If you care for a parent or other family member in Iowa, you may be paid through Attendant Care, the Medicaid waiver service that pays for hands-on help with everyday living.Centers for Medicare & Medicaid Services. (1915). Medicaid.gov - Iowa 1915(c) waiver descriptions (which waivers carry consumer-directed attendant care). medicaid.gov. Retrieved Sep 6, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA Iowa Attendant Care family caregiver pay reaches a relative, including an adult child, in two ways: as an employee of an agency that agrees to hire you, or through the Consumer Choices Option, where your relative hires you from a Medicaid budget.Centers for Medicare & Medicaid Services. (n.d.). Iowa Waiver Factsheet — medicaid.gov (CMS). medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA,Iowa Department of Health and Human Services. (n.d.). Individual Consumer Directed Attendant Care (ICDAC) Transition. hhs.iowa.gov. Retrieved Jun 3, 2026, from https://hhs.iowa.gov/medicaid/services-care/individual-consumer-directed-attendant-care-icdac-transition For a spouse, Iowa's sources conflict, so get the case manager's written OK first.Iowa Department of Health and Human Services. (n.d.). Individual Consumer Directed Attendant Care (ICDAC) Transition. hhs.iowa.gov. Retrieved Jul 13, 2026, from https://hhs.iowa.gov/medicaid/services-care/individual-consumer-directed-attendant-care-icdac-transition To start, talk to your relative's case manager or Iowa Medicaid Member Services.Centers for Medicare & Medicaid Services. (n.d.). CMS Medicaid.gov - Where Can People Get Help With Medicaid & CHIP? (Iowa row). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/about-us/where-can-people-get-help-medicaid-chip
Who Can Get Iowa Attendant Care Family Caregiver Pay?
The January 2025 version of the CMS-approved Iowa Elderly Waiver (IA.4155.R07.01, effective Jan. 1, 2025) says "Payments may be made to any relative including a spouse, or a legal representative of the member," working under the Consumer Choices Option (CCO) or as "an employee hired by a provider agency," the two routes left now that Individual CDAC, the third route that text names, has ended.Centers for Medicare & Medicaid Services. (n.d.). Iowa Waiver Factsheet — medicaid.gov (CMS). medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA For spouses, Iowa HHS's June 2024 member townhall says they may be employed "in extraordinary circumstances as defined by the state," and an Iowa rule conflicts (see below).Centers for Medicare & Medicaid Services. (n.d.). Iowa Waiver Factsheet — medicaid.gov (CMS). medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA The townhall doesn't define those circumstances, but the January 2025 waiver text gives the test for a legally responsible person such as a spouse: care isn't "extraordinary" if it's something a household member would ordinarily do for a person the same age without a disability or chronic illness and isn't necessary to protect your relative's health and welfare and avoid institutionalization. That same text also says such a person may be paid for services that are not considered extraordinary.Centers for Medicare & Medicaid Services. (n.d.). Iowa Waiver Factsheet — medicaid.gov (CMS). medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA Iowa's Health and Disability (HD) Waiver amendment, effective Jan. 22, 2026, likewise pays an adult child meeting the minimum age as an agency or CCO employee.Centers for Medicare & Medicaid Services. (n.d.). Iowa Waiver Factsheet — medicaid.gov (CMS). medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA
| Your relationship | Through an agency | Through the Consumer Choices Option |
|---|---|---|
| Adult child | Only if the agency hires you | Yes, if you aren't also the budget or employer authority |
| Other relative | Only if the agency hires you | Yes, if you aren't also the budget or employer authority |
| Spouse | Sources conflict; get written OK | Sources conflict; get written OK |
| Legal representative (not a spouse) | Yes, for Attendant Care | Yes, if you aren't also the budget or employer authority |
Iowa HHS says a CCO employee can't also be the budget or employer authority, so if you'll be the paid worker, your relative or someone else has to hold those roles.Centers for Medicare & Medicaid Services. (n.d.). Iowa Waiver Factsheet — medicaid.gov (CMS). medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA
Iowa HHS says an agency "would have to agree to hire the individual. This is not something Medicaid can control."Iowa Department of Health and Human Services. (n.d.). Individual Consumer Directed Attendant Care (ICDAC) Transition. hhs.iowa.gov. Retrieved Jun 3, 2026, from https://hhs.iowa.gov/medicaid/services-care/individual-consumer-directed-attendant-care-icdac-transition
If you're the spouse
The HD amendment says a spouse, as a legally responsible person, may provide services as an Attendant Care agency or CCO employee, with the planning team reviewing whether the care is "extraordinary." But Iowa's rule 441 IAC 79.10(7)"a", in the edition effective July 1, 2026, still lists a spouse among the people to whom Medicaid funds are "incorrectly paid," and neither says which governs.Iowa Department of Health and Human Services. (n.d.). Individual Consumer Directed Attendant Care (ICDAC) Transition. hhs.iowa.gov. Retrieved Jul 13, 2026, from https://hhs.iowa.gov/medicaid/services-care/individual-consumer-directed-attendant-care-icdac-transition,Centers for Medicare & Medicaid Services. (n.d.). Iowa Waiver Factsheet — medicaid.gov (CMS). medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA
Ask the case manager: "Does the plan of care authorize paying me as the spouse? Please confirm in writing."Iowa Department of Health and Human Services. (n.d.). Individual Consumer Directed Attendant Care (ICDAC) Transition. hhs.iowa.gov. Retrieved Jul 13, 2026, from https://hhs.iowa.gov/medicaid/services-care/individual-consumer-directed-attendant-care-icdac-transition,Centers for Medicare & Medicaid Services. (1915). Medicaid.gov - Iowa 1915(c) waiver descriptions (which waivers carry consumer-directed attendant care). medicaid.gov. Retrieved Sep 6, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA Some services bar a spouse outright, such as the HD Chore Provider agency type and self-directed homemaker work under the January 2025 Iowa Elderly Waiver text.Centers for Medicare & Medicaid Services. (1915). Medicaid.gov - Iowa 1915(c) waiver descriptions (which waivers carry consumer-directed attendant care). medicaid.gov. Retrieved Sep 6, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA For the 2011 CDAC handbook's spouse ban and VA options, see getting paid to care for your spouse in Iowa.
If you're the legal representative
A legal representative (someone authorized by law to act for your relative, other than a spouse) can be paid under an attendant care or CCO employment agreement. Iowa's HD waiver rule (441 IAC 78.34(7)) and the January 2025 Iowa Elderly Waiver text cap a legal representative's attendant care pay at 40 hours a week, base the rate on skill with a ceiling at the median statewide reimbursement rate unless the department approves more in advance, and require a backup plan in the service plan for days you can't work.Centers for Medicare & Medicaid Services. (n.d.). Iowa Waiver Factsheet — medicaid.gov (CMS). medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA,Iowa Department of Health and Human Services. (n.d.). Individual Consumer Directed Attendant Care (ICDAC) Transition. hhs.iowa.gov. Retrieved Jul 13, 2026, from https://hhs.iowa.gov/medicaid/services-care/individual-consumer-directed-attendant-care-icdac-transition The cited sources don't clearly say whether that 40-hour cap reaches CCO employment or other relatives.Centers for Medicare & Medicaid Services. (n.d.). Iowa Waiver Factsheet — medicaid.gov (CMS). medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA If an agency employs you, the HD waiver says it may pay you as its employee, with Medicaid paying the agency, not you directly.Centers for Medicare & Medicaid Services. (n.d.). Iowa Waiver Factsheet — medicaid.gov (CMS). medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA
What Changed: From CDAC to Attendant Care
Iowa HHS said the Individual CDAC (ICDAC) route would end effective Dec. 31, 2025, with all ICDAC providers disenrolled by then, after the Centers for Medicare & Medicaid Services told Iowa it was out of compliance with IRS rules on the federal tax treatment of service recipients in publicly funded HCBS programs; members had to move to CCO or an agency provider before that date to avoid a gap in services.Iowa Department of Health and Human Services. (n.d.). Individual Consumer Directed Attendant Care (ICDAC) Transition. hhs.iowa.gov. Retrieved Jun 3, 2026, from https://hhs.iowa.gov/medicaid/services-care/individual-consumer-directed-attendant-care-icdac-transition Iowa HHS's service-code guide, effective Jan. 1, 2026, then gave Individual CDAC service plans an end date of Dec. 31, 2025; since Jan. 1, 2026, a member who self-directs gets Attendant Care through CCO only.Iowa Department of Health and Human Services. (n.d.). Individual Consumer Directed Attendant Care (ICDAC) Transition. hhs.iowa.gov. Retrieved Jun 3, 2026, from https://hhs.iowa.gov/medicaid/services-care/individual-consumer-directed-attendant-care-icdac-transition
The HD amendment dropped the individual provider type, kept the agency type and CCO, and renamed Consumer-Directed Attendant Care to Attendant Care and Skilled Attendant Care with unchanged scope, amount and duration.Centers for Medicare & Medicaid Services. (1915). Medicaid.gov - Iowa 1915(c) waiver descriptions (which waivers carry consumer-directed attendant care). medicaid.gov. Retrieved Sep 6, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA For the Iowa Elderly Waiver and the other waivers, the service-code guide carries the new names: agency CDAC continues as Attendant Care under traditional services and CCO.Centers for Medicare & Medicaid Services. (1915). Iowa 1915(c) Waiver Descriptions Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA
What Attendant Care Pays For
Iowa's 2011 CDAC handbook describes unskilled help with everyday living (its examples include getting dressed and undressed, getting in and out of bed, taking a bath and taking medicine) and skilled, more medical services, which a licensed nurse or therapist must supervise. The handbook says the care must be direct and hands-on; it can't pay for supervision alone or for someone to stay overnight.Centers for Medicare & Medicaid Services. (1915). Medicaid.gov - Iowa 1915(c) waiver descriptions (which waivers carry consumer-directed attendant care). medicaid.gov. Retrieved Sep 6, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA For the HD Waiver, the 2026 amendment says the renamed Attendant Care keeps the same scope, amount and duration.Centers for Medicare & Medicaid Services. (1915). Medicaid.gov - Iowa 1915(c) waiver descriptions (which waivers carry consumer-directed attendant care). medicaid.gov. Retrieved Sep 6, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA
Which Waiver Your Relative Needs
Attendant Care isn't a stand-alone benefit: it's a service of Iowa's home and community-based services (HCBS) waivers, so your relative must be on one. The 2011 handbook adds that the member asks for it and the case manager or service worker must agree it's right for them; confirm today's steps with the case manager. Iowa HCBS waivers that carry Attendant Care include Elderly, Health and Disability, Intellectual Disabilities, Brain Injury, Physical Disability, and AIDS/HIV.Centers for Medicare & Medicaid Services. (1915). Medicaid.gov - Iowa 1915(c) waiver descriptions (which waivers carry consumer-directed attendant care). medicaid.gov. Retrieved Sep 6, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA
For a parent, the usual route is the Iowa Elderly Waiver, for people 65 or older who meet a nursing facility level of care and the Medicaid rules in 441 IAC Chapter 83; there may be a waiting list.Centers for Medicare & Medicaid Services. (1915). Medicaid.gov - Iowa 1915(c) waiver descriptions (CMS-approved services, population and level of care). medicaid.gov. Retrieved Sep 6, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA Iowa's HD Waiver serves people with physical disabilities up to age 64 who meet a nursing facility or ICF/IID level of care.Centers for Medicare & Medicaid Services. (n.d.). Iowa Waiver Factsheet — medicaid.gov (CMS). medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA See Iowa's HCBS waivers for covered services and the waiting list.
How Much Iowa Attendant Care Pays a Family Caregiver
Under CCO, the member is the employer and sets your wages, within the individual budget.Centers for Medicare & Medicaid Services. (1915). Iowa 1915(c) Waiver Descriptions Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA Talking pay with a parent can feel awkward, so agree on it in writing before the first shift; through an agency, ask its hourly wage. If a spouse or other legally responsible person is paid, Iowa's Elderly and HD waivers say the rate of pay and the care they provide are set in the member's plan of care, which the case manager authorizes.Centers for Medicare & Medicaid Services. (1915). Medicaid.gov - Iowa 1915(c) waiver descriptions (which waivers carry consumer-directed attendant care). medicaid.gov. Retrieved Sep 6, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA The HD waiver states no such rate rule for an adult child or other relative.Centers for Medicare & Medicaid Services. (n.d.). Iowa Waiver Factsheet — medicaid.gov (CMS). medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA
Iowa home care aides typically earn about $17.34 an hour (estimate based on home care aide wages in Iowa, BLS, May 2025), an occupation-wide figure, not a rate any program pays a family caregiver.data.bls.gov. (2025). BLS OEWS Profiles, May 2025, 31-1120 Home Health and Personal Care Aides (national estimates). Retrieved Oct 14, 2026, from https://data.bls.gov/oesprofile/?year=2025&major_group=310000&occupation=311120&measure=01&areas=INDUSTRY,STATE,MSA
How to Start Getting Paid
Not on Iowa Medicaid yet?
Call Iowa Medicaid Member Services at 1-800-338-8366 (515-256-4606 in the Des Moines area), Monday to Friday, 8 a.m. to 5 p.m., or see how to apply for Iowa Medicaid.Centers for Medicare & Medicaid Services. (n.d.). CMS Medicaid.gov - Where Can People Get Help With Medicaid & CHIP? (Iowa row). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/about-us/where-can-people-get-help-medicaid-chip
Get on an HCBS waiver,
usually the Iowa Elderly Waiver for a parent.Centers for Medicare & Medicaid Services. (1915). Medicaid.gov - Iowa 1915(c) waiver descriptions (CMS-approved services, population and level of care). medicaid.gov. Retrieved Sep 6, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA
Ask the case manager to add Attendant Care to the service plan
The case manager and the team decide what activities a relative will provide.Centers for Medicare & Medicaid Services. (n.d.). Iowa Waiver Factsheet — medicaid.gov (CMS). medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA
Pick your route
For CCO, contact the case manager, services or the assigned managed care organization; for an agency, find one willing to hire you.Centers for Medicare & Medicaid Services. (1915). Iowa 1915(c) Waiver Descriptions Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA,Iowa Department of Health and Human Services. (n.d.). Individual Consumer Directed Attendant Care (ICDAC) Transition. hhs.iowa.gov. Retrieved Jun 3, 2026, from https://hhs.iowa.gov/medicaid/services-care/individual-consumer-directed-attendant-care-icdac-transition
Frequently Asked Questions
I was my mom's Individual CDAC attendant. Can I keep caring for her?
Yes, through CCO or an agency. Iowa HHS said a member could enroll in CCO and hire their ICDAC provider. Your mom then becomes the employer of record, a Financial Management Services provider pays you from her budget, and she stays personally responsible if spending goes over it.Iowa Department of Health and Human Services. (n.d.). Individual Consumer Directed Attendant Care (ICDAC) Transition. hhs.iowa.gov. Retrieved Jun 3, 2026, from https://hhs.iowa.gov/medicaid/services-care/individual-consumer-directed-attendant-care-icdac-transition You can't also be her budget or employer authority.Centers for Medicare & Medicaid Services. (n.d.). Iowa Waiver Factsheet — medicaid.gov (CMS). medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/IA An agency can employ you instead if it agrees to hire you.Iowa Department of Health and Human Services. (n.d.). Individual Consumer Directed Attendant Care (ICDAC) Transition. hhs.iowa.gov. Retrieved Jun 3, 2026, from https://hhs.iowa.gov/medicaid/services-care/individual-consumer-directed-attendant-care-icdac-transition
Can my relative get respite care while I'm their paid attendant?
Not on the HD Waiver: Iowa's HD rule says respite can't be provided to a member whose usual caregiver is their attendant care provider. Ask the case manager about other waivers.Iowa Department of Health and Human Services. (n.d.). Individual Consumer Directed Attendant Care (ICDAC) Transition. hhs.iowa.gov. Retrieved Jul 13, 2026, from https://hhs.iowa.gov/medicaid/services-care/individual-consumer-directed-attendant-care-icdac-transition
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