Iowa provides long-term care resources to seniors through its Department of Human Services (DHS), Medicaid Services for Long-Term Care. Some of the resources provided include the Iowa Health Link, which provides services to Medicaid beneficiaries through Managed Care Organizations. Further, the DHS helps seniors with Medicaid find long-term care options, including Home Health Care, which provides in-home medical services by Medicare-certified home health agencies. For Home Health Care, a physician must certify a member’s medical need for HHS through a face-to-face encounter. The physician must also review and sign the HHS plan of care (POC) every 60 days. The physician’s signature on the plan of care authorizes the service(s) as an assessed medical need(s).

The Iowa Department of Aging also offers resources for non-Medicaid programs for seniors, administered through the state’s local Area Agencies on Aging.

Additionally, the DHS oversees Medicaid-specific long-term care services, which may include services through one of the Medicaid home-and-community-based (HCBS) waiver programs available to eligible Medicaid recipients. Iowa offers seven HCBS Medicaid waivers depending on your age, type of care needed and financial situation. For seniors over 65 years of age, the Iowa Elderly Waiver provides assistance for assisted living and in-home care and additional Medicaid benefits for eligible applicants.

Medicaid Waiver Program for Assisted Living and In-Home Care

Medicaid Home and Community-Based Services Elderly Waiver (HCBS Elderly Waiver)

The Iowa HCBS Elderly Waiver is for seniors over the age of 65 who would rather live in their own home or community setting rather than a nursing home. The applicant must choose that they would rather receive a nursing home level of care outside of a nursing facility to be eligible. It provides an array of services, including assisted living and in-home care, as well as many additional long-term care services tailored to the specific waiver recipient.


Services included in the HCBS Elderly Waiver consist of Adult Day Care, Assistive Devices, Case Management, Chore Services, Consumer Directed Attendant Care, 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, and Consumer Choices Option.


Members may be eligible for HCBS Elderly Waiver services by meeting the following criteria:

  • Be an Iowa resident and a United States citizen or a person of foreign birth with legal entry into the United States
  • Be 65 years of age or older
  • Be determined eligible for Medicaid (Title XIX) as if the member was in a medical institution.
  1. Health: An applicant for the Elderly Waiver must be determined by the Iowa Medicaid Enterprise Medical Services to need either a Nursing or Skilled Level of Care.
  2. Financial: If an applicant is not already Medicaid-eligible, the applicant’s income and assets must be below certain limits. For 2022, The applicant’s income must be less than $2,349 (300%, or three times the Supplemental Security Income allowance) per month and countable resources less than $2,000 for a single person or $3,000 for a couple. If an applicant’s income is too high, then a Miller Trust (also known as a Qualified Income Trust) can allow them to access the benefits by funnelling their income into the trust for the purpose of paying for care. An individual cannot make more income than the total cost of care. In Iowa, the Elderly Waiver has certain rules for the non-applicant spouse, subject to federal Medicaid law. If married, the community spouse is the non-applicant spouse and is subject to asset limits and requirements for additional related income that is disregarded for determining the applicant’s eligibility. The resource allowance, or CSRA, for 2022 was $128,640, and the community spouse may keep up to a maximum of $3,216 for their monthly needs, known as the Maximum Monthly Maintenance Needs Allowance, or MMMNA.

Practical Considerations

Iowa’s enrollment has a cap for the number of participants. There is currently no waitlist for services under the Elderly Waiver in Iowa.

In some cases, an otherwise eligible applicant will not be eligible because there is a cost limit for care, depending on the level of care needed, which the applicant can not exceed if they participate in the Elderly Waiver Program.


Iowa is a great state for Medicaid Planning if the applicant wants to have assisted living or in-home care resources. The current lack of a waitlist is rare and should mean the application process will likely be much faster than in most states. Additionally, as a Special Income Limit state that allows Miller Trusts, a Medicaid Planning specialist may be able to help applicants with too much income and would not otherwise qualify based on the strict financial criteria.

Access all state Medicaid Waiver pages.