IA Intellectual Disability Waiver Explained

The Intellectual Disability Waiver is a Medicaid program that provides services and supports to eligible individuals with intellectual disabilities in Iowa. 

Overview of Intellectual Disability Waiver

The Intellectual Disability Waiver (IDW) 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 empower individuals with intellectual disabilities to live in their own homes or other community settings rather than in institutions. The IDW serves individuals who meet the following criteria:

• They have an intellectual disability or a related condition that causes significant functional limitations in at least three areas of major life activity (such as 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 an intermediate care facility for individuals with intellectual disabilities (ICF/ID).
• They choose to receive services in the community instead of in an institution.

The IDW is designed to meet each participant's individual needs and preferences. The participant and their family, guardian, or advocate work 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 IDW, an individual must meet the following requirements:

• Be a resident of Iowa.
• Be at least 18 years old or older.
• Have an intellectual disability or a related condition that causes significant functional limitations in at least three areas of major life activity.
• Be eligible for Medicaid based on income and resources. The income limit for the IDW 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 an ICF/ID. This means that the individual needs active treatment and supervision daily due to their intellectual disability or related condition.
• Choose to receive services in the community instead of in an institution.

To apply for the IDW, 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 will be put 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 IDW offers various services and supports that help individuals with intellectual disabilities live independently and participate in their communities. Some of the services and supports available under the IDW 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.).
• Day habilitation: A service that provides structured activities that enhance participants' skills and abilities in communication, socialization, self-care, mobility, 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.
• Prevocational services: A service that provides training and support to participants who are not ready for competitive employment but have the potential to work in the future. The service focuses on developing work-related skills such as attendance, task completion, problem-solving, etc.
• 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.
• Supported employment: A service that provides ongoing support to participants employed in competitive or integrated settings. The service helps participants find and keep jobs that match their interests and abilities.
• Transportation: A service that provides non-medical transportation to participants who need assistance to access their waiver and other community services.

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

The number and type of services each participant receives under the IDW depends on their 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 IDW has a cost cap that limits the amount of money spent on each participant's services. The cost cap for the IDW is $47,000 per year in 2023.

Compensation for Caregivers

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

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 IDW 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 an intellectual disability, you may be eligible for this program that can provide you with valuable services and support, including compensation for your caregiving work. Please fill out this form to determine if you qualify for this program, and we will contact you soon.