Iowa Medicaid Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. In Iowa, Medicaid is also called IA Health Link. This article focuses on Iowa Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other setting through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. These programs are different from regular Medicaid, which is for financially limited people of all ages.

Last Updated: Mar 27, 2024

Iowa Medicaid Long Term Care Programs Nursing Home Care Care at Home via HCBS Waivers Care at Home via ABD Medicaid Eligibility Criteria Nursing Homes HCBS Waivers ABD Medicaid How Medicaid Treats the Home Applying Choosing a Nursing Home

Iowa Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Iowa Nursing Home Medicaid will cover the cost of long-term care in a nursing home for eligible Iowa residents who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
Skilled nursing care
Physician’s visits
Prescription medication
Medication management
Mental health counseling
Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Iowa Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover the nursing home expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $50/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Iowa Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

A Nursing Home Alternative – Iowa Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living in the community can receive financial and functional help with that transition through Iowa’s Money Follows the Person (MFP) program. This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents. Iowa’s MFP program is called The Partnership for Community Integration Project.

Home and Community Based Services (HCBS) Waivers

Home and Community Based Service (HCBS) Waivers will pay for long-term care services and supports that help Iowa Medicaid recipients who require a Nursing Facility Level of Care remain living in the community instead of residing in a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for Iowa residents who live in their home, the home of a loved one or an assisted living residence. While Iowa’s HCBS Waivers will cover some long-term care services and supports in those settings, it will not cover room and board costs.

The HCBS Waiver available to Iowa seniors is the Home and Community Based Services Elderly Waiver.

Home and Community Based Services Elderly Waiver
Iowa’s Home and Community Based Services Elderly Waiver, which is commonly called the Elderly Waiver, provides long-term care services and supports for Iowa Medicaid beneficiaries who live in their own home, the home of a loved one or an assisted living residence. The intention of the Elderly Waiver is to delay nursing home placement.

Benefits of the Elderly Waiver include adult day care, case management, meal delivery, homemaker services, home modifications, transportation and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). These benefits are made available depending on the needs and circumstances of each individual. Benefits can be delivered by a licensed caregiver, but the Elderly Waiver program participant can also direct their own care through two programs: Consumer-Directed Attendant Care (CDAC) or the Consumer Choices Option (CCO).

CDAC allows the program participant to select and train a caregiver of their choice, including family members, to provide both skilled and unskilled services. This does not include spouses, and the caregiver must be enrolled with the Iowa Medicaid Enterprise as a provider.

CCO supplies the Elderly Waiver program participant with an individualized monthly budget to spend on required healthcare goods and services. The budget can be used to hire caregivers of their choice, including family members, but spouses can not be hired through CCO, either. Goods can include home/vehicle modifications, assistive devices and Personal Emergency Response Systems.

Unlike Nursing Home Medicaid, HCBS Waivers are not an entitlement. Remember, entitlement means guaranteed by law. Instead, there are a limited number of enrollment spots for each waiver program, and once those spots are full, additional eligible applicants are placed on a waitlist. The Home and Community Based Services Elderly Waiver had roughly 10,500 enrollment spots per year as of 2022.

Aged, Blind, and Disabled Medicaid

Iowa’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare coverage and long-term care benefits to financially limited Iowa residents who are aged (65 and over), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for financially needy people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the beneficiary’s region.

1. ABD Long Term Care Benefits
Eligible Iowa seniors who show a medical need for long-term care services can receive those services through ABD Medicaid. These benefits can include in-home personal care, adult day care, meal delivery, home modifications and Personal Emergency Response Systems (PERS). ABD Medicaid recipients qualify for these benefits one at a time. This is different from Nursing Home Medicaid, which makes all of its benefits immediately available for anyone who qualifies. Instead, Iowa seniors will be evaluated by the state to determine what kind of long-term care benefits they need and will receive.

2. Program of All-Inclusive Care for the Elderly (PACE)
Iowa residents who are age 55 or older and have Aged, Blind, and Disabled Medicaid can cover their medical, social service and long-term care needs with one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE program participants are required to need a Nursing Facility Level of Care, but they must live in the community. Iowa’s PACE programs can be used by people who are “dual eligible” for Medicaid and Medicare, and it will coordinate the care and benefits from those two programs into one plan. PACE also administers vision and dental care, and PACE day centers provide meals, social activities, exercise programs and regular health checkups and services to program participants. Iowa’s PACE programs are located in Council Bluffs (PACE Iowa) and Sioux City (Siouxland PACE). To learn more about PACE, click here.

Eligibility Criteria For Iowa Medicaid Long Term Care Programs

To be eligible for the Iowa Medicaid, a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

Just For You: The easiest way to find the most current Iowa Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

Iowa Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Iowa residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through Iowa Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Iowa Nursing Home Medicaid beneficiaries must give most of their income to the state to help cover the cost of nursing home care. They are only allowed to keep $50/month of their income as a “personal needs allowance,” plus enough to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through Iowa Medicaid is $3,000 combined, and the income limit is $2,829/month per spouse. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for Iowa Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Iowa has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for nursing home coverage through Iowa Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is usually associated with a nursing home. To determine level of care need for Medicaid purposes, Iowa uses the interRAI – Home Care (HC) Assessment tool to determine if HCBS Waiver applicants do require that level of care. This tool takes into consideration an applicant’s ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, etc.), as well as the applicant’s cognitive function.

Iowa Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
Iowa residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Services (HCBS) Waivers. For a single applicant in 2024, the asset limit for HCBS Waivers in Iowa is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for HCBS Waivers in Iowa for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in Iowa is a combined $3,000, and the income limit is $2,829/month per spouse. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for Iowa HCBS Waivers applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Iowa has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Services (HCBS) Waivers through Iowa Medicaid is needing a Nursing Facility Level of Care, which means the applicant requires the kind of full-time care that is usually associated with a nursing home. Iowa uses the interRAI – Home Care Assessment tool to determine if HCBS Waiver applicants do require that level of care. This tool takes into consideration an applicant’s ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, etc.), as well as the applicant’s cognitive function.

Iowa Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
Iowa residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind, and Disabled (ABD) Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Iowa ABD Medicaid for a single applicant is $943/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.

For married applicants, the 2024 asset limit for Iowa’s ABD Medicaid is a combined $3,000, and the income limit is a combined $1,415/month. This applies to married couples with both spouses applying or with just one spouse applying.

Plan Ahead: There are alternative pathways to eligibility for ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Iowa has a Look-Back Period of five years for Nursing Home Medicaid and HCBS Waivers applicants to make sure they don’t give away their assets to get under the limit, the Look-Back Period does not apply to ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirement to receive basic healthcare coverage through Iowa ABD Medicaid is being aged (65 and over), blind or disabled. For ABD Medicaid applicants and beneficiaries who require long-term care services and supports, the state will administer an assessment of their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Instrumental Activities of Daily Living (which include shopping, cooking, housekeeping and medication management) to determine the kind of long-term care benefits the state will cover.

How Iowa Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status.

Iowa Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Iowa and how you can protect your home from it, click here.

Applying For Iowa Medicaid Long Term Care Programs

The first step in applying for Iowa Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Iowa Medicaid coverage when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Iowa Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Iowa residents can apply online through the Iowa Department of Human Services Services Portal.

For a comprehensive guide that will take you through the application process for all three types of Medicaid Long Term Care, click on the program you want: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.

Choosing an Iowa Medicaid Nursing Home

After being approved for nursing home coverage through Iowa Medicaid, seniors have to choose a Medicaid-accepting nursing home that best meets their needs. Even though Iowa Medicaid nursing home coverage is an entitlement, not all nursing homes accept Medicaid, and those that do might not have available space. Finding the right nursing home can be time-consuming, especially if you’re looking in a specific location, but Iowa residents have more options than most.

Iowa is the 32nd largest state by population in the country, but it ranks No. 11 in terms of total number of nursing homes with 433. That’s more than states like North Carolina, Georgia and Massachusetts.

Iowa nursing homes are spread throughout the state, but there are cluster around cities. There are roughly 40 facilities in the Des Moines area, including Ankeny and West Des Moines, and another five in nearby Ames. Cedar Rapids and Iowa City have about 25 nursing homes near them. There are approximately 15 facilities in Sioux City, and a dozen between Davenport and Bettendorf in the Quad Cities area.

Residents in some Iowa communities travel over state lines regularly for personal and business reasons, including healthcare. Medicaid coverage, however, does not travel across state lines. So, someone with Indiana Medicaid would not be covered in a nursing home in Chicago, Louisville or Cincinnati, even though there may be more convenient options in those cities for some Indiana residents.

TOOLS: To find and compare nursing homes, Iowa residents can use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country. They can also use this Iowa Care Planning Council list of nursing homes to search for facility.

Once you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you can be a great source of information. You can also contact your local Area Agency on Aging to find out more information about nursing homes in the state.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence offer social activities? What is the food like? Does it provide transportation? Who are the staff doctors? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

Data collected by CMS shows that Iowa nursing homes had 20.8 health deficiencies during a three-year period from 2019-2022, which is lower than the national average of 25.7. The data also revealed that 4.6% of Iowa nursing home residents had depressive symptoms, which is better than the national average of 8.1%.