Gathering Comments
In early 2026, Iowa HHS held a public comment period as part of the HOME Project. The goal is to make services easier to access and help people stay in their homes and communities.
During this time, 176 comments were submitted about the proposed waiver changes. Feedback came from providers, current and former waiver members, family members, and others.
Most comments included questions, concerns about possible gaps or risks, and support for the proposed changes. Some feedback shared personal perspectives that were helpful for understanding individual experiences, but not all comments applied to the broader waiver system or the proposal overall.
A summary of the public comment period, including HHS responses, is available on the HHS website.
 What are the proposed changes?
The Centers for Medicare & Medicaid Services (CMS) approves programs called HCBS waivers, which help people get care at home or in their community instead of in a facility.
As part of the HOME project, Iowa HHS plans to simplify its current system. It would replace four existing waivers (Health and Disability, Children’s Mental Health, AIDS/HIV, and Physical Disability) with two new ones based on age.
The two proposed waivers are:
1. Children and Youth Waiver (ages 0–21):
Provides services for children and young people with disabilities, special health care needs, or mental health needs. This program helps children live at home with their families instead of in places like hospitals or nursing facilities.
2. Adults with Disabilities Waiver (ages 21+):
Provides services for adults with disabilities. This program helps adults live at home or in their community instead of in a hospital or nursing facility.
Based on stakeholder feedback, the following changes have been made to the proposed waivers:
Medical Day Care for Children: Updated to define a traditional childcare setting as “structured, center-based programs or licensed in-home care.”
Adults with Disabilities (AD) Waiver: Removed references to Phase II individualized budgeting and added the correct monthly service caps based on level of care (LOC).
WPNA Language: Updated for consistency across the CY and AD waivers.
Personal Emergency Response System (PERS) Service: Corrected service details and removed self-direction.
Respite: Amended to allow services to be delivered by individuals age 16 or older.
Other changes to be considered include:
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Home Maintenance: expansion of adding "per job" as a payment type.
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HVM Addition: The inclusion of maintenance or repair for specific home and vehicle modification (HVM).
Waitlists
The waiver applications have been submitted to CMS. They have started reviewing the applications and contact the state with questions.
If CMS has questions or concerns, they will send them to HHS via a Request for Additional Information (RAI). This can happen multiple times and can take months
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Our HHS team continues to build out the Quick Guides and other supplemental resources on our HOME website. These materials are regularly updated by our Medicaid team to provide the most up-to-date and relevant information.
Resources available to members and providers include:
HHS staff continue to review and update these materials and will ensure they are posted in a timely manner.
 New to Iowa Medicaid, the Enabling Technology Town Halls provide an opportunity for providers, members, advocates, and community partners to learn about upcoming changes and improvements, ask questions, and share feedback on services that support people living independently in their homes and communities.
What is Enabling Technology?
Enabling technology includes a range of devices and tools that support individuals in living as independently as possible. Examples include:
- Remote monitoring or support systems (e.g., clinical management platforms)
- Wearable and smart devices (e.g., smartwatches and personal emergency response systems)
- Mobile applications (e.g., medication tracking apps)
- Communication tools (e.g., smart doorbells and video conferencing platforms)
- Home sensors (e.g., motion detectors and carbon monoxide alarms)
Learn more about Enabling Technology.
Next meeting is scheduled for Thursday, April 30 from 2:30 - 4:00pm CT
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