IRIS in Wisconsin: how a family member gets paid as a caregiver

What the IRIS program in Wisconsin is

DHS describes IRIS as a self-directed Medicaid long-term care program for older adults and adults with disabilities. Self-direction means the participant, or their legal decision maker, picks the services, stays inside a set budget, hires and manages the providers and follows the program rules. There is no charge to join, although some participants owe a monthly cost share based on income, billed by their fiscal employer agent; DHS warns that not paying it on time can end enrollment.

The budget comes from the results of the Long-Term Care Functional Screen. It can pay for a long list of goods and services, and the ones that matter most to a family caregiver are supportive home care (help with daily living, housekeeping and personal needs), respite, and IRIS Self-Directed Personal Care (SDPC). Under what DHS calls employer authority, the participant can either use an agency or hire, train, schedule and supervise their own workers. A relative hired this way is a participant-hired worker.

Two organizations sit beside the participant. An IRIS consultant agency handles planning and day-to-day program operations, and a fiscal employer agent (FEA) runs the payroll side, described below.

Who qualifies for IRIS

The DHS IRIS page lists these requirements for the person who needs care:

• Lives in Wisconsin and is at least 18.
• Is an older adult or an adult with a disability.
• Is enrolled in Medicaid. DHS adds that anyone who already has Medicaid, or meets its income limits, also meets the income limits for IRIS.
• Lives in a home, an apartment, an adult family home or a residential care apartment complex.
• Is functionally eligible, confirmed through the Long-Term Care Functional Screen.

Because IRIS starts at 18, it does not cover a parent caring for a young child. For an adult son, daughter, sibling or friend caring for an older relative, it is the program to ask about first.

How to apply for IRIS through your ADRC

Every IRIS application starts with the local aging and disability resource center (ADRC), or for tribal members a Tribal aging and disability resource specialist (ADRS). The DHS enrollment page sets out three steps:

1. Screen and apply for Medicaid. The ADRC completes the functional screen with you and helps with the Medicaid application, which goes to an income maintenance agency online or on paper.
2. Choose an IRIS consultant agency and consultant. The consultant explains the program rules and your duties as an employer, and helps with paperwork.
3. Choose a fiscal employer agent. The ADRC helps you pick one.

The IRIS Participant Handbook (P-01008) says enrollment should be complete and the plan active within 45 days of the first visit, and that no hired worker may start until their paperwork is done and they have passed the required background checks. If you cannot find your local office, the statewide line 844-WIS-ADRC (844-947-2372) will connect you. Questions about IRIS itself go to the IRIS Call Center at 888-515-4747.

Which relatives can be paid in IRIS, and the 40-hour rule

The current IRIS Policy Manual (P-00708, dated June 2026) states that the program "permits family members, guardians, and legal representatives to be paid caregivers." It names guardians and active health care powers of attorney as the legally responsible people who can be paid, and limits them to certain services, including supportive home care, respite, nursing services and specialized transportation. Where one person is both the paid caregiver and the one making budget decisions, the IRIS consultant reviews the arrangement for conflicts of interest and caregiver burnout.

• Adult children and other relatives can be hired like any other participant-hired worker.
• Spouses. The 2026 manual does not address spouses by name. The participant handbook, last revised in August 2021 and still the version DHS links, marks supportive home care, respite and several other services as ones a "qualified spouse, relative, or guardian" may provide. Because that handbook is older, ask the IRIS consultant agency to confirm the current spouse rule before you plan around it.
• Self-Directed Personal Care. DHS says SDPC participants may hire family members, but whoever represents the participant in SDPC cannot also be the one providing their personal care.
• Shared households. The supportive home care hours are calculated with a tool that leaves out the ordinary tasks of living in the same household, so only care beyond those everyday chores counts.

Hour cap. DHS policy stops a single participant-hired worker from providing more than 40 hours a week of paid caregiving to one participant, whatever mix of services those hours are. The cap does not reduce the participant's plan; it limits what one worker can deliver. The participant education manual (P-01704) explains that an exception needs prior approval from the IRIS consultant agency through form F-01689, and that the agency decides within five business days.

Who runs payroll: fiscal employer agents

The participant is the legal employer; the FEA supports that role. According to DHS, the FEA runs background checks on the workers you hire, processes payroll, works out federal and state tax withholding, helps with other employer tasks and collects any cost share. Wisconsin currently has three statewide FEAs:

Pay depends on timesheets. The participant must approve each worker's timesheet and get it to the FEA by the deadline; DHS warns that late timesheets can mean a worker is not paid. Only the ADRC can change your FEA or consultant agency.

Family Care: the other route to paying a family member

Family Care is Wisconsin's managed-care long-term care program. You enroll with a managed care organization (MCO), and the MCO arranges services based on need. Eligibility is similar to IRIS: 18 or older, a frail elder or an adult with a disability, eligible for Medicaid, functionally eligible, and with a long-term condition expected to last more than 90 days. DHS says the program reached every county in 2018, and its history page records that the wait list ended in 2015.

There are two ways a relative can be paid inside Family Care. First, the DHS member guide says an MCO can buy hands-on care from family when it involves frequent visits to the member's home, provided the relative meets MCO requirements and agrees to a cost close to what other providers charge. Second, members can choose self-directed supports (SDS) for one or more services, often in-home care, and pick who provides them, which can be a relative. Support brokers, co-employment agencies and fiscal agents can handle recruiting, payroll and background checks. Personal care can also be self-directed, with the member acting as employer or co-employer.

One extra note: DHS has placed My Choice Wisconsin, one of the MCOs, under corrective action for its Family Care and Partnership programs. Ask your ADRC how that affects your county.

How much does a paid family caregiver earn in Wisconsin?

None of the DHS pages we checked publishes an hourly wage for IRIS workers. The wage is set in the participant's plan and must fit the budget, and the participant must check that each timesheet shows the authorized rate. For context only, here are two public reference points, neither of which is a program rate:

The participant education manual also notes that a live-in worker can be paid minimum wage without overtime and, with prior approval, can work up to 60 hours; that manual dates from 2021, so confirm with your consultant.

VA programs and taxes on IRIS pay

Veterans. Wisconsin families looking after a veteran have two VA routes to check. Under PCAFC, short for the VA's Program of Comprehensive Assistance for Family Caregivers, whoever is designated Primary Family Caregiver receives a monthly stipend when the veteran is rated 70% disabled or more, uses VA health care and has needed hands-on personal care for six months or longer without a break. That caregiver, 18 or over, is either related to the veteran or shares, or agrees to share, the veteran's home, and the two of them file VA Form 10-10CG jointly. Veteran-Directed Care works more like IRIS: the veteran or a representative manages a spending plan and hires workers, and the VA notes a relative can be one of them. It is not offered everywhere, so a VA social worker is the person to ask.

Federal income tax. IRIS is a 1915(c) waiver program, and IRS Notice 2014-7 lets a care provider exclude Medicaid waiver payments from gross income when the person receiving care lives in the provider's home. The IRS Q&A gives the example of a son or daughter who moved into a mother's house and lives nowhere else: that counts as the provider's home. A worker who goes back to a separate home of their own does not qualify. Whether Social Security and Medicare taxes apply depends on who the employer is, so ask your FEA how it reports your wages.

Hiring privately. Paying someone yourself, outside IRIS, makes you a household employer. IRS Topic 756 sets the 2026 threshold at $3,000: give one household employee that much in cash wages and you generally owe both halves of Social Security and Medicare tax, which goes on Schedule H. A spouse, a parent (subject to exceptions) and a child younger than 21 fall outside those taxes.

Local help and reporting abuse

• ADRCs serve Wisconsin residents regardless of income. The ADRC of Milwaukee County is at 414-289-6874; other counties are on the DHS ADRC contacts page.
• Ombudsman help with IRIS. People 18 to 59 can call Disability Rights Wisconsin at 800-928-8778, and people 60 and older the Board on Aging and Long-Term Care at 800-815-0015. Complaints can also go to MetaStar at 888-203-8338.
• Adult Protective Services. Every county runs an APS helpline. For someone 60 or older you can instead call the Wisconsin Elder Abuse Hotline at 833-586-0107. In an emergency, call 911.

Where CaregiverConnect fits

CaregiverConnect is not a Medicaid provider, an IRIS consultant agency, a fiscal employer agent or a home care agency, and it does not enroll anyone in IRIS or Family Care. What it offers is simpler. A family can post the job at no cost and hire someone privately, and the family itself then becomes that worker's household employer. Caregivers set up a profile free of charge and apply to posts. An IRIS participant looking for a backup worker outside the family could search there too, but that person would still have to complete the FEA's hiring paperwork and background check before being paid through IRIS. See how it works and the optional plans on the pricing page.

Caregivers in Wisconsin are listed on the Milwaukee and Phillips pages. Families hiring on their own can follow how to hire a private caregiver; for a wider view of Medicaid options, see Medicaid programs for family caregivers.

Frequently asked questions

Sources

1. Wisconsin DHS, IRIS (Include, Respect, I Self-Direct)
2. Wisconsin DHS, IRIS: How to Apply
3. Wisconsin DHS, IRIS Waiver Renewal: Defining Self-Direction
4. Wisconsin DHS, IRIS Policy Manual P-00708 (06/2026)
5. Wisconsin DHS, IRIS Participant Handbook P-01008 (08/2021)
6. Wisconsin DHS, IRIS Participant Education Manual P-01704 (08/2021)
7. Wisconsin DHS, IRIS Self-Directed Personal Care
8. Wisconsin DHS, IRIS: Fiscal Employer Agents
9. Wisconsin DHS, IRIS: Frequently Asked Questions
10. Wisconsin DHS, Family Care
11. Wisconsin DHS, Family Care and Partnership member information (family providers, SDS)
12. Wisconsin DHS, Family Care: Benefits
13. Wisconsin DHS, Aging and Disability Resource Centers
14. Wisconsin DHS, ADRC contacts
15. Wisconsin DHS, How to report adult abuse (APS)
16. BLS, OEWS May 2025 data query (SOC 31-1120, Wisconsin)
17. Wisconsin DWD, Minimum Wage
18. VA, Program of Comprehensive Assistance for Family Caregivers
19. VA, Veteran-Directed Care
20. IRS, Certain Medicaid waiver payments may be excludable from income (Notice 2014-7 Q&A)
21. IRS, Topic 756: Employment taxes for household employees