Yes: the Iowa Elderly Waiver, a Medicaid program that pays for home care for Iowans 65 and older who need nursing-home-level care, can pay an adult child or other relative.
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Brevy Care Team
7 min read · Published October 16, 2026 · Last verified October 18, 2026
What the Iowa Elderly Waiver Does and Who Qualifies
The Iowa Elderly Waiver is one of Iowa's seven home and community-based services (HCBS) waivers, and the one for people 65 and older. These waivers help people stay home instead of going to a medical institution. Iowa HHS's HCBS page lists its services, some under names retired in 2026, including adult day care, homemaker and chore help, home-delivered meals, nursing, respite, transportation and Consumer-Directed Attendant Care (CDAC). Medicaid pays only for services written into your relative's service plan.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 Since January 1, 2026, Iowa HHS's service-code guide calls CDAC Attendant Care and homemaker and chore help Home Maintenance Support, and the Individual CDAC route has ended.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 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
Many families feel stuck on the money rules, but they don't always close the door. To qualify for the Iowa Elderly Waiver, your relative needs to meet two sets of rules:U.S. Government Publishing Office. (2024). 42 U.S.C. §3030s-1 — Program authorized (Older Americans Act, Title III Part E; U.S. Code 2024 ed., govinfo.gov). govinfo.gov. Retrieved Oct 12, 2026, from https://www.govinfo.gov/link/uscode/42/3030s-1?link-type=html
Care needs: the Iowa Elderly Waiver requires a nursing facility level of care. An assessor completes the interRAI Home Care assessment when your relative applies and again each year, and the state makes the first decision.Iowa Legislature. (n.d.). Iowa Administrative Code 441—83.22(249A) Eligibility (Elderly Waiver) [ARC 0318D, IAB 5/27/26, effective 7/1/26]. legis.iowa.gov. Retrieved Oct 4, 2026, from https://www.legis.iowa.gov/docs/ACO/rule/441.83.22.pdf
Iowa HHS says there is currently no waitlist for the Iowa Elderly Waiver, though that could change.U.S. Government Publishing Office. (2024). 42 U.S.C. §3030s-1 — Program authorized (Older Americans Act, Title III Part E; U.S. Code 2024 ed., govinfo.gov). govinfo.gov. Retrieved Oct 12, 2026, from https://www.govinfo.gov/link/uscode/42/3030s-1?link-type=html
Can a Family Member Be Paid Through the Iowa Elderly Waiver?
The Iowa Elderly Waiver's January 2025 text, approved by the Centers for Medicare & Medicaid Services (CMS), 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 of the waiver, and the spouse part of that sentence is disputed by Iowa's own rule (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
Your relationship
Can you be paid?
Adult child or other relative
Yes, through CCO or a hiring agency
Spouse
Sources conflict; get it in writing
Legal representative (not a spouse)
Yes for attendant care or CCO
Relative who lives with them
Not in our sources; ask the case manager
A CCO employee can't also be the budget or employer authority. Some Iowa Elderly Waiver services bar a spouse outright: self-directed homemaker (renamed Home Maintenance Support in 2026), adult day health and home health aide providers can't be the member's spouse.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 On the Iowa Elderly Waiver, a legal representative providing attendant care can be paid for up to 40 hours a week, at a rate based on their skill level and no higher than the median statewide reimbursement rate for the service unless the state approves more in advance.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 a spouse, Iowa's own documents disagree. Iowa's rule 441 IAC 79.10(7), in the edition effective July 1, 2026, counts Medicaid funds as incorrectly paid when the worker was the member's spouse, and its carve-out for legal representatives doesn't reach a spouse.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 Iowa HHS's June 2024 member townhall said instead that spouses may be employed to deliver supported community living or CDAC services, but only "in extraordinary circumstances as defined by the state." The townhall doesn't define them, but the January 2025 Iowa Elderly Waiver text gives the state's test for a legally responsible person such as a spouse: the service planning team reviews whether the needed services are "extraordinary," and tasks that person would ordinarily do in the household for someone the same age without a disability or chronic illness, and that aren't necessary for the member's health and welfare or to avoid institutionalization, are not extraordinary. The same text also says a legally responsible 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 Before a spouse starts paid work, ask the case manager: "Does the service plan authorize paying me as the spouse? Please confirm in writing." See getting paid to care for your spouse in Iowa.
How Iowa Elderly Waiver Family Caregiver Pay Works
If you were your parent's paid attendant, this can feel unsettling, but a relative can still be paid. Iowa HHS announced that Individual Consumer-Directed Attendant Care (ICDAC), where an attendant enrolled directly with Medicaid, would end effective December 31, 2025, with all ICDAC providers to be disenrolled by that date. Members were told to move to CCO or an agency provider before then.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 In August 2025, Iowa HHS gave notice it would remove the individual CDAC provider type from the Elderly Waiver and rename the service Attendant Care.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 HHS's service-code guide, effective January 1, 2026, then set December 31, 2025 as the end date for Elderly Waiver service plans with Individual CDAC. Since January 1, 2026, self-directed Attendant Care is available only through CCO, and agency CDAC continues as Attendant Care.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 So two routes remain: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
Typical pay: about $17.34 an hour (estimate based on home care aide wages in Iowa, BLS, May 2025). That's the BLS median wage for Iowa home health and personal care aides, 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
at 1-800-338-8366 (515-256-4606 in the Des Moines area), Monday to Friday, 8 a.m. to 5 p.m.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
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Step 3
Complete the level of care assessment
For the Iowa Elderly Waiver, an assessor uses the interRAI Home Care tool to see whether your relative needs a nursing facility level of care.Iowa Legislature. (n.d.). Iowa Administrative Code 441—83.22(249A) Eligibility (Elderly Waiver) [ARC 0318D, IAB 5/27/26, effective 7/1/26]. legis.iowa.gov. Retrieved Oct 4, 2026, from https://www.legis.iowa.gov/docs/ACO/rule/441.83.22.pdf
I was my dad's Individual CDAC attendant. Can I still be paid?
Yes, through CCO or an agency. Iowa HHS's ICDAC FAQ said a member could enroll in CCO and hire their current ICDAC provider, and that moving to an agency depends on the agency agreeing to hire you. Under CCO, your dad becomes the employer of record, makes sure employer taxes are paid from his individual budget through a financial management services (FMS) provider, and stays personally responsible for expenses if he goes over that budget.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
My mom is under 65 and disabled. Is the Elderly Waiver the right program?
Find personalized help getting paid through the Iowa Elderly Waiver 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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Brevy Care Team
Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.