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Medicaid Home and Community Based Services Waivers- Medical Assistance - Iowa

HCBS waivers provide a variety of services in clients’ homes that are not available through regular Medicaid. The total costs of these services and regular Medicaid cannot exceed the total cost of care and services provided in a medical institution.

There are currently six types of HCBS waivers:

·           AIDS/HIV waiver: Must be disabled and have a diagnosis of AIDS or HIV . Can be FMAP-related or SSI-Related.

·           Brain Injury waiver: Must be in a medical facility for 30 days before application and currently living in one. Must be between the ages of 1 month and 65 years old. Can be FMAP-related or SSI-related. Must be assigned a slot before can be eligible.

·           Elderly waiver: Only persons in certain counties. In any SSI-related coverage groups except Medically Needy.

·           Ill and Handicapped waiver: There is a 500 person limit. Must be ineligible for other Medicaid groups except for Medically Needy. Must be a child with MR who meets skilled nursing level of care.

·           Mental Retardation waiver: Must get Medicaid case management services. Can be FMAP-related or SSI-Related. Must have slot assigned before can be eligible.

·           Physical Disability waiver: Must be in a medical facility for 30 days before date of application. Must be determined to be disabled. Can be FMAP-related or SSI-Related.

Recipients who are already Medicaid-eligible are not required to file a new application, unless the recipient is at the end of a Medically Needy certification period. The date of the waiver request is the date that the recipient or the authorized representative submits to the county office a written statement requesting the HCBS program or form SS-1645, Home- and Community-Based Service Report.

Updated information is obtained for current Medicaid recipients as necessary to determine whether the client meets the eligibility requirements for the waivers.

NOTE: The brain injury, mental retardation, and physical disability waivers each have limits to the number of persons who will be served. The county of legal settlement (for ICF/MR level of care for adults) and the state (for all other) designate the number of people to be served under each waiver.

NOTE ALSO: Rental assistance may be available for HCBS Waiver participants.

See Also:

·           Effective Date of Eligibility for HCBS Waivers,

·           Nonfinancial Eligibility for HCBS Waivers,

·           Income and Resources for HCBS Waivers,

·           Client Participation for HCBS Waivers.

·           Overview of Medical Assistance in Iowa

·           Welcome and Introduction to Benefits in Iowa

Source: Iowa Dept of Human Services Employees Manual

Title 8 Medicaid

·                        Chapter N, pages 1, 2, and 5

Regulation citations: 42 CFR 441.13, 441 IAC 76.1(249A), 83.3(249A), 83.23(249A), 83.43(249A), 83.62(249A), 83.83(249A), 83.103(249A)

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