What is IRIS?
IRIS stands for Include, Respect, I Self-Direct. It is a Wisconsin Medicaid Home and Community-Based Services (HCBS) program, authorized under Section 1915(c) of the Social Security Act, that began in 2008. IRIS is the "self-directed" alternative to Family Care, Wisconsin's managed long-term care option. When someone qualifies for publicly funded long-term care, the local Aging and Disability Resource Center (ADRC) offers them a choice: let a managed care organization arrange their services, or self-direct through IRIS and control the plan and budget themselves.
The core idea of IRIS is that the person who needs care, not an agency, decides who provides it. Participants receive an individual budget based on their assessed needs and use it to hire, train, schedule, supervise, and (if needed) fire their own workers. Wisconsin explicitly allows those workers to be family members. Under both the IRIS waiver and its companion Self-Directed Personal Care (SDPC) benefit, the state elects to permit participants to hire "legally liable relatives" as paid providers, which by definition includes a spouse and the parent of a minor child.
IRIS is designed to keep people out of nursing homes and in their own homes and communities. Because you are the employer, there is no agency assigning a stranger to your loved one. An adult daughter who has been caring for her mother for years, or a husband caring for his wife, can be paid for that work as long as the person receiving care is Medicaid-eligible and meets the level-of-care requirement. Wisconsin renewed the IRIS 1915(c) waiver for the period January 1, 2026 through December 31, 2030, so the program is stable and continuing.
Two contracted agencies support every IRIS participant. An IRIS Consultant Agency (ICA) provides a consultant who helps you understand the program, build your service and support plan, and stay within budget, without directing your choices. A Fiscal Employer Agent (FEA) handles the money side: running payroll for your workers, withholding and paying taxes, completing required criminal and caregiver background checks, and paying vendors. You choose both your ICA and your FEA when you enroll.
IRIS eligibility requirements
To join IRIS, the person who needs care must meet Wisconsin Medicaid rules and require a nursing-home level of care. The worker you hire does not have to meet income or asset limits; only the participant does. Eligibility is confirmed through your local ADRC or Tribal aging and disability resource specialist (ADRS).
Who can and cannot be paid through IRIS
IRIS is unusually open about who you can hire. Wisconsin permits family members, including spouses and parents, to be paid as your workers. The main limit is a conflict-of-interest rule: the person who serves as your IRIS or SDPC representative cannot also be your paid worker, and no worker may run a group home you live in unless they are related to you.
- A spouse (spouses are "legally liable relatives," whom the waiver allows to be paid)
- Adult children, parents, siblings, grandchildren, and other relatives
- The parent of an adult participant (the person receiving care is 18 or older)
- In-laws, step-relatives, and other family by marriage
- Friends, neighbors, and other trusted community members
- Multiple workers at once (for example, two adult children splitting the week)
- Anyone who is also acting as your IRIS or SDPC representative (choose a different representative so a relative can be your paid worker)
- A worker who has not passed the required criminal and caregiver background checks
- For SDPC only: someone who owns or runs a home you live in, unless they are related to you by blood or marriage
- An agency, for SDPC personal care (SDPC workers must be individuals you hire directly, not an agency)
IRIS pay, hours, and overtime
In IRIS you are the employer, so you negotiate what each worker is paid, within the individual budget the state approves for you. Wisconsin sets rate ranges and a standard reference wage, and the FEA makes sure pay complies with minimum wage and labor law. Your budget and hours are driven by the Long-Term Care Functional Screen and, for personal care, a Personal Care Screening Tool.
Hourly pay
IRIS participants negotiate a "reasonable and customary" hourly rate with each worker rather than being handed a fixed wage. In practice, many family workers in 2026 are paid roughly $12 to $17 per hour, which reflects Wisconsin's minimum wage floor at the low end and higher rates for demanding or skilled care. For the Self-Directed Personal Care (SDPC) benefit, the state uses a standard reference wage (about $12.07 per hour in the IRIS Policy Manual) to build the personal-care budget, though the actual amount you pay is set within that budget. Workers are employees whose pay runs through the FEA, so federal and state taxes are withheld. Workers must bill by the hour or in 15-minute increments and are not permitted to charge a flat daily rate.
Hours and scheduling
There is no single fixed number of hours. Your authorized hours and budget come from the Wisconsin Adult Long-Term Care Functional Screen and, for personal care, the Personal Care Screening Tool, which translate your assessed needs into a dollar budget. You then decide how to spend that budget across the workers and supports you choose. If your medical condition, functional status, or living situation changes, you, your SDPC nurse, and your physician can request a reassessment to increase your hours.
Overtime rules
Wisconsin states that IRIS practice and policy comply with the federal Fair Labor Standards Act (FLSA). That means workers who exceed 40 hours in a workweek for one employer are generally owed overtime at 1.5 times their regular rate. The FEA processes payroll in line with these rules, and many families schedule two or more workers specifically to keep any one worker under the overtime threshold and stretch the budget further.
How to apply for IRIS in Wisconsin
- Contact your local Aging and Disability Resource Center (ADRC) or Tribal aging and disability resource specialist (ADRS). Call 844-WIS-ADRC (844-947-2372) to find yours. The ADRC provides free, unbiased options counseling and is the front door to IRIS.
- Complete the Long-Term Care Functional Screen and confirm Medicaid.
- The ADRC arranges the Wisconsin Adult Long-Term Care Functional Screen (LTC FS) to confirm you need a nursing-home level of care
- If you are not yet on Medicaid, the ADRC helps you submit a Medicaid application at the same time
- An income maintenance worker verifies financial eligibility
- Choose IRIS over managed long-term care. Once you are found eligible, the ADRC explains your options and you tell them you want to self-direct through IRIS rather than enroll in Family Care.
- Pick your IRIS Consultant Agency (ICA) and Fiscal Employer Agent (FEA) during enrollment counseling. The ADRC gives you the list of agencies serving your area; your consultant helps you plan, and the FEA handles payroll, taxes, and background checks.
- Build your Individual Support and Service Plan (ISSP) and budget with your IRIS Consultant. This plan lists your goals, the services you will buy, and the workers you will hire. For personal care, you also complete the SDPC forms with your physician and an RN.
- Enroll and background-check your workers, then start care.
- Your worker (including a spouse or adult child) completes hiring paperwork through the FEA
- The FEA runs the required criminal and caregiver background checks on every worker
- Once approved, workers submit timesheets and the FEA pays them; DHS reassesses your plan at least annually
IRIS Wisconsin frequently asked questions
Can my spouse be paid to care for me through IRIS?
Yes. This is one of the biggest differences between Wisconsin IRIS and programs in other states. Wisconsin classifies a spouse as a "legally liable relative," and both the IRIS 1915(c) waiver and the Self-Directed Personal Care (SDPC) benefit specifically allow participants to hire legally liable relatives as paid workers. So a husband can be paid to care for his wife, or a wife for her husband. The one important limit is the conflict-of-interest rule: whoever serves as your IRIS or SDPC representative cannot also be your paid worker. If your spouse would normally be your representative, you simply name someone else as representative so your spouse can be the paid caregiver. Your spouse still has to pass the required criminal and caregiver background checks and be paid through the Fiscal Employer Agent like any other worker.
How much does IRIS pay a caregiver in 2026?
Because you are the employer in IRIS, you negotiate each worker's hourly wage within the individual budget the state approves for you, rather than getting a single fixed rate. In 2026, many family caregivers are paid roughly $12 to $17 per hour, with the low end anchored to Wisconsin's minimum wage and higher pay for more demanding or skilled care. For the Self-Directed Personal Care benefit, Wisconsin uses a standard reference wage (around $12.07 per hour in the IRIS Policy Manual) to build your personal-care budget, but the exact amount you pay a worker is set within that budget. Workers are paid through the Fiscal Employer Agent as employees, so federal and state taxes are withheld. Workers must bill hourly or in 15-minute increments and cannot charge a flat daily rate. If your needs increase, your budget and pay capacity can be reassessed.
How long does it take to get approved for IRIS?
Timelines vary, but from first contact to your first paid shift often takes about 45 to 90 days. The steps that drive the timeline are the Long-Term Care Functional Screen (which confirms you need a nursing-home level of care), the Medicaid financial determination, and enrollment counseling where you choose your IRIS Consultant Agency and Fiscal Employer Agent. If you are already enrolled in Wisconsin Medicaid, the process is faster because financial eligibility is settled. After you enroll, there is a short additional wait while your worker completes hiring paperwork and clears the required criminal and caregiver background checks through the FEA. You can speed things up by contacting your ADRC early at 844-947-2372 and gathering proof of Wisconsin residency, identification, and income and asset documentation in advance.
What training or certification does an IRIS caregiver need?
IRIS does not require your worker to be a Certified Nursing Assistant, Home Health Aide, or any other licensed professional to provide most support and personal care. As the employer, you are responsible for training your worker on the specific tasks you need, and Wisconsin explicitly protects your right to have them provide care in a way that fits your personal, cultural, and religious preferences. Every worker must, however, pass a criminal background check and a caregiver background check that searches the Wisconsin Department of Justice records and the state Caregiver Registry; certain convictions permanently disqualify a person while others may be appealable. For Self-Directed Personal Care specifically, a Registered Nurse reviews the plan and the worker's performance and evaluates your condition about every 60 days, and workers can perform some home-health-aide tasks once the RN has provided delegation, training, and supervision.
What is the difference between an IRIS Consultant Agency and a Fiscal Employer Agent?
They are two separate agencies that support you, and you choose both when you enroll. Your IRIS Consultant Agency (ICA) provides an IRIS consultant who helps you understand the program, develop your Individual Support and Service Plan, find providers, and stay within your budget. The consultant advises and provides tools but does not direct your choices or hire your workers for you. Your Fiscal Employer Agent (FEA) handles the money and employer paperwork: it runs payroll for your workers, withholds and pays federal and state taxes, completes the required background checks, pays vendors, and processes any cost share you owe. Neither the ICA nor the FEA chooses your workers or supervises your care; those decisions stay with you as the employer. Your local ADRC gives you the list of ICAs and FEAs serving your area so you can pick the ones you prefer.
Can I be paid to care for my adult child or my parent through IRIS?
Yes. IRIS is an adults-only program, so the person receiving care must be 18 or older, but within that rule almost any family relationship can be a paid worker. A parent can be paid to care for their adult son or daughter who has a disability, and an adult child can be paid to care for an aging parent. Siblings, grandchildren, in-laws, and other relatives are all eligible too. Wisconsin permits family members, legal guardians, and legal representatives to be paid with IRIS funds. The same core rule applies to everyone: the person acting as the participant's IRIS or SDPC representative cannot also be the paid worker, so if you plan to be the paid caregiver, make sure someone else is named as the representative. Every worker, including relatives, must clear the required criminal and caregiver background checks.
Can I live with the person I care for and still be paid?
Yes. Living in the same home as the person you care for does not disqualify you from being paid in IRIS. Family caregivers, including spouses and adult children, very commonly live with the person they support. There is one narrow restriction that applies only to the Self-Directed Personal Care benefit: you cannot self-direct personal care if you live in a home or property that is owned, operated, or controlled by your worker and that worker is not related to you by blood or marriage, and you cannot be in most group residential settings. For an ordinary family situation, where a relative lives in the participant's own home or in a shared household, none of that is a problem. The important line to watch is the representative rule, not the living arrangement: one relative can be the paid worker while a different person serves as the IRIS representative.
Does joining IRIS change my other Medicaid benefits?
No. Enrolling in IRIS does not take away your regular Medicaid benefits. You keep your doctor visits, hospital coverage, prescription drug coverage, and other Medicaid services. IRIS is a long-term care program that sits alongside the rest of your Medicaid benefit package to fund home and community-based supports so you can stay out of a nursing home. If you are also enrolled in Medicare, Medicare continues to cover acute care such as hospital stays, physician visits, and short-term skilled home health, while IRIS and Medicaid cover the ongoing long-term supports and the workers you hire. IRIS is the self-directed alternative to Family Care, so you generally choose one or the other for your long-term care, but choosing IRIS does not disturb your underlying Medicaid eligibility or your day-to-day health coverage.
See also: Wisconsin caregiver guide
For all the ways to get paid to care for a family member in Wisconsin — including IRIS, VA programs, long-term care insurance, and more — read the full Wisconsin guide.