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Family Care vs IRIS — which one's right for you?

Both are Wisconsin Medicaid's managed long-term-care programs for adults needing nursing-home-level care. Eligibility is identical. The difference is who manages the care and money.

Side-by-side

Family Care

Agency-managed

  • A managed-care organization (MCO) coordinates everything. Care manager, service plan, vendor contracts, billing — all handled by the MCO.
  • You pick from a list of contracted providers. The MCO has agreements with specific home-care agencies, day programs, transportation, and equipment vendors.
  • Less paperwork on your side. Caregiving employer responsibilities (taxes, scheduling, insurance) live with the MCO, not you.
  • Less flexibility.If you want a specific caregiver who isn't in the MCO's network, you'll need to switch to IRIS.

IRIS

Self-directed

  • You get a budget; you spend it. Medicaid calculates a monthly budget based on your assessed needs, and you (or a legal decision-maker) decide who and what it pays for.
  • You can hire your own caregivers. Family members (with some exclusions), neighbors, friends — anyone you trust who clears the worker requirements.
  • An IRIS consultant supports you. They're your guide, not your manager — they help with budgeting and paperwork but don't make decisions for you.
  • More control, more responsibility.You're effectively running a small business — interviewing, scheduling, doing payroll (via a Fiscal Employer Agent).

Same eligibility for both

  1. Functional eligibility — you must pass the Long-Term Care Functional Screen (LTCFS), which determines you need nursing-home-level care or equivalent in-home support. Conducted by an ADRC.
  2. Financial eligibility — typically EBD Medicaid (income up to ~$1,304/mo single in 2026, asset limit $2,000) or institutional Medicaid for higher-income people who require institutional-level care (income up to ~$2,901/mo with cost-share).
  3. Age 18+. Family Care and IRIS serve adults 65+ as well as adults 18-64 with physical, intellectual, or developmental disabilities.

How to apply

  1. Call your local ADRC. They run the LTCFS and explain both programs. Find yours at dhs.wisconsin.gov/adrc.
  2. Apply for Medicaid (EBD or institutional) through ACCESS at access.wisconsin.gov or 1-800-362-3002. Mention you're applying for Family Care / IRIS as well.
  3. Pick Family Care or IRIS once enrolled. You can switch programs later if your needs or preferences change.

Quick decision: which one?

Choose Family Care if:

  • You want care managed for you with minimal administrative burden
  • You don't have specific people you want to hire
  • You're fine with the MCO's contracted vendors
  • You need help making decisions but want professional oversight

Choose IRIS if:

  • You want to hire family or specific people as caregivers
  • You're comfortable directing your own care plan
  • You have the time and capacity to manage scheduling and paperwork
  • You have a trusted person who can help you self-direct (legal decision-maker, family member)

Partnership Plan — a third option

In some Wisconsin counties, there's a third option: Partnership. It combines Family Care's long-term care benefits with Medicare benefits in a single coordinated plan. Same eligibility as Family Care, but available only in specific counties (Dane, Milwaukee, Waukesha, and a few others). Ask your ADRC if it's offered in your county.

Long-term care planning is complex and individualized. ADRCs do this for free; Disability Rights Wisconsin (1-800-928-8778) helps when there's a Medicaid eligibility dispute. WI DHS runs detailed guides at dhs.wisconsin.gov/familycare and dhs.wisconsin.gov/iris.

Run the screener

The Medicaid screener flags Family Care, IRIS, and Partnership when you mark “needs long-term care.”

Check my eligibility