Significant Medicaid waiver changes will affect current recipients and thousands on waitlists.
DES MOINES – Starting October 2026, Iowa will consolidate seven disability-specific Medicaid waiver programs into three age-based systems, affecting more than 25,000 current recipients and potentially thousands more on waiting lists, the Iowa Department of Health and Human Services announced.
The restructuring, known as the HOME initiative (Hope and Opportunity in Many Environments), represents the most significant overhaul of Iowa's Home and Community-Based Services (HCBS) in decades.
The changes will introduce new funding limits, standardized assessment tools, and unified service definitions across all waiver programs.
Home and Community-Based Service
HCBS waivers allow Medicaid recipients to receive long-term in-home care or care in community settings rather than in nursing facilities. The programs cover services including personal care assistance, adult day care, home modifications, and respite care.
Iowa currently operates seven distinct waiver programs, each serving specific populations based on diagnosis or disability type. As of December 2025, approximately 25,505 Iowans are enrolled across all programs, with an additional 26,665 individuals on waiting lists.
The Intellectual Disability waiver has the largest enrollment, with 12,427 participants, followed by the Elderly waiver, which has 7,510 participants. Wait times vary dramatically by program, with some applicants waiting since 2020 for services.
HOME Waiver Redesign
The new HOME structure will consist of three waivers organized by age rather than diagnosis:
Children and Youth Waiver will serve individuals from birth through age 20.
Adults with Disabilities Waiver begins at age 21 and includes all current diagnostic groups.
Elderly Waiver, serving those 65 and older, remains essentially unchanged.
"Having age-based waivers would focus on the person and their needs across the lifespan instead of the person's diagnosis," explained Tyler Smith, managing partner at IowaMedicaidHelp.
The Adults with Disabilities waiver will specifically include autism and developmental disabilities, addressing previous coverage gaps. The state notes that "autism is listed separately from developmental disabilities so that anyone diagnosed with autism after age 21 is also eligible."
Iowa will also standardize service definitions across all programs. The state will also unify provider qualifications, eliminating the need for separate enrollments in multiple waiver programs.
Implementation Timeline and Phases
Iowa Health and Human Services (HHS) submitted its waiver amendments to the Centers for Medicare & Medicaid Services in January 2026. However, federal approval is required before implementation can begin.
Phase 1: Starts in October 2026 and includes:
- Physical Disability Waiver recipients
- HIV/AIDS Waiver recipients
- Children's Mental Health Waiver recipients
- Health and Disability Waiver recipients
Phase 2: Scheduled for 2027, will transition:
- Brain Injury Waiver recipients
- Intellectual Disability Waiver recipients
Current waiver recipients will not need to reapply for services. "Members currently on existing waivers will not need to apply for the new HOME waivers," according to the state’s HCBS website. " HHS will also publish updates to help Iowans understand and plan during the transition."
Service delivery will continue uninterrupted during the changeover. And case managers will update service plans before members transition into the new rules to ensure continuity of care.
My Service Plan Limit (mySPL)
The state is also introducing a new funding methodology in 2026 called My Service Plan Limit, which assigns monthly dollar amounts based on assessed needs rather than diagnosis categories.
Phase 1: Iowa will implement "updated service funding methodology based on assessed need, evidence-based service limits, consistent approach across populations," according to planning documents.
Phase 2: The HHS will introduce "individual monthly dollar amounts (mySPL) based on uniform assessment results."
Several services will not count toward monthly limits:
- Home and Vehicle Modifications
- Supported Community Living
- Residential-based Supported Community Living
- Specialized Medical Equipment
- Community Transition Services
- Supported Employment
Some recipients may experience changes in their service levels under the new funding structure.
"The goal of the HOME waivers is better to match services to each person's actual needs," state officials noted. That means some members may notice changes in the level of services that they can use as a base for comparison.
Uniform Assessment Tools For Eligibility Processing
Beginning July 2025, Telligen became the sole assessment vendor for all HCBS evaluations, replacing the previous system that managed care organizations used to conduct assessments.
The state also adopted interRAI assessment tools, which multiple other states use for eligibility processing. Each assessment includes core questions for all participants, as well as population-specific modules tailored to the needs of each group.
"The time it takes to complete new assessments will depend on things like having information ready before starting, who is involved in your Medicaid planning team, your health and social conditions, and the assessor's experience," according to Tyler Smith.
Enhanced Case Management
New regulations will limit community-based case managers to an average of 45 members, with a maximum of 50.
Additionally, face-to-face visit requirements will increase under the new rules. Case managers must meet with members at least quarterly, with participants who receive Intellectual Disability waivers requiring visits every two months.
Since July 2024, managed care organizations have hired over 100 new case managers to meet the new caseload requirements.
Case managers will also receive specialized training on transition procedures. Service plan updates will likewise occur before the transition date to ensure a seamless continuation of support.
"Case managers will work with members to update service plans before the transition, so members will continue receiving the support they need," state officials confirmed.
Maintaining Consumer Choice in the HCBS System
The new updates and rules will continue to allow Medicaid recipients to maintain control over caregiver selection, including family members, though spouses remain ineligible as paid providers.
People can also opt to self-direct services and will not lose access to their Independent Support Broker (ISB). However, ISB services will become optional rather than mandatory.
For youths turning 21 on the Adults with Disabilities Waiver, the HHS will reserve slots to determine the level of care during transitions. Recipients will also undergo reassessment one year after transitioning to adult services.
Iowa Medicaid HCBS Resources and Information
The Iowa HHS HOME website provides regular updates and detailed guidance for HCBS Waiver recipients.
- HHS Benefits Portal: Online waiver applications and account management
- Medicaid Member Services: 1-800-338-8366 or [email protected]
- Aging and Disability Resource Centers: 1-800-779-2001
- Assessment Questions: [email protected]
The state's virtual assistant, "Ellie," also offers chat support for Medicaid application status and general inquiries.
Local HHS offices provide in-person assistance for complex situations. Office locations are available through the HHS interactive map.
Connect with Professionals for Guidance
The comprehensive changes to Iowa’s Medicaid HCBS system represent a significant shift in how the HHS will deliver services across the state, requiring careful attention and timely action from both families and recipients.
Medicaid planning firms, such as IowaMedicaidHelp, offer Iowans dedicated support to help them understand the upcoming transitions and prepare effectively for the HOME initiative changes.
State officials recommend that families connect with professionals who can help them weigh their options and make informed decisions, rather than attempting to tackle these important transitions alone.