Iowa As First To Add Home And Community-Based Services To Medicaid State Plan

Armen Hareyan's picture

Mdicaid in Iowa

Iowa is the first state to receive federal approval to add home and community based services as a permanent feature of its Medicaid plan, eliminating the need for repeated requests for time-limited waivers.

"Iowa is the first to benefit from the federal law giving states more choice over their Medicaid benefit plans," Secretary Mike Leavitt said. "Stopping the burdensome cycle of continually having to request federal government permission to offer a benefit that is good for people and programs will be a huge relief for states and beneficiaries."

Under section 6086 of the Deficit Reduction Act of 2005 (DRA), states may now permanently alter their standard Medicaid benefit package, eliminating the need to get previous statutory requirements "waived." Such waivers were generally limited to three or five years, requiring states to ask for renewals. The waiver process can take months to complete.


States still must seek federal approval to add such things as home and community-based services -- even as an optional benefit -- to the agreement they have with federal authorities, known as the "state plan." Once a state plan has been approved, any changes to it must be reviewed and approved by HHS. However, once that is done, no further permission to offer the benefit is required.

Iowa's new benefit will provide statewide HCBS case management services and "habilitation services" at home or in day treatment programs that can include such things as support in the workplace. Services approved under this option will help individuals to delay or avoid institutional stays or other high-cost out-of-home placements.

In addition to eliminating the need for waiver renewals, the DRA also removes the prior statutory requirement that beneficiaries get needed services at home only if they would need institutional care without them. States can now provide home- and community-based care under its state plan to those who may not yet be at risk for immediate institutionalization. The DRA also allows states to empower beneficiaries to make their own choices regarding the kind of services they need and from whom they will receive them.

"We expect many states to follow Iowa's lead in taking advantage of the DRA's provision which grants new freedom to state Medicaid programs and the people who depend upon them," said Leslie Norwalk, acting administrator of the Centers for Medicare & Medicaid Services, the federal agency that regulates the Medicare, Medicaid and State Children's Health Insurance Program.

"I look forward to working with more states to provide the most up-to-date care possible for those on Medicaid," she said.