PUBLIC NOTICE: Public Comment Period for the Proposed 1915(c) Home and Community-Based Services (HCBS) Children and Youth Waiver and Adults with Disabilities Waiver

The Iowa Department of Health and Human Services (HHS), pursuant to the requirements outlined in 42 CFR 441.304(f), hereby gives notice of the intention to implement two new HCBS waivers, the Children and Youth waiver and the Adults with Disabilities waiver on October 1, 2026.

Summary

The Centers for Medicare and Medicaid Services (CMS) authorizes 1915(c) HCBS waivers. As part of the Hope and Opportunity in Many Environments (HOME) project, Iowa HHS proposes replacing four of the current six disability based HCBS waivers— Health and Disability waiver, Children’s Mental Health waiver, AIDS/HIV waiver and Physical Disability waiver —with the Children and Youth waiver and Adults with Disabilities waiver.

Iowa HHS is redesigning its Medicaid home and community-based services (HCBS) waiver system to enhance services, support people to remain in their communities with their loved ones and make it easier for them to access the supports they need. Iowa HHS proposes two new age-based waivers:

  • The Iowa HHS is proposing a new Children and Youth waiver. This waiver would provide Medicaid services for children and youth with disabilities, special health care needs, and mental health needs between the ages of 0 and 21. The waiver program could allow your child to live at home with family instead of in an institution like a hospital or nursing facility.
  • The Iowa HHS is proposing a new Adults with Disabilities waiver. This waiver would provide Medicaid services for adults with disabilities aged 21 and older. The waiver program could allow you to live at home instead of an institution like a hospital or nursing facility.

See the Public Comment Information webpage for additional materials including quick guides with more details on eligibility criteria, services, and how current HCBS members will access the new HOME waivers.

Fiscal Impact

Replacing four of the current six disability based HCBS waivers— Health and Disability waiver, Children’s Mental Health waiver, AIDS/HIV waiver and Physical Disability waiver —with the Children and Youth waiver and Adults with Disabilities waiver will result in an estimated impact of $2.4 million (State $).  

Public Review and Comments

A copy of the proposed new waivers and this public notice are available at the following link: https://hhs.iowa.gov/public-notice/2026-01-12/public-notice-public-comment-period-proposed-1915-c-home-and-community-based-services-hcbs-children 

To reach all stakeholders, non-electronic copies may be made available for review at the HHS Field Offices.

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

Written comments concerning this notice, or the proposed new waivers, may be addressed to LTSS Policy Team, Iowa Department of Health and Human Services, Iowa Medicaid, 312 East 12th Street, Des Moines, IA 50319 or via email at HCBS_Public_Comment@hhs.iowa.gov

Please indicate “HCBS new HOME Waivers” in the subject line of the email.  All comments must be received by: Friday, February 13th, 2026, at 11:59pm CT.

Submitted by:

Lee Grossman, Medicaid Director

Iowa Department of Health and Human Services

Related Documents 

Children and Youth (CY) Waiver 

Adults with Disabilities (AD) Waiver