Long Term Care Funding
Family Care and Include, Respect, I Self-Direct (IRIS) are Medicaid long-term care programs for frail elders, and adults with physical, developmental, or intellectual disabilities. People in the program receive long-term care services to help them manage their home and community-based long-term care needs. If individuals do not have their own long-term care insurance and meet the qualifications for Medicaid, they are eligible to receive either Family Care or IRIS, which help to fund the cost of long term care services.
The Family Care program is facilitated through managed care organizations, however enrollment in the program is provided through the Aging and Disability Resource Center (ADRC). Anyone interested in learning more about their options for long-term care, including applying for Family Care should contact their local ADRC.
To be eligible for Family Care a person must have long-term care service needs, be an older adult or an adult with a disability, and meet financial eligibility requirements. Medicaid-eligible individuals automatically meet the financial eligibility criteria for Family Care. People receiving the Family Care benefit may be required to pay a cost share to their managed care organization.
If you choose to become a Family Care member you will have a care management team that will help you create goals and set up services to help you with your long term care needs.
IRIS is a self-directed program for Wisconsin’s frail elders and adults with disabilities. Anyone interested in learning more about their options for long-term care, including applying for IRIS should contact their local ADRC.
What to Expect
IRIS is built on the principles of self-determination and self-direction. That means that you will have the freedom to decide how you want to live your life. When you join IRIS, a budget is established for you based on your long-term care needs and goals. You get to decide what goods, support, and services will help you achieve your goals and, using your budget, you will help create a support and service plan to meet your needs.
Since you will have a lot of freedom and choice, you will be taking on the responsibilities of managing your budget, acting as an employer to workers you choose to hire, and completing important paperwork for the program and your workers. You will also be responsible for reporting changes in your health or safety and maintaining your eligibility for Medicaid and the IRIS program.
Program Rules & Policies
You will need to understand and follow IRIS program rules and policies. If you choose to work with a provider, you will be responsible for negotiating the rate. If you choose to hire your own workers, you will be responsible for recruiting, hiring, training and supervising your employees. You will also need to have an emergency back-up plan to make sure someone is there to help you if your regular worker is unavailable. If there are changes in your health, condition, or safety, you will be responsible for reporting those changes.
Although you will be self-directing, you can have others help you along the way. Every IRIS participant has an IRIS consultant agency and fiscal employer agent to help support self-direction.
To learn more about Long Term Care funding or to receive options counseling please contact the ADRC at 262-741-3400.