Self-Direction and FMS in Wisconsin

All states: self-direction map

Wisconsin self-direction at a glance

Last verified against state sources: 2026-10-13.

Which Medicaid programs in Wisconsin offer self-direction?

Wisconsin offers self-direction in five Medicaid long-term care programs: IRIS, Family Care, Family Care Partnership, PACE and the Children's Long-Term Support (CLTS) Program. IRIS (Include, Respect, I Self-Direct) is the state's dedicated self-directed program for adults. In the three managed care programs, self-direction is an option called Self-Directed Supports (SDS) that a member can use for some services. Wisconsin has no single self-direction model, so the rules depend on the program.

• IRIS (Include, Respect, I Self-Direct): serves adults 18 and older who are older adults or adults with disabilities, are enrolled in Medicaid, meet the Long-Term Care Functional Screen, and live in a home, apartment, adult family home or residential care apartment complex. It is run by the Wisconsin Department of Health Services (DHS), Division of Medicaid Services, with contracted IRIS consultant agencies and fiscal employer agents. The participant has both employer authority and budget authority. IRIS operates under a 1915(c) waiver, and the renewed waiver runs from January 1, 2026 through December 31, 2030.
• IRIS Self-Directed Personal Care (SDPC): a separate benefit for IRIS participants who meet Medicaid personal care criteria and do not live in a group residential setting (unless the residential provider is a relative). DHS runs it through a single contracted IRIS SDPC Oversight Agency, which supplies the SDPC nurse. The participant hires, trains and oversees the personal care workers, and the SDPC hours are a budget separate from the IRIS base budget. A participant cannot use agency personal care and SDPC at the same time.
• Family Care, Self-Directed Supports (SDS): serves older adults and adults with physical, intellectual or developmental disabilities who are enrolled in a Family Care managed care organization (MCO). DHS runs the program through contracted MCOs, and the member's interdisciplinary team authorizes the SDS budget. The member has employer authority and budget authority. Self-direction is optional and can cover one service or many. Residential care, care management and Medicaid state plan services cannot be self-directed.
• Family Care Partnership, Self-Directed Supports (SDS): serves the same groups through Partnership plans, which combine long-term care with primary and acute care and are funded by Medicaid and Medicare. DHS runs it through contracted Partnership MCOs. The member has employer authority and budget authority, with the same two FMS options as Family Care.
• PACE (Program of All-Inclusive Care for the Elderly), self-directed supports: run by DHS through contracted PACE organizations. Participants can self-direct, but only as a managing employer through a co-employment agency. The DHS manual covers PACE alongside Family Care and Partnership and notes where PACE differs.
• Children's Long-Term Support (CLTS) Program: serves children with substantial needs and their families under a 1915(c) waiver. It is run by the DHS Bureau of Children's Services and operated locally by county waiver agencies. Families have employer authority. We did not find a clear statement on whether families use budget authority today.

Employer authority means the participant recruits, hires, schedules and supervises the workers. Budget authority means the participant also manages a set amount of money for services. In Family Care, the DHS Self-Directed Supports manual says the SDS budget equals what the MCO would have spent buying the same services.

Who handles financial management services (FMS) in Wisconsin?

It depends on the program. In IRIS, participants choose among three statewide fiscal employer agents (FEAs) under contract with DHS: GT Independence, iLIFE Financial Management Services and Premier Financial Management Services. In Family Care, Partnership and PACE, the FMS provider is contracted by the member's managed care organization, not by the state. DHS does not publish a list of those providers by MCO.

A fiscal employer agent is the organization that handles the paperwork side of being an employer. DHS's IRIS FEA page says the FEA runs background checks, processes payroll and vendor payments, manages tax withholding and collects cost share. A co-employment agency, which DHS also calls Agency with Choice, works differently: the agency is the legal employer of the workers and the member is the managing employer who directs the day-to-day work.

• IRIS: the participant, not the FEA, is the employer of the workers. DHS lists GT Independence (contracted since May 2016), iLIFE Financial Management Services (since 2008) and Premier Financial Management Services (since July 2016), all statewide. Participants pick one, and in 2026 they can transfer among the three each quarter. IRIS consultant agencies are separate from the FEAs. DHS lists six of them.
• Family Care and Family Care Partnership: the member picks one of two options. With a fiscal employer agent, the member is the legal employer and the FEA handles payroll and taxes. With a co-employment agency, the agency is the legal employer and the member is the managing employer. For goods and vendor services, the FMS provider acts as a fiscal conduit, which means it pays the bills from the member's budget.
• PACE: DHS says the only way to hire and manage staff when self-directing in PACE is through a co-employment agency. The agency is the legal employer and the participant is the managing employer.
• CLTS: workers hired by families are set up with a fiscal agent, and county waiver agencies help with that setup. We did not find a published list of CLTS fiscal agents or a description of their role. Ask the county waiver agency.

DHS sets rules for FMS providers in the managed care programs. They must be enrolled in Medicaid, hold a contract with the MCO and be IRS-authorized employer agents, and the MCO may not administer financial management services itself. To learn which FMS providers a plan uses, and whether a member can choose among more than one, ask the MCO. On pay, Family Care members set worker wages within ranges that follow federal and state labor standards under both options. A worker who wants less than the minimum fee schedule amount must sign a minimum fee rate agreement.

Who can be a paid caregiver under self-direction in Wisconsin?

Family members can be hired and paid in Wisconsin, but the limits differ by program and by service. IRIS bars spouses, relatives and legal guardians from providing many service categories. Family Care lets members pay family members or legal decision makers, but not for tasks that are a normal part of day-to-day family life.

• IRIS: the IRIS Service Definition Manual says legally responsible persons, relatives and legal guardians cannot provide many services, for example life skills training and education, day habilitation, home modifications and support broker services. For IRIS, the legally responsible person is the participant's spouse, and a relative is anyone related by blood, adoption or marriage. The manual carries no such statement for supportive home care, respite, community transportation or individual supported employment.
• IRIS respite: a respite provider may not also be the primary caregiver for the participant's supportive home care and may not share a residence with the participant.
• IRIS Self-Directed Personal Care: family members may be hired. The person who represents the participant (a legal representative or a non-limited guardian) may not be the paid personal care worker.
• Family Care, Partnership and PACE: members may pay family members or legal decision makers, but family cannot be paid for tasks that are a normal part of day-to-day family activities. Each MCO sets its own guidelines, and the contract between DHS and the MCOs has no specific requirements for guardians as paid caregivers. Ask the MCO for its written policy.
• CLTS: we did not find the current rules on paying parents, relatives or guardians. Ask the county waiver agency or the child's support and service coordinator.

Two points could not be confirmed. We did not find a statement that says outright whether a spouse can be paid for IRIS supportive home care or Self-Directed Personal Care. We also did not find a confirmed weekly hour cap for IRIS workers in the documents we could read. The IRIS service code list does include separate overtime codes for participant-hired workers in supportive home care, respite, daily living skills training and individual supported employment. For either question, ask the IRIS consultant or the IRIS Call Center at 888-515-4747.

Does EVV apply to self-directed workers in Wisconsin?

Yes. Electronic visit verification (EVV) applies to self-directed personal care and supportive home care in Wisconsin. In IRIS, a worker hired by the participant uses the EVV system chosen by the fiscal employer agent, and a worker who lives with the participant does not need to use EVV. IRIS workers are still paid when EVV data is missing, but continued non-use can lead to the participant being disenrolled.

• IRIS services covered: DHS's IRIS EVV page requires EVV for self-directed personal care and routine supportive home care (service codes T1019, S5125 and S5126). Participant-hired workers use the system their FEA chooses. Provider agency workers use the agency's system.
• IRIS live-in workers: participant-hired workers who live with the participant are exempt.
• IRIS and pay: FEAs pay participant-hired workers' claims and work with them to fix missing or inaccurate EVV data. The consequence of a non live-in worker not using EVV is possible disenrollment of the participant. Provider agency claims without EVV are denied.
• IRIS ways to record a visit: a DHS comparison sheet dated July 2025 shows GT Independence offering a mobile app only, and iLIFE and Premier each offering a mobile app, landline telephone and fixed device.
• Family Care, Partnership and PACE: the DHS Self-Directed Supports manual says SDS workers must use an EVV system for a listed set of personal care, supportive home care and home health codes. The FMS provider trains workers on timesheets or the EVV system.

Some points could not be confirmed. We did not find a DHS statement on whether a Family Care self-directed worker is paid when a visit lacks EVV, or on a live-in exemption for SDS workers. Those answers sit with each MCO and its FMS provider, so ask the MCO. We also did not find whether EVV applies to workers hired by families in CLTS. Ask the county waiver agency.

What is changing next for self-direction in Wisconsin?

The state intends to move IRIS from three fiscal employer agents to one, with participant transfers in 2027. The award is under protest and is not final. Until DHS announces an outcome, GT Independence, iLIFE and Premier remain the IRIS fiscal employer agents.

DHS's FEA transition page describes the notice of intent under RFP S-1640 DMS-25. Protests were filed from January 29 to February 7, 2026, and DHS began reviewing them on February 8, 2026. DHS says participants would begin transferring to the new FEA sometime in 2027, that early transfers are not allowed, that participants would keep their workers, and that details on timesheets, claims and EVV would be shared before the transition. None of this is final. In the meantime, participants can still transfer among the three current FEAs each quarter in 2026.

A second change concerns children's services. DHS submitted the final CLTS waiver renewal to the federal Centers for Medicare and Medicaid Services (CMS) on July 24, 2026. DHS expects it to start at the beginning of 2027, but that depends on CMS approval. The renewal summary posted for public comment would remove budget authority from CLTS self-direction, keep employer authority for daily living skills training, personal supports, respite, transportation and specialized youth care, and end Participant and Family Directed Goods and Services. We did not confirm whether the version sent to CMS kept these terms. Check DHS's CLTS waiver renewal page for the current status.

One change is already in effect. The renewed IRIS waiver that began in January 2026 added training hours for participant-hired workers under respite and supportive home care, and it redefined support broker services as help with maintaining public assistance benefits.

Wisconsin self-direction sources

• Wisconsin DHS: IRIS (Include, Respect, I Self-Direct)
• Wisconsin DHS: IRIS fiscal employer agents
• Wisconsin DHS: IRIS fiscal employer agent announcement and transition
• Wisconsin DHS: IRIS Self-Directed Personal Care
• Wisconsin DHS: IRIS waiver renewal
• Wisconsin DHS: IRIS Service Definition Manual (P-00708B)
• Wisconsin DHS: Self-Directed Supports manual for Family Care, Partnership and PACE (P-00593)
• Wisconsin DHS: EVV in IRIS
• Wisconsin DHS: CLTS waiver renewal

Related reading

• Self-Directed Medicaid Home Care Services in 2026
• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• Why Do Self-Directed Participants Choose Your FMS as Their Fiscal Intermediary?
• Self-direction in every state (map)
• Wisconsin EVV requirements

Page history

• October 13, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.