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FAQ from Families:
Waiver Services in Iowa
Home and Community Based Services (HCBS)
When accessing a Medicaid HCBS waiver an individual will be assigned either a Managed Care Organization (MCO) or Fee for Service (FFS). Most individuals will be covered by a MCO. These are common questions from families about applying for and utilizing HCBS waiver services.
Do I need to have documentation about my child’s disability before applying for any HCBS waiver?
No. Individuals do not need to have documentation of disability to prove eligibility before applying for a waiver. There are specific criteria that must be met for an individual to be eligible for HCBS waivers. These requirements will be considered when a slot is available for your child. The Health and Disability (HD) waiver is an exception that requires you to have a disability determination in order to be put on the waiting list.
Can my child be on more than one waiver at a time?
A child can be on more than one waiver waiting list. However, your child cannot be on more than one waiver at a time. It is possible to be on one waiver and on the waiting list for another waiver. 2
Can I switch my child to a different waiver?
Yes, but you must follow the same process to apply for a different waiver. You will want to remain on your current waiver until a slot opens for the other waiver. Being on a waiver already does not allow you to skip the wait list.
What can I expect after waiver eligibility is determined?
After assessments are completed, the Department of Health and Human Services (HHS) determines eligibility and the level of care needed for the individual. The individual’s care team then meets to develop a care plan. The team meets once per year, but can meet more frequently to discuss goals met, changes to service needs, etc.
How do I find out who my child’s case manager is?
When you receive your letter notifying you of eligibility for Medicaid, the name of your case manager should be noted at the top of the documents. However, case management can change.
If a family is unable to reach their child’s case manager, they can:
• Contact Medicaid Member Services if they have been assigned Fee-for-Service (FFS) or;
• Contact Managed Care Organization (MCO) Member Services if they have been assigned a MCO.
Member Services Contact Directory | Iowa Department of Health and Human Services
Who is a part of my child’s care team?
In addition to the member and their family, the team can include: a case manager, providers and others close to the individual. The member can choose additional people to be a part of their care team.
What are some of the responsibilities of a case manager?
Some of the responsibilities of a case manager include:
• Determine the individual’s level of need through assessments;
• Help develop the individual’s care plan;
• Help the member and their family navigate support services that might be available;
• Connect the member with resources available;
• Help obtain needed services and;
• Authorize services.
Do I have a choice in the provider we use for services?
Yes. Families and the individual should have a choice in their direct service providers, such as respite providers.
• The family can choose a traditional waiver provider/agency that is contracted through the state to provide services.
• Another option is Consumer Choice Options (CCO). When using CCO, the family or individual can hire their own staff and direct their own services. In this case the family would work with an Independent Support Broker (ISB) to develop a budget and a case manager to help determine and authorize services on your budget.
• Families can also utilize both CCO and a traditional waiver provider.
How do I appeal a Notice of Decision (NOD) or denial of services?
A NOD is provided whenever a decision is made about services.
If you disagree with the NOD, you can file:
• An appeal or;
• An Exception to Policy. Families can file either of these on their own or request help from their case manager.
If your child is denied eligibility for a waiver but you think that they should qualify, you can also file an appeal.
How to Appeal a Decision by DHS | Iowa Department of Human Services
What can I do if I have concerns about the services and supports provided through the waiver?
• Start by communicating with your case manager about your concerns.
• The procedures for filing a grievance can be found through your MCO Member Handbook.
• Contact the Managed Care Ombudsman Program.
Can waiver services be used for childcare or to replace special education services in an IEP?
No. Waiver services cannot be a replacement for childcare. The state considers childcare a family responsibility. Waiver services also cannot not be a replacement for special education services in an IEP. If the individual is needing supports or services at school through their IEP or 504 plan, the school is responsible for providing those, not the waiver program.
Look for the following resources on the ASK website:
• Applying for a Waiver in Iowa
• ASK an Expert: Home and Community Based Services—Webinar
• ASK an Expert: Health Insurance Premium Payment program—Webinar
• ASK an Expert: Consumer Choice Options— Webinar
• Are Home and Community Based Services Right for You? - Iowa Medicaid