Medicaid renewals underway
For the first time since March 2020, some IRIS participants and other Wisconsin Medicaid members must complete an annual renewal process. If you are an IRIS participant, it’s important to complete and submit your renewal as soon as you can after receiving your renewal packet in the mail. And if you plan to send in your information by mail or fax, build in extra time!
Electronic Visit Verification and IRIS
Electronic visit verification hard launch for personal care and certain supportive home care services (service codes T1019, T1020, S5125, S5126) began on May 1, 2023. To learn more about electronic visit verification requirements for IRIS, visit the IRIS EVV webpage.
Corrective action—Advocates4U and Premier FMS
Advocates4U (an IRIS consultant agency) and Premier FMS (fiscal employer agent) separately contract with the Wisconsin Department of Health Services (DHS) for the IRIS program. DHS has ordered Advocates4U and Premier FMS to correct issues within their IRIS programs. Advocates4U and Premier FMS will be under corrective action until they meet all requirements.
What is the IRIS program?
IRIS (Include, Respect, I Self-Direct) is a program for adults with disabilities and elderly people in Wisconsin. It is a self-directed program. That means that you will have the freedom to decide how you want to live your life.
Who is eligible
To enroll in IRIS, you must:
- Live in Wisconsin.
- Be at least 18 years old.
- Meet certain financial and non-financial criteria.
- Be eligible for Medicaid.
- Be an adult or elder with a disability.
- Need the same level of care as someone in a nursing home.
- Live in a home, apartment, adult family home, or residential care apartment complex.
What services are available
In IRIS, you will have a budget for goods, support, and services that will help you reach your long-term care goals. You’ll be able to choose from a range of goods and services, including:
- Adaptive technology
- Adult day care center
- Adult family home
- Education and training for yourself and your workers
- Counseling and therapeutic services
- Individual directed goods and services
- Daily living skills training
- Day services
- Home-delivered meals
- Home modifications (like ramps)
- Housing counseling and startup
- IRIS self-directed personal care
- Prevocational services
- Vocational futures planning and support
- Nursing services over your Medicaid card coverage
- Personal emergency response system
- Residential care apartment complex
- Adult family home
- Support broker
- Supported employment
- Supportive home care
How it works
When you join IRIS, you get to decide what goods, support, and services will help you meet your goals. A budget is made just for you. It is based on your long-term care needs and goals. Using your budget, you will help create a support and service plan to meet your needs. Your IRIS services will help you live a meaningful life.
You will have a lot of freedom and choice. You will:
- Manage your budget.
- Act as an employer to workers you hire.
- Complete paperwork for the program and your workers.
You will need to understand and follow IRIS program rules and policies. If you choose to work with a provider, you will be the one to negotiate how much they are paid.
If you choose to hire your own workers, you will be responsible for:
Sometimes your regular worker can’t be there to help you. You will need to have an emergency back-up plan in case that happens. If there are changes in your health, condition, or safety, you must report those changes. And you need to keep up your eligibility for Medicaid and the IRIS program.
Support from others
Joining IRIS does not mean doing things all by yourself. You will have others to help you along the way. You will have both an IRIS consultant agency and a fiscal employer agent to help guide you.
IRIS is a Medicaid program. There is no cost for you to join.
Some people may have to pay a monthly payment called a cost share. Your cost share is based on your income and eligibility for Medicaid and IRIS. If you have a cost share, you will get a bill from IRIS every month. You must make sure you pay it on time. If you don’t, you could be removed from the IRIS program.
Who to contact for help
If you are already a part of IRIS and need help, contact your IRIS consultant. You can also contact the IRIS Call Center at 888-515-4747.
Mail: Wisconsin Department of Health Services
Division of Medicaid Services
IRIS Management Section
1 West Wilson St., Room 518
PO Box 309
Madison WI 53701-0309