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Iowa Department of Health and Human Services

Home- and Community-Based Services (HCBS)


Home- and Community-Based Services (HCBS) are Medicaid programs that give you more choices about how and where you receive services. HCBS are for people with disabilities and older Iowans who require services to allow them to stay in their homes and communities rather than transitioning to an institution. There are several programs that provide HCBS. The program names are HCBS waivers (there are seven waivers), habilitation services, Program of All-Inclusive Care for the Elderly (PACE), home health, hospice, targeted case management (TCM), and Money Follows the Person (MFP).

In addition to HCBS waiver services, waiver-enrolled members have access to Medicaid covered services and benefits. Medicaid covers a broad array of health services, in addition to the services provided by the waiver, and limits out-of-pocket costs. These include, but are not limited to: primary care, behavioral health services, skilled nursing care, dental, vision, and emergency care. Most of Iowa's Medicaid members are served by the managed care program IA Health Link. Managed care oraganizations coordinate your care. 

News and Announcements
  • HCBS Work Process Flow Chart for Various Medicaid Programs: Presented below is a flow chart that outlines the different work flows that illustrate various policies and processes in the HCBS Waiver program.
  • On September 17, 2015, the Iowa Medicaid Enterprise (IME) Medical Services Unit and Department of Human Services (DHS) policy staff conducted a webinar regarding the Home- and Community-Based Services (HCBS) Waiver and Nursing Facility Level of Care (LOC) review process. This process involves the AIDS/HIV, Elderly, Health and Disability, and Physical Disability waivers. The following topics were covered:
    • The purpose of an HCBS waiver program
    • Nursing Facility (NF)/Intermediate Care Facility (ICF), and Skilled Nursing Facility (SNF) level of care requirements
    • Information necessary for the IME Medical Services Unit to determine LOC
    • Revised LOC Certification for HCBS Waiver Program, form 470-4392
    • The DHS Medicaid benefit extension period for members no longer meeting NF/ICF LOC 
    • The IME Medical Services Unit resource coordination process with case managers and service workers for members no longer meeting NF/ICF LOC 

      Access the slide presentation and the recording of the webinar.
      (Please note that the recording of the webinar is a .zip (compressed) file that must be downloaded to your PC. Once downloaded, it must be unzipped in order to access the recorded webinar.)

Below are the various Home- and Community-Based Services (HCBS) programs. Please access each program web page to learn more about each program.

Home- and Community-Based Services (HCBS) Waiver Program

Iowa currently has seven HCBS Waivers in the Waiver Program that provides service funding and individualized supports to maintain eligible members in their own homes or communities who would otherwise require care in a medical institution.

  • Consumer Choices Option (CCO)
    In the HCBS Waiver Program, members can also take advantage of a Consumer Choices Option (CCO) which gives members more control over how to choose their services.
  • Consumer Directed Attendant Care (CDAC)
    In the HCBS Waiver Program, there is an opportunity for people to have help in their own homes through the CDAC services.
  • HCBS Provider Quality Management Self-Assessment
    The Home and Community-Based Services (HCBS) Provider Quality Management Self-Assessment will be required of all providers enrolled for the services identified, regardless of whether those services are currently being provided. All sections of the self-assessment must be completed as requested (Sections A, B, C, D, E, and F) and submitted as a single document by the deadline indicated each year.
  • HCBS Waiver Provider Contacts
    Access the contact lists of HCBS waiver providers, specialists and map of specialist regions, and program managers.


Habilitation Services

Habilitation services provide HCBS for Iowans with the functional impairments typically associated with chronic mental illnesses.


Community-Based Neurobahavioral Rehabilitation Services (CNRS)

CNRS is a specialized category of neuro-rehabilitation provided by a multidisciplinary team of allied health and support staff that have been trained in, and deliver, services individually designed to address cognitive, medical, behavioral, and psychosocial challenges, as well as the physical manifestations of an acquired brain injury. The service is provided to adults with brain injury and co-occurring mental health diagnosis.


Program of All-Inclusive Care for the Elderly (PACE)

This program helps members and health providers come together for preventive care, primary care, social services, therapeutic recreation, acute and long-term care services. This program aims to protect and improve the member's health; and quality of life. The goal of PACE is to keep members in their home. PACE is only available in a limited area. 


Home Health Services

This program covers both children and adult members who need medical supports provided in the home by Medicare-certified home health agencies. Services included in this program are skilled nursing, home health aide, occupational therapy, physical therapy, speech therapy and medical social services.


Private Duty Nursing/Personal Cares Program

The private duty nursing/personal cares (PDN/PC) program is part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program that provides in home private duty nursing and personal cares services by Medicare-certified home health agencies. 


Hospice Services

A hospice provides palliative and supportive services to meet the physical, psychosocial, social, and spiritual needs of a terminally ill person and the persons family or others caring for the person, regardless of where the person resides. Hospice services are those services to control pain and provide support to people to continue life with as little disruption as possible. Payment for hospice services will be approved for Medicaid recipients who are certified terminally ill and who elect hospice care rather than active treatment for the illness.


Targeted Case Management

Targeted case management (TCM) is a method to manage multiple resources effectively for the benefit of Medicaid members. The service is designed to ensure the health, safety, and welfare of members by assisting them in gaining access to appropriate and necessary medical services and interrelated social, educational, housing, transportation, vocational, and other services. 


Money Follows the Person

Money Follows the Person (MFP) provides opportunities for individuals in Iowa to move out of intermediate care facilities for persons with intellectual disabilities (ICF/ID) and into their own homes in the community of their choice. Individuals living in nursing facilities may also qualify. 


Relevant Resources

HCBS Waivers and Amendments

HCBS Waiver Waiting List Information
Many members apply for waivers. It is possible that there may be a waiting list for waivers. The waiting list can vary by program and by utilization rates. Your HHS worker can help you understand waiting lists.

How to apply online
Follow this link to obtain information on making an application online.

Where to go for assistance 
Use the interactive HHS map to locate a HHS office for assistance.

Are you having trouble affording rent?
The Iowa Finance Authority provides temporary rental assistance for members who receive services through Medicaid waivers. For more information, visit their website or contact their office toll free at 1-800-432-7230.

Iowa Finance Authority
2015 Grand Ave.
Des Moines, IA 50312
515-725-4900 (Des Moines metro area)

Information regarding Estate Recovery:
When you received Medicaid benefits, which includes capitation fees paid to a managed care organization, even if the plan did not pay for any services, the State of Iowa has the right to ask for money back from your estate after your death. Members affected by the estate recovery policy are those who are: 
  • 55 years of age or older, regardless of where they are living; or
  • under age 55 and: 
    • reside in a nursing facility, an intermediate care facility for persons with intellectual disability, or a mental health institute, and
    • cannot reasonably be expected to be discharged and return home. 

Competency-Based Training for Providers and Direct Support Professionals
Competency-based training (CBT), technical assistance (TA), and consultation for Iowa long-term services and supports (LTSS) providers and case managers has come to Iowa Medicaid. The Iowa Legislature has provided for specific funding to provide TA and statewide CBT to Medicaid providers and case managers of LTSS. Iowa Legislature appropriates funding for these services annually. The CBT and TA will be provided with the intent of generating positive outcomes for providers and members. This CBT will be focused on providing a better understanding of, and compliance with, state and federal regulations concerning service provision. It will also be implemented to increase provider staff competencies in provision of direct services. This CBT is a statewide initiative for LTSS service providers and case managers.