IRIS Waiver Renewal

 What is the waiver? Why did we renew it?

The Wisconsin Department of Health Services (DHS) recently renewed the IRIS (Include, Respect, I Self-Direct) waiver. The new waiver will be in effect January 1, 2026, through December 31, 2030. We must renew the waiver every five years.

A waiver allows us 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 supports and services they need to get within their budget and are responsible for sticking to their budget and following program rules.

Review the renewed 2026–2030 waiver (PDF)

 Summary of changes

We heard a lot of valuable feedback in 2024 from IRIS participants, families, caregivers and providers, IRIS consultant agencies, fiscal employer agents, the self-directed personal care oversight agency, advocates, and other partners. We used public input to make changes to the program waiver.

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

• Increasing accuracy and clarity within current practices.
• Addressing Centers for Medicare and Medicaid Services (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 waiver renewal.

• 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 for education expenses 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.

 The process DHS used to renew the waiver

The renewed waiver is in effect January 1, 2026. DHS used this timeline and steps to keep the renewed waiver on schedule:

• 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 began.
• September 2025: DHS submitted proposed changes to CMS.
• January 2026: The renewed waiver is in effect.

 What we heard in 2024

DHS gathered input on the IRIS program throughout the waiver renewal process. We heard from IRIS participants, families, caregivers and providers, IRIS contract staff, advocates, and other partners.

• More than 150 people attended two online public input sessions in July 2024. View the presentation slides in English (PDF), Hmong (PDF), and Spanish (PDF).
• More than 2,100 people responded to an input survey from July to August 2024.
• We gathered input on the draft waiver renewal application during a 30-day public comment and Tribal consultation from July to August 2025.

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.

The six major themes

• Services: Expansion of services and service providers in rural areas, more accessible mental health and non-traditional medical treatments and therapies, and more access to employment services and recreational activities.
• Transportation: More reliable, accessible, flexible, and convenient transportation. This includes more options for self-direction of transportation, and more provider types.
• Cultural Competency: Resources for culturally competent and inclusive services to ensure that care is tailored to the diverse needs of individuals.
• Integrity: More robust oversight to ensure IRIS participants have the tools they need to self-direct, manage funds, and receive quality care.
• Housing: More assistance with finding 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.

Thank you to those who shared their input and helped spread the word!

 Have questions?

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