As part of the Hope and Opportunity in Many Environments (HOME) project, the Iowa Department of Health and Human Services (Iowa HHS) is redesigning its Medicaid home and community-based services (HCBS) waiver system. The goal is to make services easier to understand, help people remain in their homes and communities, and better connect them with the supports they need.

Iowa HHS plans to replace the current six disability-based HCBS waivers with two new waivers: the Children and Youth waiver and the Adults with Disabilities waiver. Before these new waivers can take effect, they must be approved by the Centers for Medicare & Medicaid Services (CMS). As part of this process, Iowa HHS is gathering public comments on the draft waivers before submitting them to CMS for approval.

Iowa HHS is proposing two new age-based waivers, while keeping the Elderly waiver. The new waivers are:  

• A Children and Youth waiver to provide extra Medicaid services for children and youth with disabilities, special health care needs, and mental health needs up to age 21. The waiver program is intended to help children to live at home with family instead of in an institution like a hospital or nursing facility. 

• An Adults with Disabilities waiver to provide extra Medicaid services for adults with disabilities aged 21 and older. The waiver program is intended to help adults live at home instead of an institution like a hospital or nursing facility.  

Iowa HHS is proposing a phased approach for moving people on current HCBS waivers to the new HOME waivers. People who are on a waiver now will not need to re-apply to move onto the new waiver. People who are not on a waitlist now will not be placed on a waitlist. 

Phase 1: Starting later in 2026, all members on the AIDS/HIV, Health and Disability, Physical Disability, and Children’s Mental Health waivers will transition to the new HOME waivers. Members on the Brain Injury and Intellectual Disability waivers will remain on their current waivers but will continue to have access to all current services on those waivers.  

Phase 2: In 2027, all members on the Brain Injury and Intellectual Disability waivers will transition to the new HOME waivers. 

See the HOME Public Comment webpage for quick guides with more information on eligibility criteria, waitlists, services, and how current HCBS members will access the new HOME waivers.  

1. Once the waiver applications are ready, Iowa HHS will put the document online and notify Iowans. The public will have five weeks to review the waiver amendments and comment. The waiver amendments are very long, so Iowa HHS also made several shorter documents (quick guides) to give details on key changes.  
2. During the public comment period, anyone--including people who need or use HCBS, families, providers, and advocates--can share thoughts on the waiver amendments and proposed changes. They can submit feedback by mail or email. 
3. Once the public comment period ends, Iowa HHS will review all the input. Iowa HHS may revise parts of the waiver applications based on feedback. 

Iowa HHS will not respond to each individual question but will summarize the public feedback and explain any response to the comments. Iowa HHS will send this summary to CMS along with the new HOME waiver applications. CMS will either approve the changes or ask for updates. If needed, Iowa HHS will make further changes and send the waiver applications back to CMS for final approval. 

 Public comments can suggest changes, point out problems, or highlight things that are good in the proposed new waivers. Comments will be most helpful if the comments are clear and specific. Try to give an example and explain why the change matters to you. Focus on what is most important for you, your family, or your community. 

The details you share help Iowa HHS understand your point of view. 

 Written comments are to be submitted to the Long-Term Services and Supports (LTSS) Policy Team. See the address below.

Iowa Department of Health and Human Services
Iowa Medicaid
312 East 12th Street
Des Moines, IA 50319

You can also email comments to HCBS_Public_Comment@hhs.iowa.gov. 

Please write “HCBS new HOME Waivers” in the subject line of the email.