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

Issued: May 1, 2026 

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 

Iowa Medicaid is conducting a second round of public notice for the Children and Youth and the Adults with Disabilities 1915(c) waiver applications. After the first public notice period, both waiver applications were submitted to CMS to begin the approval process. While under review with CMS, it was identified that the declaration regarding printed copies being made available to the public at field offices was missing in the waiver application. As a result, a second public notice is required. No changes have been made to the applications in this posting, they are identical to those posted on January 12, 2026. Individuals who submitted comments during the first comment period do not need to resubmit those same comments.

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 Hope and Opportunity in Many Environments (HOME) 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 $).