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Home- and Community-Based Care

The Iowa Home and Community Based Services (HCBS) Waiver Program provides members who are older or have disabilities with individualized benefits. The benefits allow them to live in their own home or community when they would otherwise require care in a nursing facility or other institution.

This gives you more choices about how and where you get services. These services may let you to stay in your home. You must be eligible for Medicaid and also meet the requirements for the waiver you are applying for and/or receiving. You will need to meet certain requirements that show you are in need of:

  • Nursing facility.
  • Skilled nursing facility.
  • Hospital care.
  • Care in an intermediate care facility for individuals with intellectual disabilities.

Before a member can access waiver services, the member must be awarded a funding slot. If no funding slot is available, then the member will be placed on a waiting list.

Waivers

Iowa currently has the following Medicaid HCBS waivers:

  • AIDS/HIV Waiver.
  • Brain Injury Waiver.
  • Child Mental Health Waiver.
  • Elderly Waiver.
  • Health and Disability Waiver.
  • Intellectual Disabilities Waiver.
  • Physical Disabilities Waiver.

Iowa currently has a 1915(i) State Plan HCBS Program for habilitation services. Services provided under the State's 1915(i) program must be provided to members who have incomes at or below 150 percent of the federal poverty level. Members must also meet the needs-based eligibility criteria for the Habilitation program by Iowa Department of Human Services (DHS).

Waiver benefits

AIDS/HIV

  • Adult Day Care.
  • Consumer Directed Attendant Care.
  • Counseling Services.
  • Home Delivered Meals.
  • Home Health Aide.
  • Homemaker Services.
  • Nursing Care.
  • Respite.
  • Consumer Choices Option.

Brain injury

  • Adult day care.
  • Behavioral programming.
  • Care management.
  • Consumer-directed attendant care.
  • Family counseling and training.
  • Home and vehicle modifications.
  • Interim medical monitoring and treatment.
  • Personal emergency response system.
  • Prevocational services.
  • Respite.
  • Specialized medical equipment.
  • Supported community living.
  • Supported employment.
  • Transportation.
  • Consumer Choices Option.

Children’s mental health

  • Environmental modifications and adaptive devices.
  • Family and community support services.
  • In-home family therapy.
  • Respite.

Elderly

  • Adult day care.
  • Assistive devices.
  • Assisted living.Care management.
  • Chore services.
  • Consumer-directed attendant care.
  • Consumer Choices Option.
  • Emergency response system.
  • Home and vehicle modifications.
  • Home-delivered meals.
  • Home health aide.
  • Homemaker services.
  • Mental health outreach.
  • Nursing care.
  • Nutritional counseling.
  • Respite.
  • Senior companions.
  • Transportation.

Habilitation

  • Home-based habilitation.
  • Day habilitation.
  • Prevocational services.
  • Supported Employment.

Health and disability

  • Adult day care.
  • Consumer-directed attendant care.
  • Consumer Choices Option.
  • Counseling.
  • Home and vehicle modification.
  • Home-delivered meals.
  • Home health aide.
  • Homemaker services.
  • Interim medical monitoring and treatment.
  • Nursing.
  • Nutritional counseling.
  • Personal emergency response system.
  • Respite.

Intellectual disability

  • Adult day care.
  • Consumer-directed attendant care.
  • Consumer Choices Option.
  • Day habilitation.
  • Home and vehicle modifications.
  • Home health aide.
  • Interim medical monitoring and treatment.
  • Nursing.
  • Personal emergency.
  • Response system.
  • Prevocational.
  • Respite.
  • Supported community living.
  • Supported community living — residential based.
  • Supported employment.
  • Transportation.

Physical disability

  • Consumer-directed attendant care.
  • Consumer Choices Option.
  • Home and vehicle modification.
  • Personal emergency response system.
  • Specialized medical equipment.
  • Transportation.

Eligibility

The federal law that this program operates under bans targeting a specific population group to be served. The program gives the type of services adults with a chronic mental illness need.

Anyone who needs services through this program must be eligible for Medicaid. They must have a need for these services. The need will be shown by meeting the following needs-based criteria.

The person meets at least one of these risk factors:

  • Has received or is currently receiving psychiatric treatment more intensive than outpatient care, more than once in a lifetime (e.g., emergency services, alternative home care, partial hospitalization or inpatient hospitalization).
  • Has a history of psychiatric illness resulting in at least one episode of continuous, professional supportive care other than hospitalization.

In addition, the person has a need for assistance usually shown by meeting at least 2 of these criteria on a continuing or irregular basis for at least 2 years:

  • Is unemployed, or employed in a sheltered setting, or has noticeably limited skills and a poor work history.
  • Needs financial help for out-of-hospital maintenance and may not be able to get this assistance without help.
  • Shows severe inability to form or keep a personal social support system.
  • Needs help in basic living skills, such as self-care, money management, housekeeping, cooking, or medication management. 
  • Shows inappropriate social behavior that results in demand for intervention.

There is no age restriction to get habilitation services. Anyone who meets all eligibility requirements for the program can get the service. The needs-based criteria most likely do not apply to most younger children, regardless of disability.

Adolescents who are transitioning from children's services to adult services would likely benefit from the program without the need to make an abrupt transition at the age of 18.

Federal law restricts eligibility to individuals whose household income does not exceed 150 percent of the federal poverty level.

Services may be provided to a member regardless of Waiver enrollment. A person must still meet all eligibility criteria for both programs. Services may not be duplicative between the 2 programs.

For more information on the benefits and benefit limits for each waiver program, please call AmeriHealth Caritas Iowa Member Services at 1-855-332-2440/TTY 1-844-214-2471 24 hours a day, 7 days a week.