Service Funding

Service funding refers to how Medicaid determines how much funding is available for your approved waiver services.

Service funding may include:

• A monthly spending limit 
• Rules for approving services
• A budget for self-directed services 
• Payment methods based on a member’s needs or service setting 

Your case manager uses these waiver and service rules when helping develop your person-centered service plan.

These terms are related, but they mean different things.

• A provider rate is the amount Medicaid pays a provider for a unit of service. 
• A service limit is a rule about how much of a particular service Medicaid may cover, such as a maximum number of hours, units, or dollars. 

A member budget or spending limit is the total amount available to a member for their services during a set period. 

A fee schedule lists how much Medicaid pays providers (the “provider rate”) for covered services.

Beginning January 1, 2027, Iowa HHS plans to use one fee-for-service payment rate for each service across the waivers. Managed care organizations will continue to work with providers in their networks to determine payment rates. 

The fee schedule does not, by itself, determine:

• Whether you qualify for a service 
• Which services your service plan includes
• How much of a service is authorized 

Most members will not need to take action because a provider payment rate changes. Contact your case manager if:

• Your provider says it will stop offering an approved service 
• You are having trouble finding a provider 
• A payment change appears to be affecting your access to services 

You receive a notice that you do not understand

How will service funding work when the new HOME Waivers begin?

As part of the future HOME Waivers, Iowa HHS plans to update how service funding works so Medicaid dollars are used in a consistent and sustainable way. A member’s funding will be based on their assessed level-of-care. 

Iowa HHS already uses monthly funding caps, or spending limits, on several existing waivers. In the future, Iowa HHS plans to use this approach more broadly across groups served by the new HOME Waivers.

Each member will have a monthly amount for services called My Service Plan Limit (mySPL). 

Iowa HHS plans for mySPL to:

• Be based on a member’s assessed level of need 
• Identify the funding amount available for services that count toward the limit 
• Support a more consistent funding approach across members and waiver populations 

No. mySPL is not the current service funding method for Iowa’s seven existing waivers.

Iowa HHS plans to use mySPL as part of the future HOME Waivers.

Iowa HHS is still developing the mySPL policy.

HHS plans to calculate a member’s mySPL based on a member’s core assessment and data about their needs, service use, and spending. 

The core assessment is the group of questions asked of ALL waiver members, regardless of their disability or the interRAI assessment they use . 

However, Iowa HHS has not finalized the method it will use to calculate each member’s mySPL. 

Before mySPL begins, Iowa HHS will share more about:

• What assessment information they will use 
• How they will group members into levels of need
• How they will calculate the monthly amount 
• How members can ask for more funding if their needs change or if the amount they are assigned does not meet their needs 
• How they will notify members of their mySPL 
• How and when mySPLs will be implemented

Iowa HHS has proposed that some services may be outside the monthly mySPL amount, particularly certain residential, employment, equipment, or one-time transition services, but they have not finalized this list.

 Iowa HHS will publish which services count toward mySPL, and which services are funded separately before the policy takes effect.

Iowa HHS has not finalized how current authorizations and funding limits will transition to mySPL.

For now, continue using the services in your current approved plan unless you receive an official notice explaining a change.

Tell your case manager as soon as possible. A change in your health, safety, caregivers, housing, or daily support needs may require:

• A service plan update 
• A new assessment 
• A review of your funding amount 
• A change in services or providers 

Iowa HHS is still developing the process for reviewing mySPL when a member’s needs change.

The goal of the HOME Waivers is to better match services to each person's needs. Some members may notice changes in the level of services they can use.

If that happens, you will have options. You can work with your case manager to make the most of your mySPL by choosing services that best meet your needs, adjusting how often you use some services, or combining supports in different ways. You can also explore services available outside the HCBS waivers. 

Finally, if needed, you can also use the mySPL review process to request more funding and 

Iowa HHS will have a consistent review process for you to request more funding if your mySPL is not enough to cover the services you need.

mySPL is tied to the future HOME Waiver structure so it will not happen before the Children and Youth Waiver and Adults with Disabilities Waiver launch.

Iowa HHS will provide advance notice and member guidance before any new service funding method takes effect.