Adult Medicaid & HCBS Transition

Which current HCBS waivers serve children and young adults?

Children may qualify for the following current waivers, depending on their Medicaid eligibility, diagnosis, needs, and other program requirements:

• AIDS/HIV Waiver 
• Brain Injury Waiver 
• Children’s Mental Health Waiver 
• Health and Disability Waiver 
• Intellectual Disability Waiver 

Two waivers do not serve children: The Physical Disability Waiver begins at age 18 and may serve eligible young adults. The Elderly Waiver serves people age 65 and older.

What happens when a young person on  the AIDS/HIV Waiver, Brain Injury Waiver, Health and Disability Waiver, or Intellectual Disability Waiver turns 18?

Turning 18 does not end enrollment in the AIDS/HIV Waiver, Brain Injury Waiver, Health and Disability Waiver, or Intellectual Disability Waiver. A member may remain on the current waiver as long as they continue to meet Medicaid, diagnosis or disability, and level-of-care requirements.

However, turning 18 can affect other parts of Medicaid and adult services. The member and case manager should review:

• Medicaid and financial eligibility 
• Disability status or Social Security requirements 
• Who can receive information or help make decisions for the member 
• Whether current providers serve adults 
• Whether the service plan should be updated for adult goals and needs 

So, the member does not need to apply for a different current waiver just because they turn 18. They should continue completing Medicaid renewals, waiver assessments, and other required reviews.

What happens when someone on Children’s Mental Health Waiver turns 18 and ages out of the waiver?

Members age out of the Children’s Mental Health Waiver when they turn 18. Before that happens, the member and case manager should review the person’s expected adult needs and identify other services or programs that may help.

Possible options include:

• 1915(i) Habilitation Services 
• Medicaid State Plan services, which include adult outpatient mental health services  
• Another current HCBS waiver, if the person has a qualifying co-occurring condition and meets the other eligibility requirements 
• Community programs and supports 
• Options available through other insurance 

Not every Children’s Mental Health Waiver member will qualify for the same adult program. Transition planning should be based on the person’s diagnosis, level-of-care, Medicaid eligibility, and service needs.

The Habilitation Services program provides Medicaid home and community-based services (HCBS) for Iowans who are at risk of hospitalization, going to jail or being admitted to a facility without help to live and work in the community.  

The services available through this program can help you learn and practice key skills like taking care of yourself, taking care of your home, finding and keeping a job, and adapting to different situations so you can live and work successfully in your home and community. 

The Habilitation Services program does not have a waiting list.

Depending on the person’s needs, Habilitation Services may include:

• Case management 
• Home-based habilitation 
• Day habilitation 
• Prevocational services 
• Supported employment 

Some Children’s Mental Health Waiver members start using Habilitation Services before they turn 18 so supports can continue as they move into adulthood. 

Not every Children’s Mental Health Waiver member will meet the Habilitation Services eligibility requirements. 

Can someone on the Children’s Mental Health Waiver apply for another current waiver?

Yes. A child or young person with a co-occurring diagnosis may apply for another waiver if they meet that waiver’s diagnosis, financial, and level-of-care requirements.

A person may only be enrolled in one waiver at a time. 

If the person qualifies for more than one waiver, the member or family chooses which waiver to use. 

When should transition planning begin for members on the current Children’s Mental Health Waiver?

Transition planning for a current Children’s Mental Health Waiver member should begin around the member’s 17th birthday. Young people on other waivers should also begin discussing adulthood with their case manager before or around age 18, even when their current waiver does not end at that age.

Members and families should discuss:

• Adult health and behavioral health needs 
• Medicaid and financial eligibility 
• Disability-determination or Social Security requirements 
• Services that may end, change, or move to another Medicaid benefit 
• Whether current providers serve adults 
• Habilitation Services or another waiver 
• Education, employment, housing, and community-support goals 
• Who will help the member manage applications, notices, and decisions after age 18 

A case manager can help identify the applications, records, and other documents that may be needed.

Can applying for another current waiver help preserve an application date for a future HOME Waiver?

Yes. If you are aging out of the Children’s Mental Health Waiver and may qualify for another current HCBS waiver, you can apply for that waiver now and be placed on that waiver’s waitlist if no slot is available. 

Applying now may help establish an application date that could carry forward when Iowa HHS combines the current waitlists under the future HOME Waiver structure.

Applying does not guarantee that you will qualify or receive a waiver slot right away. You can be on more than one current waiver a waitlist, but you can only be enrolled on one HCBS waiver at a time. 

Iowa HHS will explain how current waitlist records and application dates will transfer before the new Children and Youth Waiver and Adults with Disabilities Waiver launch. Ask your case manager or Iowa HHS which current waiver may fit your needs and how to apply.

How will the transition to adult waiver services change under HOME?

After the future HOME Waivers launch:

• The Children and Youth Waiver will serve eligible members through age 20. 
• The Adults with Disabilities Waiver will serve eligible members beginning at age 21. 

A Children and Youth Waiver member who wants waiver services after turning 21 will need to apply for the Adults with Disabilities Waiver about 45 days before their 21st birthday. To move onto the Adults with Disabilities Waiver, they will need to meet the Adults with Disabilities Waiver’s eligibility requirements. 

The Children and Youth Waiver serves youth through age 20 (instead of 17) to provide continuity of waiver services during the early adult years. This gives members and families additional time to address other changes that may begin at age 18, such as adult Medicaid eligibility, disability determinations, adult providers, and legal or decision-making arrangements, before the waiver transition occurs at age 21.

The transition will not be automatic. Planning should begin early to reduce the risk of a gap in services. 

How will people move from the Children and Youth Waiver to the Adults with Disabilities Waiver?

In the future, people will move from the Children and Youth Waiver to the Adults with Disabilities Waiver when they turn 21. 

About six months before they turn 21, their case manager will check with them to determine whether they want to move to the Adults with Disabilities Waiver and whether they qualify. 

Not everyone who qualifies for the Children and Youth Waiver will automatically qualify for the Adults with Disabilities Waiver. If they do not qualify, their case manager will help them explore other options, such as the 1915(i) Habilitation Services program, so they can continue to access services.

If they are eligible, their case manager will guide them through the application process for the Adults with Disabilities Waiver, help with the disability determination, and update their service plan to reflect their adult needs.

Will the move from the Children and Youth Waiver to the Adults with Disabilities Waiver be automatic?

No. The member will need to apply for the Adults with Disabilities Waiver and meet its:

• Medicaid and financial requirements 
• Disability and qualifying-condition requirements 
• Level-of-care requirements 

Iowa HHS eligibility staff make the final eligibility decision. The case manager can explain the process, help track dates, and help the member gather information, but does not determine eligibility.

When will planning for the move to the Adults with Disabilities Waiver begin?

Preparation can begin between ages 18 and 20.

At age 18, the member and family should find out whether the member already has an approved disability determination from the Social Security Administration or Iowa HHS. If not, they should begin that process. Obtaining the disability determination early can make the Adults with Disabilities Waiver application process easier and reduce the risk of delays.

Formal transition planning starts about six months before the member turns 21. The case manager will help the member and family:

• Review expected adult support needs 
• Discuss Adults with Disabilities Waiver eligibility 
• Identify possible adult providers 
• Gather financial, disability, and diagnosis information 
• Plan for changes in services 

Prepare the adult person-centered service plan 

What is a disability determination, and why should planning begin at age 18?

A disability determination is an official decision by the Social Security Administration or Iowa HHS that a person meets disability requirements. 

An approved disability determination is one of the eligibility requirements for the Adults with Disabilities Waiver. 

Some members may already have a determination on file. Others may need to complete a new adult determination, including some people who received disability benefits as children and must complete an age-18 review.

Beginning this process at age 18 gives the member more time to gather medical records, provider information, psychological evaluations, or other documents that may be needed.

Learn more about Iowa’s disability determination process.

Will people moving from the Children and Youth Waiver to the Adults with Disabilities Waiver be guaranteed a waiver spot?

Yes. Iowa HHS plans to reserve slots so people moving from the Children and Youth Waiver to the Adults with Disabilities Waiver will have a slot when they turn 21, as long as they meet the Adults with Disabilities Waiver’s eligibility requirements.. 

Your level-of-care will carry over based on your last waiver continued stay review (CSR). One year after your last CSR under the Children and Youth Waiver, you will be reassessed under the Adults with Disabilities Waiver.

Will a member need a new level-of-care assessment just because they turn 21?

No. The member’s existing level-of-care and assessment will carry forward from the Children and Youth Waiver. Members will not need a new level-of-care assessment just because they turn 21, and they will keep their current Continued Stay Review or CSR date, unless they have a change in condition or unique circumstance.

The member will complete the next assessment when it is due. CareStar, Iowa HHS’s assessment vendor, may contact the member during the transition if the regular assessment is due or updated information is needed.

Will services stay the same when a member moves from the Children and Youth Waiver to the Adults with Disabilities Waiver?

Not necessarily. The Children and Youth Waiver and the Adults with Disabilities Waiver will have different service packages, and some services available to children and young adults through Iowa Care for Kids or other Medicaid State Plan benefits may change at age 21.

During transition planning, the case manager will help the member:

• Compare Children and Youth Waiver services with the Adults with Disabilities Waiver services
• Identify services available through the Medicaid State Plan 
• Find adult providers 
• Update the person-centered service plan 

Plan service start dates to reduce the risk of a gap 

What if a Children and Youth Waiver member does not qualify for the Adults with Disabilities Waiver?

Not every person eligible for the Children and Youth Waiver will automatically qualify for the Adults with Disabilities Waiver because the two waivers have different eligibility requirements. 

If someone is not qualified for the Adults with Disabilities Waiver, their case manager will help the member explore other ways to meet their needs, which may include:

• 1915(i) Habilitation Services 
• Medicaid State Plan services 
• Behavioral health services 
• Other Medicaid programs 
• Community services and supports 

Transition planning will still occur even when the member is not expected to enroll in the Adults with Disabilities Waiver.