Notice is hereby given, in accordance with 42 CFR §441.304, that the Iowa Department of Human Services (DHS) has submitted to the Centers for Medicare and Medicaid Services (CMS) an Appendix K waiver to address the home and community-based services (HCBS) provider workforce shortages exacerbated by the COVID-19 public health emergency. Under CMS authority, due to the national PHE, the requirement for a public comment opportunity prior to submission was waived.


Pending federal approval, this submission will permit DHS to make one-time recruitment and retention payments, as outlined in Information Letter (IL) 2309-MC-FFS, to HCBS Waiver Individual Consumer Directed Attendant Care (ICDAC) providers, HCBS Waiver Agency Consumer Directed Attendant Care (CDAC), HCBS Waiver Consumer Choices Option Employees (CCO), HCBS Waiver Day Habilitation Providers, HCBS Waiver Supported Community Living (SCL) Providers, and HCBS Waiver Respite Providers that meet the following criteria:

  1. Provided services:
    1. Between July 1, 2020, and June 30, 2021; and
    2. Continued to provide patient care after April 1, 2021.
  2. Has not permanently ceased providing patient care directly or indirectly.
  3. With respect to Medicare, any state Medicaid program, and any Federal health care program, is not:
    1. Suspended or excluded from participation.
    2. Suspended from receiving payments; or
    3. Under any other sanction or penalty.

Fiscal Impact

The fiscal impact for fee-for-service (FFS) is $4,290,668

State:  $929,359

Federal:  $3,361,309

Public Review and Comment

A copy of the Appendix K and this public notice are posted on the DHS website at  To reach all stakeholders, non-electronic copies will be made available for review at each local DHS office.

Written comments may be sent to: LeAnn Moskowitz, Program Manager, Iowa Medicaid, 1305 E. Walnut Street, Des Moines, IA 50319-0114. Comments may also be sent via e-mail to  Please indicate “Appendix K – Recruitment & Retention Grants” in the subject line of the email.

All comments must be received by Thursday, May 5, 2022 at 4:30 p.m.


Appendix K 6 ARPA Recruitment and Retention Grant

Submitted by:  
Elizabeth Matney, Medicaid Director
Iowa Department of Human Services