Key Changes to Home and Community Based Services (HCBS) Case Management
Iowa HHS is making Medicaid HCBS case management better by limiting the number of members each community-based case manager can work with, meaning members can get more personal and timely support. These limits, which are called caseload ratios, do not apply to facility-based or fee-for-service case management. New training and rules help case managers do their jobs better and meet with members more often. This page explains these changes and why they matter.
List items for Case Management Questions
A case manager works with you to create a plan that fits your needs, strengths, and preferences. This is called a person-centered plan. Case managers talk with you to help figure out what support you need, help set up services, and make sure everything is going as planned. They also check in on your health, track your progress, update your plan when needed, and support you along the way.
Your case manager is on your side. You can count on them to:
- Listen to you: They respect your choices.
- Help you get the support you need:  They’ll connect you with services that make it easier to live the life you want to live.
- Explain your options: They help you understand Medicaid and HCBS so you can make informed decisions about your life.
- Speak up for you: They can help you advocate for yourself.
- Find helpful solutions: They know about many programs and resources that can support you.
- Treat you with respect: They value your ideas and want to help you grow and reach your goals.
More personal and timely case management
Iowa HHS asked Medicaid members and case managers for feedback. Medicaid members said it was hard to reach their case managers when they had questions or when their needs changed. Case managers said they needed to serve too many Medicaid members, which made it hard to give each person enough time and attention.
To help make sure all Medicaid members get more personal and timely support, Iowa HHS made two big changes:
- Smaller caseloads: Starting in January 2025, each community-based case manager will work with an average of 45 members, and no more than 50. This gives them more time to focus on each person. Since July 2024, Managed Care Organizations (MCOs) have hired over 100 new case managers to help meet this goal.
More in-person visits: Case managers must meet with each member face-to-face at least once every three months. Now, Case Manager must meet with members on the Intellectual Disabilities (ID) Waiver at least every two months.
Improved, more complete case manager training
- Iowa required all case managers to complete training, but there wasn’t one standard training program. As a result, case managers learned different content, which led to uneven quality in the support Medicaid members received.
- To make sure all Medicaid long-term services and supports (LTSS) members get high-quality case management, Iowa HHS created two training programs:
- The Case Manager Certification Toolkit for new case managers
- The Case Manager Refresher Toolkit for yearly ongoing training
- These programs teach important skills and include short quizzes to help case managers stay engaged and understand the material.
- New case managers will complete the Certification Toolkit within six months of their hire date. All case managers will take the Refresher Toolkit every year.
Case managers get training in many areas to better support you. Some of the topics include:
Medicaid basics: They learn how Medicaid and HCBS waivers work, and what services are available to help you.
- Working with members: They learn how to support you in a respectful, trauma-informed and culturally competent way. They also learn how to build strong relationships with you and your care teams and create person-centered plans that fit your needs.
- Technical skills: They learn how to keep records of your services and report any issues that come up.
- Helping with transitions: They learn how to support you when moving from a hospital, nursing home, or other facility back to your home or community. They also learn how to help you or your child transition from child to adult services.
- Handling emergencies: They learn how to help you if you are having a mental or behavioral health crisis or connect you to someone who can help.
- Specific programs: They learn about Iowa HHS’ Traumatic Brain Injury (TBI) program, Medicaid-funded HCBS Employment Services, and Consumer Choice Options (CCO). They also learn how to make sure you are safe and supported where you live.
- Specific populations: They learn about the unique needs, challenges and resources for people with intellectual and developmental disabilities, children, older adults, and people with behavioral health needs, HIV/AIDS, and chronic health conditions.
Case managers have always received training in these areas, but now everyone will get the same high-quality training and take yearly refresher courses to keep their skills up to date.
Anyone can see the free case manager training on Trualta, Iowa HHS’ online learning management system.
To access trainings, you need to make an account with Trualta. To make an account with Trualta:
- Click here to access Trualta.
- Click on “Sign in” at the top right corner. This will take you to a screen that says “Sign In.”
- Click the button that says “Click Here” in green. This will take you to a new screen.
- At the bottom of the screen, it will say “Don’t have an account? Sign up.” Click on “Sign up”
- Enter your first name, last name, and email address in the text boxes, and click “Sign up” This will take you to a screen that says “Set up security methods”
- In the middle of the “Set up security methods” screen, under “Email” click “Set up” to verify your email address. Trualta will send a link or code to your email.
- Once you click the link in your email, it will take you to Trualta to create a password for your account.
- Once you’ve created your password, you can access the trainings on Trualta.
If you need more guidance making an account, click here for more information.
To access the case manager training:
- At the top of the Trualta home screen, click on “Learning” in light blue. This will take you to the learning screen.
- On the right, click on “Case manager certification”
Looking at the case manager training materials can be helpful for members and their families. It can:
- Clear up confusion if you have questions about your case manager’s decisions.
- Build trust by showing what case managers are trained to do.
- Improve teamwork by helping everyone—like CCOs, MCOs, Independent Support Brokers (ISBs), and case managers—understand each other’s roles and work better together.