Pursuant to the authority of Iowa Code Section 249A.4, the Iowa Department of Health and Human Services (HHS) intends to renew the Home and Community Based services (HCBS) Children’s Mental Health (CMH) and Elderly Waiver (EW) programs. This notice provides details about the waiver renewals and serves to open the 30-day public comment period which closes on June 29, 2023. 


The Centers for Medicare and Medicaid Services (CMS) authorizes 1915(c) HCBS Waivers for a period of five years.  Both the CMH and EW waivers are up for renewal in 2023. The CMH and EW renewal applications both include substantive changes to the currently approved waivers. The renewal applications also reflect updated language and references in several sections.

  • Technical corrections include:
    • Changing Iowa Medicaid Enterprise and IME to Iowa Medicaid.
    • Changing ISIS to IoWANS.
    • Updating the address and contact information for Iowa Medicaid.
    • Removing language that is now outdated.
    • Adding and updating Iowa Administrative Code (IAC) references.
  • Substantive changes include:
    • Changes to the following performance measures
    • QP-b3 was eliminated as this information should already be captured in QP-b1
    • SP-c1 was rewritten.  As written, it was always going to be 100% so we needed a measure that would capture the true intent.
    • Added a new measure, HW-b3, to ensure that we fully measure to meet the sub assurance.
    • HW-c1 was rewritten.  As written, it was difficult to measure and also for providers to meet the expected outcome.  
    • HW-d1 was rewritten.  As written, it was nearly impossible for us to meet the given threshold for acceptance.
      • FA-a1 was rewritten.  As written this measure was found difficult to fulfill the requirements to properly measure the outcome.
      • FA-b1 was renumbered to FA-a3 to go under the correct sub assurance.  Then then caused FA-b2 to be renumbered to FA-b1.
  • Changes to the CMH waiver:
    • Add Medical Day Care for Children as a service.
    • Remove foster care placement as a restriction for eligibility.
    • Add a Waiver Priority Needs Assessment to determine applicants’ priority need for waiver waitlist.
    • Increase Reserved Capacity Slots to 40 per waiver year.
    • Add Telehealth as a service delivery method to for services where it will be allowed.
  • Changes to the Elderly waiver:
    • Add Adult Day Care as providers under CCO.
    • Add Community Businesses under CDAC.
    • Remove the restriction of spouses to be caregivers.
    • Add Telehealth as a service delivery method to for services where it will be allowed.

Fiscal Impact

There is no expected fiscal impact related to the changes proposed in the HCBS CMH or EW Waiver Renewals.

Public Review and Comments

A copy of the CMH and EW waiver renewals and this public notice are available at the following link: https://hhs.iowa.gov/public-notices. To reach all stakeholders, non-electronic copies will be made available for review at the HHS Field Offices.

Prior to finalizing, HHS will consider all written comments received.  The comments will be summarized and addressed in the final renewal application submitted to CMS.

Written comments concerning this notice, or the proposed renewals, may be addressed to:

LeAnn Moskowitz, LTSS Policy Specialist

Iowa Department of Health and Human Services

Iowa Medicaid, 1305 East Walnut Street

Des Moines, Iowa 50319-0114

or via email at lmoskow@dhs.state.ia.us. Please indicate CMH and/or EW Waiver Renewal in the subject line of the email.

All written and e-mailed comments must be received within 30 days from the issuance of this notice.  All comments must be received by: June 29, 2023 at 4:30 PM.


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Submitted by:

Elizabeth Matney

Medicaid Director

Iowa Department of Health and Human Services