If your parent is on an Iowa Medicaid home-care waiver, the Consumer Choices Option (CCO) can let them hire you, turning the care you already give into family caregiver pay. CCO gives a waiver member a targeted amount of Medicaid dollars to hire their own workers, and the Iowa Elderly Waiver approved for January 2025 allows a relative, including an adult child, to be paid as one of them. Your first call is your parent's case manager or managed care organization (MCO).

In This Guide

How the Iowa Consumer Choices Option Pays a Family Caregiver

If you're already doing the care unpaid, CCO is how your parent can hire you. It's an option on Iowa's Home and Community-Based Services (HCBS) waivers that gives the waiver member control over a targeted amount of Medicaid dollars to hire employees or buy other goods and services. Your parent hires and manages their own workers, serves as the employer of record with employer taxes paid from the budget, and stays personally responsible for spending above it.

Iowa HHS ended Individual Consumer-Directed Attendant Care (ICDAC) on December 31, 2025, after telling members to enroll in CCO or with an agency provider before then. Iowa HHS's service-code guide, which covers the Elderly Waiver, says that since January 1, 2026, self-directed Attendant Care is available only through CCO, while agency CDAC continues under the new name Attendant Care; see what replaced CDAC in Iowa. So under the Elderly Waiver, the paid routes left for a relative are working for the member through CCO or working for an agency; for a spouse, see the conflict below. If your own paid arrangement changed at the new year, the working relationship didn't have to end: Iowa HHS said a member could enroll in CCO and hire the attendant they had under ICDAC. Moving to an agency works only if the agency agrees to hire you, which Iowa HHS's ICDAC FAQ says "is not something Medicaid can control.",

Who Can Be Paid Through CCO in Iowa?

The January 2025 version of the CMS-approved Iowa Elderly Waiver says "Payments may be made to any relative including a spouse, or a legal representative of the member." Iowa HHS has since posted a January 2026 version; this guide relies on the January 2025 text. For a spouse, see the conflict below.

Your relationship Can you be paid through CCO?
Adult child or other relative (not a spouse) Yes, under the January 2025 approved Elderly Waiver
Spouse Sources conflict; get it in writing
Legal representative of an adult member Yes; hour and rate caps may apply (see the pay section)
Relative who lives with the member The waiver and rule texts above don't address it; ask the case manager

One limit surprises families: in Iowa, a CCO employee can't also be the budget or employer authority under CCO, so someone else must hold that role.

For a spouse, Iowa's own documents disagree:

Conflicting answers are hard to plan around, so before a spouse gives up income for paid care, ask the case manager: "Does the plan of care authorize paying a spouse? Please confirm in writing." See getting paid to care for your spouse in Iowa.

How Do the CCO Broker, Budget and Payroll Service Work?

Iowa's CCO member guide, an older Iowa Medicaid publication that predates the HHS merger, names three tools.

Independent Support Broker. The broker has to stay independent of your parent's paid care, so these limits shape who in the family can take which role. An Iowa CCO Independent Support Broker can't be paid for other services to the member or work for an agency serving them. The CCO guide also bars an adult member's guardian, spouse or legal representative from serving as the broker, and the approved Iowa Elderly Waiver bars a conservator, trustee, representative payee, or attorney in fact under a health-care or financial power of attorney. In August 2025 Iowa HHS gave notice it intended to make the broker optional, so ask whether your parent needs one.

Individual Budget. This is where most families' real question sits: will the money cover the hours of care your parent needs? Your parent develops the Individual Budget, working with the broker or, under Iowa's announced plan to make the broker optional, the case manager,, and buys only approved services unless Iowa Medicaid Enterprise gives prior approval. The amount comes from your parent's service plan. Under Iowa's rule, 441 IAC 78.34(13), the monthly budget is based on their assessed needs and the services the plan authorizes, generally each valued at Iowa's average unit cost and adjusted by a utilization factor (respite, home and vehicle modifications, assistive devices and specialized medical equipment are treated differently), which reflects the share of authorized care that waiver members have actually used and can't be set below 60 percent. The amount can change only on the first of the month, and your parent is told it while the service plan is being developed. Neither Iowa's rule nor its waiver sets your parent's dollar amount (the waiver gives only a hypothetical example), so ask the case manager what the budget is before you plan around it.

Financial Management Service (FMS). In Iowa's CCO, the FMS pays employees, employer taxes and fees from the budget, so the family doesn't cut the paychecks itself. The CCO guide says your parent's monthly allowance is kept in a special account separate from their personal money, and the FMS makes sure laws such as payroll taxes are obeyed.

How Much Is Family Caregiver Pay Through Iowa's CCO?

If you're weighing whether to cut back at work, what matters most is how much of your parent's budget can go to your hours. Typical pay: about $17.34 an hour (estimate based on home care aide wages in Iowa, May 2025). That's the U.S. Bureau of Labor Statistics median for Iowa home health and personal care aides, a wage estimate for the occupation, not a rate any program pays a family caregiver.

Your wage is your parent's call: the CCO guide tells the member, "You will set the wages yourself." Iowa's approved Elderly Waiver (January 2025 version) and Health and Disability Waiver both say a member determines the wages and the units of service, limited by the self-direction budget., Iowa's rule also puts the FMS and broker costs inside that budget, so your pay shares it with them. Every support employee must complete time cards, and the money is paid once your parent approves yours. Before you cut back at work, ask how much of the budget can go to your hours. A legal representative providing attendant care has two more limits: no more than 40 hours a week, and a rate no higher than the median statewide reimbursement rate unless the state approves more in advance. Whether either cap reaches CCO employment isn't settled in the waiver and rule text, so ask the case manager.

How to Get Hired Through CCO

1
Step 1

Make sure your parent has Iowa Medicaid and a waiver

CCO is an option on Iowa's HCBS waivers; the Iowa Elderly Waiver serves people 65 or older who meet a nursing facility level of care. Iowa Medicaid for long-term services and supports caps income at $2,982 a month in 2026 (300 percent of the SSI benefit), though a parent over the cap may still qualify with a Medical Assistance Income Trust if their total gross monthly income doesn't exceed 125 percent of the statewide average charge for their level of care; the countable-resource limit is $2,000 for an individual. See how to apply for Iowa Medicaid.

2
Step 2

Ask for CCO

Contact your parent's case manager, services, or assigned MCO to choose this option. No case manager? Call Iowa Medicaid Member Services at 1-800-338-8366 (weekdays, 8 a.m. to 5 p.m.).

3
Step 3

Build the CCO budget

with a broker or case manager, and ask them which FMS your parent will work with.,

4
Step 4

Agree on your duties

Under the approved Iowa Elderly Waiver, the case manager and the member's team decide the need for, and the types of, activities a relative provides through CCO.

5
Step 5

Start work and turn in time cards

for your parent to approve. Ask the FMS how often it pays and when your first check will arrive.

Frequently Asked Questions

I have my mom's power of attorney. Can I still be her paid CCO worker?

Possibly. The approved Iowa Elderly Waiver says a legal representative may be paid. Iowa's Medicaid rule (441 IAC 79.10(7)) defines a legal representative as a person authorized by law to act for the member, not including a spouse; that definition doesn't say whether a power of attorney makes you one, so ask the case manager to confirm in writing., Under Iowa's CCO, someone other than the paid worker must hold the budget or employer authority, and the paid worker can't also be the Independent Support Broker; confirm both with the case manager before you're hired. How the CCO broker works covers who may serve as broker.

Are CCO wages taxed?

For federal income tax, it depends on where you live. Under IRS Notice 2014-7, pay for care under a state's 1915(c) waiver can be left out of your federal gross income only when the care is in your own home, where your parent lives with you under their plan of care; it doesn't apply if you have a separate home where you live. Social Security and Medicare taxes are separate: the IRS says pay excludable under that notice is generally still wages for those taxes, except that, when the care recipient is the employer (as your parent is under CCO), pay to a spouse, or to a child under 21 caring for a parent, generally isn't subject to them, and household wages below an annual threshold aren't either., See whether Medicaid waiver payments are taxable.

Learn More

CaregiverHow to Get Paid as a Family Caregiver in IowaHow to get paid to care for a family member in Iowa in 2026: Medicaid attendant care, the Consumer Choices Option after ICDAC ended, and VA options. CaregiverHow to Get Paid to Care for Your Spouse in IowaCan you get paid to care for your spouse in Iowa? Iowa's own Medicaid sources conflict on paying a spouse, and the VA's PCAFC stipend can pay one. CaregiverCaregiver Programs in IowaEvery Iowa caregiver program for 2026: Attendant Care (formerly CDAC) and Consumer Choices pay, the Elderly Waiver, NFCSP respite, VA benefits, and 3.8% tax. MedicaidIowa Medicaid HCBS WaiversIowa Medicaid HCBS waivers pay for care at home through the Elderly Waiver for Iowans 65 and older at a nursing facility level of care. See 2026 eligibility. MedicaidHow to Apply for Iowa MedicaidLearn how to apply for Iowa Medicaid online, by phone, in person, or by mail, plus the income-cap and spend-down routes, documents, and 2026 timelines. CaregiverIowa Health and Disability Waiver: Can a Family Member Be the Paid Caregiver?Iowa's Health and Disability Waiver can pay an adult child or other relative as an Attendant Care or CCO employee. Who qualifies, the spouse rule, first steps.

Find personalized help getting paid through Iowa's Consumer Choices Option at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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