of Medicaid that pays for long-term care outside an institution, in your own home, a family member's home, or another community setting, rather than in a nursing home. One federal route for funding this kind of care is the Section 1915(c) HCBS waiver, which pays for home and community services for people who, without them, would need the level of care a hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities provides.3

Wisconsin delivers this kind of care primarily through two long-term care programs, both managed by the Wisconsin Department of Health Services (DHS). IRIS, which stands for Include, Respect, I Self-Direct, is the state's self-directed option and a federally approved Section 1915(c) HCBS waiver.1 Family Care is a managed long-term care program: you join a managed care organization (MCO), and it coordinates your services for you.1 Both are ways to get Medicaid to pay for care at home instead of in a facility.

Family Care and IRIS are the two main programs, and they're the focus of this guide. They aren't the only doors, though: DHS also operates Family Care Partnership and PACE (Program of All-Inclusive Care for the Elderly) as enrollment options alongside Family Care.1 Your local resource center walks you through all of them, so it's worth asking about Partnership and PACE rather than assuming the choice is only two ways.

Family Care and IRIS Compared

Here's the core difference. Family Care hands the coordination to professionals: you enroll with a managed care organization, and a care team recommends and approves your services and arranges them for you.1 IRIS puts you in the driver's seat: you hold budget authority, meaning you choose which goods, supports, and services to use, and employer authority, meaning you hire and manage your own workers. A qualified spouse, relative, or guardian may be paid to provide certain IRIS services.1

The eligibility rules aren't identical, as the next section shows, but for someone who qualifies for both, what differs is how much of the day-to-day management you want to take on yourself.

Neither program is better in the abstract. Family Care fits people who want the care organization to handle the arranging and scheduling; IRIS fits people who want a say in who provides their care and how the budget gets spent.

Who Qualifies for Wisconsin Medicaid HCBS Waivers

Qualifying comes down to two tests, and you have to clear both.

The functional test. To enroll in Family Care, Family Care Partnership, or PACE, DHS says you must need long-term care services, be an older adult or an adult with a disability, and be functionally and financially eligible, and the Long Term Care Functional Screen (LTCFS) decides whether you qualify. IRIS is narrower: you must be at least 18, fall into one of its target groups (frail elders, adults with physical disabilities, or adults with developmental disabilities), need the level of care a nursing home or an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) would provide, and have a long-term care condition expected to last more than 12 months.1 The difference matters. Family Care can be met at a nursing home level of care or at a lower non-nursing home level, for someone at risk of losing independence without help, while IRIS requires a nursing home or intellectual/developmental disability level of care.4 Meeting a nursing-home level of care doesn't mean you have to move into one. It's the threshold that opens the door to home and community-based services instead.

The financial test. Because this is long-term care Medicaid, the money rules are the long-term care ones rather than the standard Medicaid limits. Wisconsin's Group B community-waiver income standard is $2,982.00 per month, effective January 1, 2026 (the same figure the state applies to institutional care), and the countable-asset limit for a single applicant is $2,000.00.1 That limit applies to countable assets, not everything you own: the state counts real property other than your home and only some vehicles, and its 2026 long-term care home equity limit is $752,000.1 The details get involved quickly, so our Wisconsin Medicaid income and asset limits guide walks through exactly what counts.

What HCBS Waivers Cover

The point of these programs is to deliver, at home, the kind of help you'd otherwise get in a facility. The Family Care benefit package covers a full range of long-term care services, and your care team may recommend personal care, which is help with bathing, eating, dressing, managing medications, meal preparation, mobility, toileting, transferring, and using transportation.1 The team may also recommend respite care, which gives family or other primary caregivers short-term breaks, along with adult day care, home-delivered meals, and home health services such as nursing, a home health aide, and physical, occupational, or speech therapy at home.1

None of these is automatic. The care team must approve every service before you get it, and it can approve one only if the service is in the benefit package, supports your long-term care outcomes, and is the most cost-effective way to meet your need. If you need something that isn't approved, DHS tells members to talk with their care team.1

Both programs can pay a family member who is already doing the caregiving, in different ways. Under IRIS you hold employer authority, so you hire and manage your own workers, and a qualified spouse, relative, or guardian may provide certain IRIS services, among them supportive home care, respite, IRIS self-directed personal care, and transportation.1 If a relative is already providing much of the care, they may be able to be paid through IRIS to keep doing it. One exception applies to guardians: DHS's current IRIS Service Definition Manual (P-00708B, March 2026) says legal representatives and non-limited guardians may not provide IRIS self-directed personal care to a participant they represent.5

Family Care pays family caregivers too, through the member's MCO. Under the Family Care and Family Care Partnership waiver, the MCO may pay a relative or legal guardian when the service is in the member-centered plan, the person meets the provider qualifications and has a provider agreement with the MCO, and the member prefers that person. A spouse may be paid only for extraordinary care, meaning more than normal spousal caregiving, or care that requires the spouse to give up paid work. Family members are not paid for tasks that are a normal part of day-to-day family life, whether or not they live with the member, and the care team must find that paying the family member is cost-effective compared with another provider.2 Our guide to how Wisconsin Family Care pays family caregivers covers the details.

Read those two conditions closely. The relative has to be qualified for the service they're being paid to provide, and the permission covers certain IRIS services rather than everything in your plan. For a spouse, IRIS waiver services such as supportive home care and respite pay only for care that exceeds the normal caregiving responsibilities of a spouse who does not have a disability.1 Confirm which services a particular spouse or relative can be paid for before you count on that income.

How Enrollment Works

Whichever program fits, you start in the same place. DHS tells people who need long-term care to contact their local Aging and Disability Resource Center (ADRC) first, or a Tribal aging and disability resource specialist (ADRS), who explains the options.1

Here's what to expect after that first call. You complete the Long Term Care Functional Screen with the ADRC or Tribal ADRS, and you submit a Medicaid application to an income maintenance agency, which confirms you meet the income limits. Then comes the final enrollment step, where you choose a program (Family Care, IRIS, Family Care Partnership, or PACE) and, if the program uses one, a managed care organization. Some programs are only available in certain areas, so your options may depend on where you live.1 You don't have to understand the whole system before you call. Explaining it is what the ADRC is there for.

How to Apply for Family Care or IRIS

Applying has two parts: the functional screen and program enrollment, which run through the ADRC, and your financial Medicaid eligibility, which runs through an income maintenance agency.

Start with the ADRC. Contact your local Aging and Disability Resource Center (or Tribal ADRS) to complete the functional screen and talk through Family Care, IRIS, and the other options.

Apply for Medicaid. The financial side is a Medicaid application submitted to an income maintenance agency, which confirms you meet the income limits.1 Federal rules require the state to let you apply through several channels, so you can apply online, by phone, by mail, or in person.6 Once you apply, the state has a limited window to decide. Under federal Medicaid rules, an eligibility determination may take no more than 45 days for most applicants, or up to 90 days for applicants who apply for Medicaid on the basis of disability.7 Which cap applies turns on the basis you applied under, not on whether a disability determination happens to arise, so an older adult applying on the basis of age is on the 45-day standard even for a long-term-care case. These are federal outer limits, not a guaranteed decision date: the state sets its own standards in its State plan and must tell you what they are, and the limits can be exceeded in unusual circumstances, for example when the applicant or an examining physician delays a required step. If the agency runs late, it must document the reasons in your case record, and it can't use the time limits as a waiting period or as a reason to deny you.7

If you're helping a parent or a spouse, you can apply for them: federal rules let an adult in the applicant's household or family, an authorized representative, or someone acting responsibly for an incapacitated applicant submit the application.6

Learn More

Find personalized help choosing between Wisconsin's Family Care and IRIS programs at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.