HCBS Waiver Assessments

A waiver assessment is a way to check what kind of help you need. It uses standard questions to measure your level of care (how much care or support you need to do everyday tasks). 

Iowa HHS uses assessment results, along with other required information, to determine waiver eligibility and identify needs that waiver services could help meet.

A uniform assessment means that Iowa HHS uses the same overall approach to assess all waiver members. 

It does not mean that every member completes the exact same tool or answers all the same questions. 

However, everyone answers the same core set of questions so Iowa HHS can measure needs fairly and consistently across waiver members. 

You will also answer extra questions based on your diagnosis and situation to give a fuller picture of the support you need. 

Iowa HHS uses interRAI assessment tools as part of this process. There are different interRAI tools designed for different groups of people and types of support needs. 

Before you schedule your assessment, the assessment scheduler will ask you questions about your primary needs and diagnosis to make sure you are assessed using the best interRAI assessment tool for your needs. 

Iowa HHS uses several interRAI assessment tools. 

The tool used for your assessment generally depends on your age, diagnosis, current waiver, and support needs.

Some members may also complete an additional or supplemental assessment, depending on their age, program, and needs.

• Mayo-Portland Adaptability Inventory: Some people with brain injury.
• Adolescent Supplement: Some youth completing the ChYMH or ChYMH-DD assessment.
• Comprehensive Assessment and Social History (CASH), Child and Adolescent Level of Care Utilization System (CALOCUS), or Level of Care Utilization System (LOCUS) tools: Some people receiving Habilitation Services.

Your assessor or case manager can explain which tool applies to you. For more information, you can review HHS’s waiver assessment matrix.

The time it takes to complete an assessment depends on factors such as whether you have information ready, who takes part, and your health and social conditions.

You may want to have medical records and Individualized Education Plans (IEPs) or other school records ready before the assessment. 

Your first assessment when you join a waiver will take longer than future assessments. 

For most people, interRAI assessments should take about 1 to 2 hours. 

You are at the center of the assessment. You share information about your needs, and you can choose to include family, friends, your case manager, or support staff.

Your case manager and service planning team will use assessment results, along with other information, to build a service plan that reflects your preferences and supports your daily life.

If your needs change before it is time for your annual assessment, you can complete an Emergency Needs Assessment (ENA) with your case manager. The ENA is a tool to determine if you need a reassessment because your needs or risk factors have changed.

Your case manager can help update your service plan or take other action even if you do not need a reassessment.

Your assessment results may show that your needs, abilities, or risks have changed. Your care team can use this information to update your service plan, but the assessment does not automatically add, reduce, or end services. 

Your person-centered service plan is based on your assessment results, preferences, goals, other supporting information, and input from you and the people you choose to involve. 

This process will stay the same. 

You can talk to your case manager about your assessment and ask questions about how the process works. 

You can also email CareStar at [email protected] with questions or feedback about assessment changes.

What is the difference between the full assessment and off-year assessment? 

A full assessment is a comprehensive, in-person interRAI assessment.

The off-year assessment is a shorter review completed by phone in the year between interRAI assessments.

You will complete one assessment each year, either an interRAI (full) assessment or an off-year assessment. 

How does the alternating interRAI assessment and off-year assessment process, launched in January 2027, affect people on the Intellectual Disability Waiver?  

Before January 2027, people on the Intellectual Disability Waiver completed a full assessment every three years, with an off-year assessment in each of the two years between full assessments. 

Starting in January 2027, members age 7 or older on the Intellectual Disability Waiver will follow the same alternating schedule as members on the other affected waivers:

• interRAI (full) assessment one year 
• Off-year assessment the next year 
• interRAI (full) assessment the following year 

Starting January 1, 2027, members older than age 7 who are not on the Elderly Waiver will begin alternating between an interRAI assessment and an off-year assessment every two years. Iowa HHS plans to split members into two groups so that about half of members will receive an off-year assessment in 2027, and the other half will receive an off-year assessment in 2028.

CareStar or your case manager will tell you which assessment you are scheduled to complete in 2027. 

Members younger than age 7 and members on the Elderly Waiver will continue to have an interRAI assessment every year.

The assessment process will include two steps. 

1. Members will answer a few questions over the phone with someone from CareStar’s scheduling team. The questions will identify the interRAI tool that asks the right questions to understand the member’s current needs. Iowa uses several interRAI tools, and each one asks detailed questions about certain types of needs. Matching members with the right assessment tool gives a more complete picture of the support members need. 
2. The independent assessor, CareStar, will set up a meeting to conduct the assessment in-person using the identified interRAI tool. 

No. You will not need a new assessment when the HOME Waivers launch. 

You will be assessed when your next Continued Stay Review or CSR is due. 

You will keep your set CSR due date unless you have a change in condition or unique circumstance.

Will I need a new assessment when I move from the Children and Youth Waiver to the Adults with Disabilities Waiver at age 21?

No. Your assessment information will carry over when you move from the Children and Youth Waiver to the Adults with Disabilities Waiver. 

You will complete your next reassessment when your continued stay review is due.

How will Iowa HHS use my assessment results under the future HOME Waivers?

Iowa HHS will use assessment results the same way they use them now, to:

• Determine whether you meet level-of-care eligibility requirements 
• Understand your strengths and support needs 
• Help your service planning team develop your person-centered service plan