Wisconsin Medicaid pays for home and community-based care through two long-term care programs: Family Care and IRIS. Both Family Care and IRIS serve adults who need a nursing-home level of care but want to stay in their own home instead.Centers for Medicare & Medicaid Services. (n.d.). WI IRIS (Include, Respect, I Self-Direct) Waiver (0484.R04.00) - Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83621 Together, these two programs are what people mean by Wisconsin Medicaid HCBS waivers, the home and community-based services (HCBS) side of Medicaid long-term care.
The difference between the two comes down to who runs the show. Family Care coordinates your care for you through a care organization, while IRIS lets you direct your own services and even hire family members as paid caregivers.
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. Federal Medicaid law gives states several ways to fund this kind of care. The main one is the Section 1915(c) HCBS waiver, which lets a state waive certain rules so it can pay for community care for people who would otherwise need an institutional level of care.
Wisconsin uses this authority to run 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.Centers for Medicare & Medicaid Services. (n.d.). WI IRIS (Include, Respect, I Self-Direct) Waiver (0484.R04.00) - Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83621 Family Care delivers the same kind of long-term care through a managed care organization (MCO) that coordinates your services for you. Both are ways to get Medicaid to pay for care at home instead of in a facility, and both are aimed at the same people.
Family Care and IRIS Compared
Here's the core difference, and it's the choice most families end up making. Family Care hands the coordination to professionals: you enroll with a managed care organization, and a care team assesses your needs, builds your care plan, and arranges the services for you. IRIS puts you in the driver's seat: you receive an individual budget and direct your own services, and you can hire your own workers, including family members and even a spouse, as paid caregivers.Centers for Medicare & Medicaid Services. (n.d.). WI IRIS (Include, Respect, I Self-Direct) Waiver (0484.R04.00) - Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83621
Both programs serve the same population and the same level of care. What differs is how much of the day-to-day management you want to take on yourself.
| Feature | Family Care | IRIS |
|---|---|---|
| How care is managed | A managed care organization coordinates and arranges services | You direct your own services with an individual budget |
| Who provides care | The care organization's network of providers | Workers you hire, including family members and a spouse |
| Best fit | You want professionals to handle the logistics | You want control over your caregivers and budget |
| Runs under | Wisconsin DHS | Wisconsin DHS, as a Section 1915(c) waiver |
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. Both Family Care and IRIS serve adults who are frail elders or who have a physical, intellectual, or developmental disability, and who need the level of care a nursing home or an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) would provide.Centers for Medicare & Medicaid Services. (n.d.). WI IRIS (Include, Respect, I Self-Direct) Waiver (0484.R04.00) - Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83621 Wisconsin measures this with a standardized assessment called the Long-Term Care Functional Screen (LTCFS), which looks at how much help you need with everyday activities. Meeting a nursing-home level of care doesn't mean you have to move into one. It's simply 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 institutional ones. For a single applicant in 2026, Wisconsin's monthly income standard is $2,982.00 and the countable-asset limit is $2,000.00.Centers for Medicare & Medicaid Services. (n.d.). WI IRIS (Include, Respect, I Self-Direct) Waiver (0484.R04.00) - Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83621 Countable assets leave out things like your home and one vehicle, but 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. Covered services start with personal care, which is hands-on help with daily activities like bathing, eating, dressing, managing medications, meal preparation, mobility, toileting, transferring, and getting where you need to go.Centers for Medicare & Medicaid Services. (n.d.). WI IRIS (Include, Respect, I Self-Direct) Waiver (0484.R04.00) - Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83621 Beyond personal care, both programs cover respite care, which gives family or other primary caregivers short-term breaks, along with adult day care, home-delivered meals, and home health services.Centers for Medicare & Medicaid Services. (n.d.). WI IRIS (Include, Respect, I Self-Direct) Waiver (0484.R04.00) - Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83621
IRIS adds one option that matters a great deal to families already doing the caregiving. Under IRIS, you can put your individual budget toward hiring your own workers, and Wisconsin lets you pay family members, including a spouse, for that work.Centers for Medicare & Medicaid Services. (n.d.). WI IRIS (Include, Respect, I Self-Direct) Waiver (0484.R04.00) - Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83621 That's often the reason a family looks at IRIS in the first place: a relative who is already providing much of the care can be paid to keep doing it.
How Enrollment Works
Whichever program fits, you start in the same place. In Wisconsin, you enter the publicly funded long-term care system and enroll in Family Care or IRIS through your local Aging and Disability Resource Center (ADRC), which acts as the single point of access.Centers for Medicare & Medicaid Services. (n.d.). WI IRIS (Include, Respect, I Self-Direct) Waiver (0484.R04.00) - Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83621 The ADRC is a local office whose staff explain your options at no charge, help you understand how Family Care and IRIS differ, and guide you through the functional screen and the financial application.
Here's what to expect. An ADRC staff member meets with you, often in your own home, to talk through your situation and complete the Long-Term Care Functional Screen. If you meet the level-of-care threshold and the financial rules, you choose between Family Care and IRIS, and the ADRC connects you to the program you pick. Because the ADRC works with both programs, you don't have to understand the whole system before you call. Explaining it is exactly what they're there for.
How to Apply for Family Care or IRIS
Applying has two parts that run alongside each other: enrolling in the program through the ADRC, and getting your financial Medicaid eligibility approved.
Start with the ADRC. Contact your local Aging and Disability Resource Center to begin the functional screen and program enrollment. The staff there will confirm whether you meet a nursing-home level of care and help you weigh Family Care against IRIS.
Apply for Medicaid. The financial side is a Medicaid long-term care application. Federal rules require the state to let you apply through several channels, so you can apply online, by phone, by mail, or in person.U.S. Government Publishing Office. (n.d.). 42 CFR 435.907 — Application (eCFR, current). ecfr.gov. Retrieved Jul 13, 2026, from https://www.ecfr.gov/current/title-42/section-435.907 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 when eligibility is based on a disability.U.S. Government Publishing Office. (2024). 42 CFR 435.912 Timely determination and redetermination of eligibility (2024 ed.) — govinfo.gov. govinfo.gov. Retrieved Jun 25, 2026, from https://www.govinfo.gov/content/pkg/CFR-2024-title42-vol4/pdf/CFR-2024-title42-vol4-sec435-912.pdf
The two tracks meet at the ADRC, which is why starting there keeps pieces from slipping through the cracks. If you're helping a parent or a spouse, you can apply and handle the process on their behalf.
Frequently Asked Questions
Can I get paid to care for a parent or spouse through these programs?
Yes, through IRIS (Include, Respect, I Self-Direct), Wisconsin's self-directed program. IRIS gives you an individual budget and lets you hire your own workers, and the state allows you to pay family members, including a spouse, as paid caregivers.Centers for Medicare & Medicaid Services. (n.d.). WI IRIS (Include, Respect, I Self-Direct) Waiver (0484.R04.00) - Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83621 Family Care, by contrast, arranges caregivers through its provider network, so IRIS is the pathway families usually look at when a relative is already doing the care.
Do I have to move into a nursing home to qualify for Wisconsin Medicaid home care?
No. Both programs are built to keep you at home. You do have to meet a nursing-home (or ICF-IID) level of care, which is a measure of how much help you need, but that threshold is what makes you eligible for home and community-based services (HCBS) instead of institutional care.Centers for Medicare & Medicaid Services. (n.d.). WI IRIS (Include, Respect, I Self-Direct) Waiver (0484.R04.00) - Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83621 Qualifying at that level opens the door to staying in your own home, not the reverse.
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.