IA Health and Disability Waiver

The Health and Disability Waiver is a Medicaid program that provides services and supports to eligible people with chronic health conditions or physical disabilities in Iowa. 

Overview of Health and Disability Waiver

The Health and Disability Waiver (HDW) is one of seven Medicaid Home and Community-Based Services (HCBS) waivers in Iowa. The purpose of this waiver is to provide services and supports that enable individuals with chronic health conditions or physical disabilities to live in their own homes or other community settings rather than in nursing facilities. The HDW serves individuals who meet the following criteria:

• They have a chronic health condition or a physical disability that causes substantial functional limitations in at least two areas of significant life activity (self-care, communication, learning, mobility, self-direction, capacity for independent living, and economic self-sufficiency).
• They are eligible for Medicaid based on income and resources.
• They require the level of care provided in a nursing facility.
• They choose to receive services in the community instead of in a nursing facility.

The HDW is designed to meet each participant's individual needs and preferences. The participant, along with their family, guardian, or advocate, works with a case manager to develop a person-centered service plan outlining the goals, outcomes, and services the participant will receive under the waiver.

Eligibility Requirements

To be eligible for the HDW, an individual must meet the following requirements:

• Be a resident of Iowa.
• Be between 18 and 64 years old.
• Have a chronic health condition or a physical disability that causes substantial functional limitations in at least two areas of significant life activity.
• Be eligible for Medicaid based on income and resources. The income limit for the HDW is 300% of the federal benefit rate (FBR), which is $2,382 per month in 2023. The resource limit is $2,000 for an individual or $3,000 for a couple.
• Require the level of care provided in a nursing facility, meaning that the individual needs skilled nursing care or personal care on a daily basis due to their chronic health condition or physical disability.
• Choose to receive services in the community instead of in a nursing facility.

To apply for the HDW, an individual must complete an application form and submit it to their local Department of Human Services (DHS) office. The DHS will then conduct an assessment to determine the individual's eligibility and level of care needs. If the individual is found eligible, they are placed on a waiting list until a slot becomes available. The waiting time may vary depending on the availability of funding and services.

Services and Supports

The HDW offers a range of services and supports that help individuals with chronic health conditions or physical disabilities live independently and participate in their communities. Some of the services and supports available under the HDW are:

• Case management: A service that helps participants access and coordinate their waiver and other community services.
• Consumer-directed attendant care (CDAC): A service that allows participants to hire and direct their own personal care workers who assist them with activities of daily living (such as bathing, dressing, eating, etc.) and instrumental activities of daily living (such as shopping, cooking, cleaning, etc.).
• Home health aide: A service that provides skilled nursing care or personal care by a certified home health aide under the supervision of a registered nurse.
• Home modification: A service that provides physical adaptations to participants' homes necessary to ensure their health, welfare, and safety or enable them to function independently.
• Respite: A service that provides temporary relief to unpaid caregivers responsible for participants' care. Respite can be provided in the participant's home or another setting.
• Transportation: A service that provides non-medical transportation to participants who need assistance to access their waiver and other community services.

The HDW also covers other services such as assistive devices, chores, communication devices, crisis intervention, environmental accessibility adaptations, family and individual counseling, financial management services, home-delivered meals, homemaker, independent living skills training, interdisciplinary team, interpreter services, nutritional counseling, personal emergency response system, specialized medical equipment, and supplies, supported community living, vehicle modification.

The amount and type of services that each participant receives under the HDW depends on their individual needs and preferences. The participant's case manager will help them choose the most appropriate and cost-effective services that meet their goals and outcomes. The HDW has a cost cap that limits the amount of money spent on each participant's services. The cost cap for the HDW is $28,000 per year in 2023.

Compensation for Caregivers

One of the benefits of the HDW is that it allows participants to self-direct some of their services, such as CDAC and respite. This means that participants can choose who provides these services, including their family members or friends. In other words, family caregivers can get paid to be a caregiver for their loved ones under the HDW.

However, there are some limitations and conditions that apply to this option. For example:

• Family caregivers cannot be paid for providing services to their spouses or minor children.
• Family caregivers must meet the same qualifications and requirements as other service providers, such as completing training, background checks, and documentation.
• Family caregivers must be hired and supervised by a financial management service (FMS) agency that handles the payroll and taxes for the service providers.
• Family caregivers must follow the participant's service plan and budget that the DHS approves.
• Family caregivers must provide necessary and reasonable services for the participant's health and welfare.

Family caregivers' compensation for providing services under the HDW depends on several factors, such as the type and frequency of service, the FMS agency's fee schedule, and the participant's budget. The average hourly rate for CDAC providers in Iowa is $11.50 in 2023. The average hourly rate for respite providers in Iowa is $9.50 in 2023.

Learn more about Medicaid self-directed care >>

A Note from Givers

If you are a family caregiver for a person with a chronic health condition or a physical disability, you may be eligible for this program that can provide you with valuable services and support, including compensation for your caregiving work. To determine if you qualify for this program, please fill out this form, and we will contact you soon.