Iowa’s Elderly Waiver provides Medicaid-funded long-term services and supports for elderly state residents who are at risk of institutionalization (nursing home admission). Intended as a nursing home diversion program, a variety of home and community based services are available to assist seniors in remaining in their homes and communities. The exact benefits a program participant receives varies on their specific needs and circumstances. However, seniors who live independently might benefit from personal emergency response systems, homemaker services, and personal care assistance, while those residing with an informal family caregiver might benefit from adult day care or respite care.
While seniors can live in a private home (their own or that of a loved one) and receive Elderly Waiver benefits, this program also offers services in assisted living residences.
While the services offered under this program can be managed by an agency provider, there are also two options for participant directed care. The first is Consumer-Directed Attendant Care (CDAC), which allows program participants to hire, train, and manage the caregiver of their choosing to assist them with skilled and unskilled services (i.e., bathing, dressing, meal preparation, medication monitoring, colostomy care). While friends and relatives, including one’s adult child or spouse, can be hired, they must enroll with the Iowa Medicaid Enterprise (IME) as a provider.
The Consumer Choices Option (CCO) is the second option for self-directed care. With CCO, program participants are allotted an individualized monthly budget with which to purchase required goods and services. This includes hiring their own caregiver, which may be a family member, such as a spouse. Persons might also spend their budget on meal delivery, assistive devices, homemaker / chore services, respite care, transportation, senior companion, and home / vehicle modifications. A financial management services agency handles the financial aspects of employment responsibilities, such as tax withholding and caregiver payments.
The Elderly Waiver is not an entitlement program; meeting eligibility requirements does not equate to immediate receipt of program benefits. There are a limited number of participant enrollment slots, and when they are full, a wait list for program participation forms.
Your request has been received. You’ll be contacted within one business day.Wait List Alternatives: Are you interested in connecting with a Medicaid Planning Professional to discuss alternatives to Iowa’s Elderly Waiver? Wait-lists can last from months to years, but there are other Medicaid programs that offer immediate care outside of nursing homes.
Iowa’s Elderly Waiver is a statewide Medicaid program and is formally called the Home and Community Based Services Elderly Waiver, or HCBS Elderly Waiver. It is a 1915(c) Home and Community Based Services (HCBS) Medicaid Waiver.
While an individual comprehensive service plan determines the exact benefits a program participant receives, the following are potential benefits.
– Adult Day Care
– Assisted Living Services
– Assistive Devices – i.e., dressing aids, long reach brush, double handled cup
– Case Management
– Chore Services – i.e., window washing, snow removal, lawn moving
– Consumer Choices Option – persons have a monthly budget with which to purchase goods / services
– Consumer-Directed Attendant Care – persons can hire a caregiver to provide skilled and unskilled services (i.e., bathing, dressing, housekeeping, meal preparation, colostomy care, medication monitoring)
– Financial Management Services – for persons self-directing their care
– Home Delivered Meals
– Home Health Aides
– Home Modifications – i.e., installation of wheelchair ramps and grab bars
– Homemaker Services – i.e., basic housecleaning, shopping for essentials, preparing meals
– Independent Support Brokerage Services – for persons self-directing their care
– Mental Health Outreach
– Nursing Care
– Nutritional Counseling
– Personal Emergency Response Systems / Portable Locater Systems
– Respite Care – in-home and out-of-home
– Senior Companions – supervision and non-medical care assistance
– Transportation – medical and non-medical
– Vehicle Modifications – for safety and accessibility
While program participants can receive care services in an assisted living residence, the Elderly Waiver will not cover the cost of room and board.
The Elderly Waiver is for Iowa residents aged 65 and over. Additional eligibility criteria are below.
The American Council on Aging now provides a quick and easy Medicaid Eligibility Test for Iowa seniors.
Income
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR), which increases annually in January. In 2024, regardless of marital status, an applicant can have a monthly income up to $2,829. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,829 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Only the applicant spouse’s income is considered, which is limited to $2,829 / month. Furthermore, the non-applicant spouse may be entitled to a Spousal Income Allowance, called a Monthly Maintenance Needs Allowance, from their applicant spouse to prevent spousal impoverishment.
In 2024, the maximum amount of income that can be transferred to the non-applicant spouse is $3,853.50 / month. This is intended to bring a non-applicant’s monthly income up to this amount. Non-applicant spouses who have their own income equal to or greater than this amount are not entitled to a Spousal Income Allowance.
Assets
In 2024, the asset limit is $2,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $3,000. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are still limited. This is because the assets of a married couple are considered jointly owned. In this case, the applicant spouse can retain up to $2,000 in assets, while the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance to prevent spousal impoverishment.
The CSRA allows the non-applicant spouse to keep 50% of the couple’s assets, up to $154,140. If 50% of the couple’s assets falls under $30,828, the non-applicant spouse can keep all of the couple’s assets, up to this amount.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. This is because Iowa Medicaid has a Look-Back Rule and violating it results in a Penalty Period of Medicaid ineligibility.
To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our Spend Down Calculator.
Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. For eligibility purposes, Iowa Medicaid considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has Intent to Return, and in 2024, their home equity interest is no greater than $713,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant has a spouse living in the home.
– The applicant has a minor child (under 21 years old) living in the home.
– The applicant has as blind or disabled child (of any age) living in the home.
An applicant must require a Nursing Facility Level of Care (NFLOC). For Iowa’s Elderly Waiver, the tool used to make this determination is the interRAI – Home Care (HC) assessment. While there are several areas of consideration, one is the ability / inability to complete one’s Activities of Daily Living (ADLs). Examples include activities such as continence, personal hygiene, bathing, dressing, mobility, and eating. Relevant to many persons with Alzheimer’s disease or a related dementia, cognitive functioning, such as decision making ability, memory, and comprehension, is also considered. A diagnosis of dementia in and of itself does not mean one will meet a NFLOC.
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for Iowa Medicaid. There are a variety of Medicaid planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
When persons have income over the limits, Miller Trusts, also called Qualified Income Trusts, and specifically, Medical Assistance Income Trusts in Iowa, can help. “Excess” income is deposited into the trust, no longer counting as income.
When persons have assets over the limits, Irrevocable Funeral Trusts (IFTs) are an option. IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Medicaid-Complaint Annuities, which turn countable assets into a stream of income, is another option. There are many other planning strategies available for when an applicant needs to lower their countable assets for eligibility purposes.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Iowa to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Some of the strategies violate Medicaid’s 60-month Look-Back Rule, and therefore, should only be implemented with careful planning. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.
Prior to applying for Iowa’s Elderly Waiver, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security cards, Medicare cards, life insurance policies, property deeds, pre-need burial contracts, bank statements up to 60-months prior to application, and proof of income. A common reason applications are delayed is required documentation is missing or not submitted in a timely manner.
The Elderly Waiver is not an entitlement program; it is approved for a maximum of approximately 10,653 beneficiaries per year. At this time, there is no wait list for program participation. If a wait list forms, persons are awarded participant slots based on the date one’s application was received.
Seniors can apply for the Elderly Waiver online at the Iowa HHS Services Portal or at their local Department of Health & Human Services office.
Persons can learn more about the Elderly Waiver here, or alternatively, call the Office of the State Long-Term Care Ombudsman at 866-236-1430.
The Elderly Waiver is administered by the Iowa Department of Health & Human Services (HHS). Iowa Medicaid, Medical Services Unit (MSU) determines functional need.
The Medicaid application process in Iowa can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. Additionally, if a wait list were to form, approved applicants could spend many months, or longer, waiting to receive benefits.
What are 1915(c) HCBS Medicaid Waivers?
Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers allow states to offer benefits outside of these institutions. “HCBS” stands for Home and Community Based Services. The goal of HCBS is to delay or prevent institutionalization, and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers can target specific groups who require a Nursing Home Level of Care and are at risk of institutionalization, such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. This means that meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.