The Elderly Waiver for Des Moines-area families

What is Iowa's Elderly Waiver?

The Elderly Waiver is an Iowa Medicaid home and community-based services program for Iowans 65 and older who need an intermediate or skilled level of care, the level a nursing facility provides, and who choose to receive services at home or in a community setting instead (441 IAC chapter 83, Division II).

It pays for services, not housing. Most members receive it through one of Iowa Medicaid's managed care organizations, currently Iowa Total Care, Wellpoint Iowa and Molina Healthcare of Iowa, which assign a community-based case manager. Iowa HHS's HOME project is redesigning other waivers in 2026 and 2027, but Iowa HHS says the Elderly Waiver is being kept and that eligibility for older adults does not change.

Who qualifies for the Elderly Waiver in 2026?

An Iowa resident aged 65 or older who is certified as needing intermediate or skilled level of care on the interRAI Home Care assessment and who is eligible for Medicaid as if in a medical institution, which in 2026 means income up to $2,982 a month and countable resources of $2,000 or less for a single person.

The $2,982 figure is 300 percent of the 2026 SSI federal benefit rate of $994. People who receive SSI or State Supplementary Assistance meet the financial test automatically. Couples applying together have their own resource rules. Some members pay a monthly client participation toward waiver services based on income above the allowance. Since July 2025, Telligen has completed HCBS level-of-care assessments for Iowa HHS.

What does the Elderly Waiver pay for?

Case management plus a menu of services written into the member's service plan, from homemaker and home health aide visits to adult day care, home-delivered meals and consumer-directed attendant care (441 IAC 83.26).

• Case management
• Adult day care
• Emergency response system
• Homemaker
• Home health aide
• Nursing
• Respite care
• Chore
• Home-delivered meals
• Home and vehicle modification
• Mental health outreach
• Transportation
• Nutritional counseling
• Assistive devices
• Senior companions
• Consumer-directed attendant care
• Financial management, independent support brokerage and self-directed personal care (Consumer Choices Option)

Respite gives family caregivers a break, and the Consumer Choices Option lets a member manage a budget and hire their own workers, including some relatives. Services must be needed regularly, and the total cost must fit within the waiver's limits.

Can the Elderly Waiver help pay for assisted living in Des Moines?

It can pay for services a member receives while living in an assisted living program, such as consumer-directed attendant care, home health aide visits, nursing and an emergency response system, but not the rent or meals, which the tenant pays from income.

Not every Des Moines program accepts waiver members, and those that do may set aside only a few apartments. Ask each program directly whether it works with the Elderly Waiver, which managed care organizations it contracts with, and what monthly amount the tenant would owe for room and board. Iowa's Consumer Choices Option is not available to members living in a residential care facility.

How do Des Moines families apply for the Elderly Waiver?

Apply for Iowa Medicaid through Iowa HHS, ask for Elderly Waiver services on the application, and complete the level-of-care assessment; Iowa Medicaid Member Services (1-800-338-8366) and Aging Resources of Central Iowa (515-255-1310) can explain each step.

Applications are processed within 30 days unless information is missing (441 IAC 83.23). Gather proof of income, bank statements, insurance cards and any power of attorney before you start. An applicant must be offered the choice between waiver services and institutional care. If the waiver has a waiting list or slot limit when you apply, ask how priority is set and whether PACE is an option in your county.