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 is a special set of rules that allows us to have Medicaid programs like the IRIS program.

The IRIS program is a Medicaid long-term care program for older adults and adults with disabilities in Wisconsin. It is a self-directed program which means participants have the freedom to decide how they want to live their lives. DHS can offer the IRIS program thanks to the 1915(c) HCBS waiver from the federal Centers for Medicare & Medicaid Services (CMS).

We must renew the 1915(c) HCBS waiver every five years. This is a chance for us to make the IRIS program better between 2026 and 2031. We can improve policy, services, and other things that can make the programs better for participants.

DHS will get input from IRIS participants, their families and friends, caregivers and providers, IRIS contract staff, advocates, and other partners. We will then submit our proposed changes to CMS for review and approval.

 Will the IRIS program change?

We want to use this opportunity to make the program the best it can be. With your input, we aim to make sure our proposed changes:

• Reflect recent program and policy changes.
• Support participant choice, self-determination, and access to high quality services.
• Use cost-effective solutions.
• Ensure equity within the IRIS program.
• Support program integrity and sustainability initiatives.

 What’s the timeline?

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

1. July 2024: Interested parties give input in an online survey and online public input sessions
2. January 2025: DHS finalizes proposed changes and internal approvals begin
3. July 2025: 30-day public comment and Tribal consultation begins
4. September 2025: DHS submits proposed changes to CMS
5. January 2026: The renewed waivers are in effect

 What input did DHS get from the community?

Who we heard from in 2024

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

• Nearly 151 webinar attendees during two online public input sessions in July. View the presentation slides in English (PDF), Hmong (PDF), and Spanish (PDF).
• More than 2,100 survey respondents from July to August.

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!

What we heard in 2024

DHS heard a lot of valuable feedback. 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’s next?

DHS will use the input we received to draft changes to the IRIS waiver. We will reach back out to IRIS participants, family, caregivers and providers, IRIS contract staff, advocates, and other partners in July of 2025 to get more input.

You'll have a chance to see the waiver renewal application. You'll also be able to submit comments during a 30-day public comment period.

 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 our current approved waiver application (PDF).

 Have questions?

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