Self-direction gives members more choice and responsibility over how they receive certain waiver services. Eligible members can choose to self-direct waiver services through the Consumer Choices Option, or CCO, which allows members to hire workers directly or purchase certain goods and services using an approved amount of Medicaid funding.
This page explains how CCO works, the roles of Independent Support Brokers and Financial Management Services providers, and what will change under HOME.
The timeline below explains what is already in place, what is happening next under Iowa’s current waivers, and what is planned for the future Children and Youth Waiver and Adults with Disabilities Waiver under HOME.
Already happened / in place
What is happening next
Future changes
Consumer Choices Option (CCO) is available through most of Iowa’s current HCBS waivers.
Members who decide to use CCO may choose whether to work with an Independent Support Broker, or ISB. An ISB is available to help with hiring employees and developing a budget but is not required.
Members who use CCO must work with an approved Financial Management Services, or FMS, provider to make payments to providers and assist with payroll-related tasks.
No changes are planned for CCO until HOME.
Iowa HHS plans to add additional options for Financial Management Services providers for members using CCO through the Children and Youth Waiver and the Adults with Disabilities Waiver.
The future Children and Youth Waiver will include CCO. Eligible members who move from the Children’s Mental Health Waiver to the Children and Youth Waiver can choose to self-direct using CCO.
Iowa HHS will explain any changes to CCO, financial management services, and Independent Support Brokers before HOME launch.
Use the questions below to learn how CCO works, what support is available, and how CCO is expected to work under the future HOME Waivers.
List items for Understanding CCO
The Consumer Choices Option (CCO) is a program for Iowans with disabilities and older Iowans on a Home and Community-Based Services (HCBS) waiver. CCO lets you self-direct (in other words, you manage) your Medicaid community-based services and supports. This program lets you hire, train and supervise your own workers.
CCO gives you a budget to cover your long-term care needs and goals. You can also use your budget to buy items and services you need for your care.
You get more choice, control and flexibility in your waiver services as well as more responsibility.
The current Children’s Mental Health Waiver does not offer CCO.
When the future Children and Youth Waiver launches, it will include CCO as an option that eligible members who move from the Children’s Mental Health Waiver to the Children and Youth Waiver can select.
The Children and Youth Waiver launch date has not yet been decided. Iowa HHS will provide more information before this option becomes available.
An Independent Support Broker, or ISB, can help you understand and manage self-directed services. Depending on your needs, an ISB may help you:
Understand CCO rules and responsibilities
Develop your individual budget and service plan
Identify workers or other supports
Solve problems related to CCO
Organize and monitor your services
No. Working with an ISB is optional.
You may choose to use an ISB if you would like help understanding or managing your services.
You may also choose to manage your services without an ISB.
Financial Management Services, or FMS, providers handle the required financial and employer-related tasks for members who use CCO. An FMS provider:
Processes payroll and worker payments
Withholds and files required taxes
Helps complete employer paperwork
Maintains required financial records
Provides information about spending within the approved budget
An FMS provider is different from an ISB. An ISB provides optional support with your budget and workers. An FMS provider completes required financial and administrative functions.
Yes. If you use CCO, you must select and work with an approved FMS provider.
The FMS provider completes required payroll, tax, worker-payment, and employer-related tasks.
If you are interested in the CCO program, you should talk to your case manager.
They will give you more information about the program and make sure you understand the rules and your responsibilities.
If you are eligible and decide that the CCO program is right for you, your case manager will help you enroll.
List items for Planning Ahead: CCO under the new HOME Waivers
Will CCO still be available when the Children and Youth Waiver and Adults with Disabilities Waiver launch?
Yes. Iowa HHS plans to continue offering CCO under the future Children and Youth Waiver and Adults with Disabilities Waiver.
If you meet the CCO requirements, you will be able to self-direct eligible services. Iowa HHS will publish the final list of services that can be self-directed through CCO and explain any process changes before the new waivers launch.
Working with an Independent Support Broker will remain optional. Members who use CCO will continue to work with an approved Financial Management Services provider.
What is changing about Financial Management Services (FMS) providers under HOME?
Iowa HHS plans to add additional FMS provider options for members under the HOME Waivers. This means FMS is not changing but members will have more approved FMS providers to choose from.
This change hasn’t happened yet and the Centers for Medicare & Medicaid Services (CMS) must approve it before it takes effect.
