State guide

Wisconsin

Programs, dollars, and people that serve autism families in Wisconsin. Federal protections always apply on top of what you see here.

Wisconsin overview

Wisconsin's Department of Health Services administers Family Care and IRIS (Include, Respect, I Self-Direct) as the two main Medicaid HCBS waiver options. IRIS is a self-directed model giving families more control over services and providers — Wisconsin's self-direction option is one of the better-structured in the country. Contact your local Aging and Disability Resource Center (ADRC) to begin enrollment. The Parent Education Project of Wisconsin (PEPS) is the state's PTI center. The Waisman Center at UW-Madison is one of the country's leading UCEDDs for autism research and family services.

Verify program names, URLs, and eligibility on official .gov sites — these change.

⏰ Act now — Medicaid waiver waitlist

Wisconsin IRIS and Family Care Waivers (DHS)

Typical wait: varies by county and program

Apply through your county's Aging and Disability Resource Center (ADRC) the day of diagnosis — Wisconsin's waiver intake is managed locally.

Wisconsin offers IRIS (self-directed) and Family Care (managed care) options. Your ADRC will help determine eligibility and program fit.

Apply or learn more →

Statewide resources

These four programs exist in every state and are the fastest entry points for most families.

Insurance Coverage

Whether private insurance must cover ABA therapy in Wisconsin.

Wisconsin requires insurance to cover ABA therapy

2009 Act 218 · effective 2010

Through age 13No dollar capDiagnosis required

One of the weaker mandates — covers ABA only through age 13 with no dollar cap. Families with teens should pursue Wisconsin Medicaid (ForwardHealth) for continued ABA coverage. Self-funded ERISA plans are exempt.

Self-funded employer plans (ERISA) are typically exempt — ask your HR department which type of plan you have.

Medicaid Waiver

Home and community-based services (HCBS) for autism families in Wisconsin.

IRIS (Include, Respect, I Self-Direct) / Family Care

Wisconsin Department of Health Services (DHS), Division of Medicaid Services

Open

Typical wait time

Generally open enrollment — IRIS and Family Care have largely eliminated waitlists

Coverage highlights

  • ✓Respite
  • ✓Supported Living
  • ✗Therapy
  • ✓Employment Supports

Wisconsin is notable for largely eliminating its DD waiver waitlists through its IRIS (consumer-directed) and Family Care (managed care) programs for adults. Children's Long-Term Support (CLTS) waiver serves children. IRIS allows individuals to hire their own workers and manage their own care budget. Wisconsin also has robust autism insurance coverage through state law.

How to apply

Apply online →888-515-4747

Medicaid Managed Care

How Medicaid pays for ABA therapy in Wisconsin.

ForwardHealth (BadgerCare Plus — Wisconsin Medicaid)

Covers ABA through under 21

How to find your plan

Visit forwardhealth.wi.gov or call 1-800-362-3002. Wisconsin uses county-based HMO options — your plan depends on your county of residence.

Major plans in this state

  • Dean Health Plan / Prevea360
  • Group Health Cooperative of South Central Wisconsin
  • Molina Healthcare of Wisconsin
  • Network Health Plan

Wisconsin ForwardHealth (BadgerCare Plus) uses regional HMO plans for Medicaid. ABA therapy is covered for children under 21 through EPSDT. Not all counties have HMO options — some areas are fee-for-service. Prior authorization is required. Contact your plan or the ForwardHealth helpline to find ABA providers in your area.

⚠️ Prior authorization is required before starting ABA services.

By county

71 counties