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IRIS Waiver Renewal

Creating the foundation for the next five years of IRIS programming

The Wisconsin Department of Health Services (DHS) is renewing the IRIS (Include, Respect, I Self-Direct) waiver. A waiver allows DHS to have Medicaid programs like IRIS.

IRIS is a Medicaid long-term care program for older adults and adults with disabilities in Wisconsin. The IRIS waiver gives participants in Wisconsin a way to self-direct their services and supports at home or in their communities. That means participants make decisions about what services to get within their budget and are responsible for sticking to their budget and following program rules.

DHS can offer the IRIS program because of the 1915(c) HCBS waiver from the federal Centers for Medicare & Medicaid Services (CMS).

Waivers need to be renewed and approved by CMS every five years. The IRIS program’s waiver is due for renewal by January 2026. This is a chance for us to make the IRIS program better between 2026 and 2030. We can improve policy, services, and other things that can make the program better for participants.

Key actions

 Request for public comment

Your feedback can make a difference! Share your input on the draft IRIS waiver renewal application (PDF) during the public comment period from July 9–August 8, 2025. Here’s how:

  • Email comments to: DHSDMSIRISRenewal@dhs.wisconsin.gov
  • Mail comments to:
    Wisconsin Department of Health Services
    Division of Medicaid Services
    Bureau of Programs and Policy
    Attn: IRIS 1915(c) Waiver Renewal
    PO Box 309
    Madison, WI 53701-0309

Read the draft IRIS waiver renewal application (PDF)

You can get a paper copy of the draft waiver renewal application mailed to you. Call 855-885-0287 to request this.

Summary of changes

There are two types of updates in the waiver renewal application: administrative changes and changes to services. Updates made across the waiver include:

  • Increasing accuracy and clarity within current practices
  • Addressing CMS waiver application requirements
  • Aligning with other states and other Wisconsin adult long-term care programs

Administrative changes

Administrative changes focus on updating service or category titles:

  • Counseling, Therapeutic, and Wellness Services (previously Counseling and Therapeutic services)
  • Day Habilitation (previously Day Services)
  • Environmental Accessibility Adaptations (Home Modifications) (previously Home Modifications)
  • Individual Supported Employment (previously Supported Employment- Individual)
  • IRIS Consultant Agency Services (previously IRIS Consultant Services)
  • Small Group Supported Employment (previously Supported Employment- Group)
  • Virtual Monitoring and Emergency Response Systems (previously Personal Emergency Response Systems [PERS])
  • Vocational Futures Planning and Support (previously Vocational and Futures Planning)

Changes to services

This is a list of the key changes in the draft waiver renewal application to provide a transparent explanation of service and category updates.

  • Housing Counseling—Added service list to broaden the scope and added a collaborative assessment to determine participant housing needs and preferences. This will help determine housing needs that promote participant choice, increase awareness of affordable housing, and promote community integration. We also provided a clear list of coverage and added a list of services to broaden this service’s scope and align with other adult long-term care programs.
  • Environmental Accessibility Adaptations (Home Modifications)—Updated to align with CMS and other adult long-term care programs. Examples include adding adaptive doorknobs and expanding railings to include indoor as well as outdoor railings.
  • Relocation-Community Transition Services—Added a service to help coordinate relocation activities for participants moving from a provider-run facility or institutional setting to a home for more community integration. Added pre-move cleaning and household preparation.
  • Competitive Integrated Employment (CIE) Exploration ( New!)—Added this new service to reflect current practices and align across other adult long-term care programs. CIE Exploration services help participants explore their interest in CIE.
  • Individual Supported Employment—Restructured this category to reflect extensive employment activities, including CIE Discovery. This service helps participants explore career options.
  • Life Skills Training and Education service ( New!)—Combined previous service categories Daily Living Skills Training and Consumer Education and Training categories into this new category.
    • Included existing services and added a service to reflect other adult long-term care programs.
    • Increased limit from $2,500 to $3,000.
  • Community Transportation—Broadened transportation options for participants.
    • Added transportation network companies (TNCs) like Uber and Lyft.
    • Clarified that transportation coverage includes public transit tickets and fare cards.
  • Assistive Technology—Moved Interpreter Services and allowable provider types to this category. Included coverage for devices for remote service delivery.
  • Virtual Monitoring and Emergency Response Systems (previously known as PERS)—Modified service category to include virtual monitoring activities.
  • Respite—Clarified language to address service scope and purpose to align with other states.
    • Defined “primary caregiver” and who is allowed to provide respite.
    • Clarified room and board is not covered to align with Wisconsin children’s programs and other states.
  • Participant-Hired Worker Training ( New!)—Hours for existing workers to train new staff are covered under respite and supportive home care (specifically routine or companion) services.
  • Clarification of IRIS roles and terms—To enhance program integrity, make sure participants get the most effective support, and avoid duplication of roles, clear definitions have been included:
    • Updated support broker service definition to “provide support to participants about maintaining a variety of public assistance benefits (for example, energy assistance programs, FoodShare).”
    • IRIS consultant agency (ICA) staff are required to meet all competency requirements to ensure participants receive the most effective information and assistance for self-direction.
    • Updated self-direction roles and responsibilities to align with CMS requirements.
  • Counseling, Therapeutic, and Wellness Services—Added culturally appropriate counseling, therapeutic, and wellness services and provider types. This could include services like, meditation, Tai Chi, Native American Healers and other wellness services associated with a particular cultural tradition.

 What’s the timeline?

The renewed waiver will be in effect January 1, 2026. Here’s the timeline:

  • July 2024: Interested parties gave input in an online survey and online public input sessions
  • January 2025: DHS began drafting proposed changes and seeking internal approvals
  • July 2025: 30-day public comment and Tribal consultation begins
  • September 2025: DHS submits proposed changes to CMS
  • January 2026: The renewed waiver is in effect

 What input has DHS received from the community so far?

DHS gathered input on the IRIS program as we look to renew the waiver. We heard from:

  • More than 150 webinar attendees during two online public input sessions in July 2024. View the presentation slides in English (PDF), Hmong (PDF), and Spanish (PDF).
  • More than 2,100 survey respondents from July to August 2024.

IRIS participants, families, caregivers and providers, IRIS contract staff, advocates, and other partners took part in these opportunities for input. Thank you to those who shared their input and helped spread the word!

DHS heard a lot of valuable feedback in 2024. We found six major themes in the survey, input sessions, and other outreach. Many of the themes are complex issues with multiple causes. While we can’t fix them all through the waiver renewal, we’re committed to addressing these issues. We’ll use this feedback to find more ways to improve the program.

The six major themes:

  • Services: Expansion of services and service providers in rural areas. Better access to mental health care, alternative medical treatments, employment services, and recreational activities.
  • Transportation: More reliable, accessible, flexible, and convenient transportation. This includes more options for participants to manage their own transportation and a wider variety of service providers.
  • Cultural competency: Resources for culturally competent and inclusive services, so care meets the diverse needs of everyone.
  • Integrity: Stronger oversight to ensure IRIS participants have the tools they need to self-direct, manage funds, and receive quality care.
  • Housing: More assistance to help participants find affordable, safe, and accessible housing.
  • Self-direction: More education for participants to support decision making about the services and supports that best meet their unique needs and preferences.

 What is the 1915(c) waiver?

The 1915(c) waiver includes the rules that make up the IRIS program and describes IRIS eligibility, services, participant rights, and finances. Find the current 2020–2024 IRIS Waiver (PDF).

 Have questions?

Send questions or ideas to DHSDMSIRISRenewal@dhs.wisconsin.gov.

Glossary

 
Last revised July 21, 2025