Wisconsin scores 63 out of 100 on the 2026 State Community Integration Index (SCII), placing it in Tier 2 Progressing and ranking 22nd nationally. The state demonstrates genuine structural innovation through its Family Care and IRIS managed long-term supports programs and the FORWARD competitive employment initiative, but persistent reliance on subminimum wage certificates, a significant nursing facility census relative to population, and a growing DD waiver waitlist constrain its ranking.
SCII Scorecard
| Metric | Value |
|---|---|
| SCII Score | 63 / 100 |
| Tier | Tier 2 — Progressing |
| National Rank | #22 of 50 |
| Judicial Posture Modifier | 0 (Seventh Circuit — Neutral) |
| Composite Score | 63 |
Domain Scores
| Domain | Points Available | Wisconsin Score |
|---|---|---|
| 1. Institutional Population Burden | 20 | 13 |
| 2. HCBS Infrastructure | 20 | 14 |
| 3. Olmstead Compliance & Legal Posture | 15 | 10 |
| 4. Criminal Justice Diversion | 15 | 9 |
| 5. Housing & Economic Self-Determination | 15 | 9 |
| 6. Voice, Oversight & Civil Rights | 15 | 8 |
| Total | 100 | 63 |
Critical Population Counts
| Population | Estimated Count |
|---|---|
| State psychiatric hospital census | ~620 |
| ICF/IID residents | ~2,800 |
| Nursing facility residents (under 65) | ~6,400 |
| DD waiver waitlist | ~4,200 |
| Section 14(c) subminimum wage workers | ~1,700 |
| Annual psychiatric diversions (estimated) | ~3,100 |
Three Strengths
1. Family Care and IRIS Managed LTSS Architecture. Wisconsin’s Family Care program — a managed care system for long-term supports and services covering adults with physical and developmental disabilities and older adults — is one of the most structurally coherent LTSS delivery systems in the nation. The program covers the majority of Wisconsin counties and manages both HCBS and institutional services under a unified managed care organization (MCO) framework, creating financial incentives for community-based alternatives. The companion IRIS (Include, Respect, I Self-Direct) program offers full consumer-directed self-determination within the same managed care architecture. Together, Family Care and IRIS have shifted Wisconsin’s Medicaid LTSS spending ratio above the national average, with roughly 68 percent of LTSS dollars flowing to community settings [1].
2. FORWARD Competitive Integrated Employment Initiative. Wisconsin’s FORWARD program — Facilitating On-Ramps and Workplaces Achieving Real Disability employment — represents a serious state-level commitment to competitive integrated employment for people with disabilities. The initiative coordinates across the Division of Vocational Rehabilitation (DVR), the Division of Long Term Care, county boards, and providers to shift employment service emphasis from facility-based settings to integrated workplaces. Wisconsin’s DVR has historically achieved above-average employment outcomes and closure rates, and the state has used WIOA coordination to strengthen that infrastructure [2]. While subminimum wage has not been eliminated, FORWARD creates structural pressure toward its phase-out.
3. Disability Rights Wisconsin and Strong P&A Infrastructure. Disability Rights Wisconsin (DRW), the state’s federally designated Protection & Advocacy organization, maintains one of the more active litigation and systemic advocacy portfolios in the Midwest. DRW has pursued cases across psychiatric hospital conditions, juvenile justice diversion, supported decision-making, and employment discrimination, and participates actively in state budget and rulemaking processes [3]. The presence of a well-resourced P&A organization with sustained litigation capacity provides accountability mechanisms that weaker P&A states lack.
Three Critical Gaps
1. Subminimum Wage Certificates Remain Active. Despite the FORWARD initiative’s emphasis on competitive integrated employment, Wisconsin has not enacted legislation to phase out Section 14(c) subminimum wage certificates. Approximately 1,700 Wisconsin workers with disabilities remain employed at subminimum wages — a figure that, scaled to population, ranks Wisconsin in the middle tier nationally but represents a significant ongoing civil rights gap. The persistence of subminimum wage has complicated FORWARD implementation, as providers with 14(c) business models resist transition without state mandates or replacement funding [4]. Until the legislature acts, Wisconsin’s employment policy is structurally bifurcated between its progressive goals and its legal tolerance of wage discrimination.
2. ICF/IID Census Disproportionate to Population. Wisconsin’s approximately 2,800 ICF/IID residents place it above the national median on institutional population burden relative to its 5.9 million residents. Wisconsin historically maintained a large network of county-operated ICF/IID facilities that have proven resistant to closure despite Family Care’s HCBS emphasis [5]. The ICF/IID system and the Family Care system operate under different financial incentive structures, meaning community integration goals embedded in Family Care do not automatically reduce ICF/IID utilization. The county board system — similar to Ohio’s county developmental disability boards — creates local political economies that resist facility closure regardless of state-level integration goals.
3. DD Waiver Waitlist Undermines System Credibility. Despite its managed care architecture, Wisconsin maintains a DD waiver waitlist of approximately 4,200 individuals — a figure that has grown despite Family Care expansion [6]. The waitlist represents a structural contradiction: a state that has invested significantly in managed LTSS infrastructure but cannot eliminate the queue for entry into that system. Individuals on the waitlist may receive limited county-funded services or no publicly funded community support at all, forcing reliance on family care or, in crisis situations, institutional alternatives. Until Wisconsin eliminates or substantially reduces its waitlist, its managed care innovation cannot be credited with full community integration success.
Key Insight
Wisconsin represents the managed care paradox: a state that built one of the nation’s most coherent LTSS delivery architectures but whose institutional census and waitlist data demonstrate that structural sophistication does not automatically produce integration outcomes. Family Care and IRIS are genuine policy achievements — they align financial incentives, support self-direction, and have shifted the LTSS spending ratio toward community. But the ICF/IID system operates partially outside those incentives, subminimum wage remains legal, and 4,200 people wait for the community supports the system promises. Wisconsin’s trajectory is positive, but the gap between its system design and its population outcomes marks the distance between framework and implementation.
References
[1] Wisconsin Department of Health Services. (2025). Family Care and IRIS annual report 2024. https://www.dhs.wisconsin.gov/familycare/index.htm
[2] Wisconsin Department of Workforce Development. (2024). FORWARD initiative: Competitive integrated employment for Wisconsinites with disabilities. https://dwd.wisconsin.gov/dvr/
[3] Disability Rights Wisconsin. (2025). Annual report and litigation summary 2024. https://www.disabilityrightswi.org
[4] National Council on Disability. (2023). Subminimum wages: Impacts on the competitive integrated employment of people with disabilities. National Council on Disability. https://www.ncd.gov
[5] Centers for Medicare & Medicaid Services. (2025). Nursing facility and ICF/IID certification and compliance data. U.S. Department of Health and Human Services. https://www.cms.gov
[6] Wisconsin Board for People with Developmental Disabilities. (2024). State of the state: Disability statistics and trends in Wisconsin. https://www.wi-bpdd.org
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