Page Reviewed / Updated – May 6, 2024

Waiver Description

The Iowa Home and Community Based Services (HCBS) Elderly Medicaid waiver provides services and support to help the elderly who are medically qualified for nursing home care. It is designed to allow individuals to remain living at home or in communities and receive care in those locations instead of in a nursing home.

This type of program is growing in popularity with the state and with families. Families prefer their loved ones to age in environments in which they are familiar and comfortable. And state officials appreciate the cost savings generated from reduced nursing home costs.

This waiver allows family members to receive payment for caregiving services provided in the home.

This waiver includes a Consumer Choices Option (CCO), as well as Consumer Directed Attendant Care (CDAC). These two options provide the beneficiary with a degree of freedom in terms of what type of care they require and from whom they receive that care. The beneficiary or their legal representative can choose whom to hire for services. They have the flexibility to hire friends, neighbors, and even some family members, such as the adult children. Spouses and legal guardians cannot be hired as caregivers.

CDAC allows assistance with both skilled and non-skilled services, which includes post-surgical care, tube feedings, medication management, transportation, meal preparation, and assistance with daily activities, such as walking, eating, and dressing. CCO allows even more freedom, as an individual budget will be determined, and the eligible applicant can work within this budget. Services covered under this option include chore and homemaker services, respite care, unskilled care attendant, vehicle and home modifications, meal delivery, senior companion, assistive devices, and transportation.

Eligibility Guidelines

The HCBS Elderly Waiver has eligibility requirements related to the applicant’s age, functional ability, and finances.

General Requirements

Iowa residents must be at least 65 years of age.

Functional Ability
Applicants must be assessed by a medical team and found to need the level of care provided in a nursing home on a long-term basis. However, they must be able to receive that care at home at a cost lower than it would cost in a nursing home.

Financial Requirements

Income Limits
Elderly waiver applicants must meet the Iowa Medicaid financial limits. In 2024, single applicants must have income less than $2,829 a month.

A married applicant whose spouse is not applying has increased flexibility, as he or she can allocate some of his or her income to the non-applicant spouse. This is referred to as the Monthly Maintenance Needs Allowance. In 2024, the spouse is permitted a monthly maximum of up to $3,853.50.

If the non-applicant spouse already has monthly income equal to, or above, this figure, a transfer of income is not permitted from the applicant spouse.

Asset Limits
Single (non-married, widowed, divorced) applicants are subject to a countable asset limit of $2,000. However, many assets are exempt. These include an owner-occupied home a maximum equity value of $713,000, home furnishings, personal items, and a single vehicle.

Married applicants with only one spouse applying are subject to a different set of rules. To enable a spouse to have the resources to remain living independently, he or she is permitted a Community Spouse Resource Allowance (CSRA).

In 2024, the non-applicant spouse can keep 50% of the couple’s assets, up to $154,140. If the couple’s assets are under $30,828, the non applicant spouse can keep all of the assets, up to this amount.

Over the Financial Limits?

Applicants with finances over these limits should consider working with a Medicaid planning professional. Persons in these situations still may be eligible for Medicaid, but just require financial expertise to help them allocate their income and resources appropriately.

Learn more about Medicaid planning here.

Benefits and Services

The Elderly Waiver aims to prevent nursing home placement. Therefore, the types of services that waiver participants are eligible for are specifically selected to help seniors function in their homes. This can include any of the following, but each individual is allocated custom benefits.

  • Adult Day Care – Daytime, weekday assistance in group environments
  • Assistive Devices – Devices to assist with activities of daily living, for example, a long reach brush to reach and pick up items
  • Assisted Living On-Call – 24-hour care access in residential care
  • Attendant Care (Self-Directed) – Assistance with eating, mobility, using the bathroom, housekeeping, medication management, etc. 
  • Case Management
  • Chore Services – Lawn moving, snow removal, window washing, etc. 
  • Home and Vehicle Modifications – Ramps, keyless entry systems, vehicle lifts, etc. 
  • Home Delivered Meals 
  • Home Health Aide
  • Homemaker Services
  • In-home and Out-of-home Respite Care – Provides temporary relief from caregiving responsibilities for the primary caregiver
  • Nursing Care
  • Nutritional Counseling
  • Personal Emergency Response System – Initial installation and monthly service, as well as location identifiers to help prevent wandering
  • Senior Companions – Assistance with shopping, laundry, housecleaning, and making meals
  • Transportation Assistance
  • Mental Health Outreach

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How to Apply / Learn More

To apply, one should contact their Iowa Department of Human Services county office

A detailed, although slightly dated, description of benefits is available here. Persons can also call 800-338-8366 to reach Iowa Medicaid Member Services for assistance.