If you care for a relative in Iowa who is under 65 and lives with a physical disability, Medicaid may pay a family member to give that care at home. The Iowa Health and Disability Waiver pays for home care for these Iowans when they need a nursing facility or intermediate care facility level of care. Iowa Health and Disability Waiver family caregiver pay can go to an adult child or other relative hired through an Attendant Care agency or as the member's own employee. Iowa's documents conflict on whether the HD Waiver can pay a spouse or the parent of a minor, so get the case manager's or managed care organization's answer in writing. Iowa Medicaid Member Services can help you start.

In This Guide

What the Iowa Health and Disability Waiver Does and Who Qualifies

The Iowa Health and Disability (HD) Waiver is one of Iowa's seven home and community-based services (HCBS) waivers, which help people stay at home instead of going to a medical institution. According to the Centers for Medicare & Medicaid Services (CMS), the HD Waiver serves people with physical disabilities ages 0 to 64 who meet a nursing facility or intermediate care facility (ICF/IID) level of care. Its services include attendant care, adult day care, homemaker help and home health aide services. Respite is also available, with limits covered in the FAQ below.

Your relative also needs Iowa Medicaid. In 2026, Iowa's income cap for Medicaid long-term services is $2,982 a month; above it, a person may qualify with a Medical Assistance Income Trust (Miller trust).

Some Iowa waivers may have a waiting list; your worker at the Iowa Department of Health and Human Services (HHS) can explain it.

Which Family Caregivers Can Be Paid Through the Iowa Health and Disability Waiver?

The HD Waiver approved effective January 22, 2026, says "Payments may be made to any relative," if they meet the minimum age to provide services.

Your relationship Can you be paid?
Adult child, sibling or other relative Yes, through CCO or an Attendant Care agency
Spouse Sources conflict; get it in writing
Parent of a child under 18 Sources conflict; get it in writing
Guardian or legal representative of an adult Yes, through Attendant Care or CCO (not as a Skilled Attendant Care chore provider)
Relative who lives with them Not in our sources; ask the case manager

The HD Waiver's section on "legally responsible" persons covers spouses and guardians of adults, and the same section names parents of children 17 and younger. When a legally responsible person is the Attendant Care or CCO employee, the HD Waiver's service planning team decides which activities they provide and reviews whether the care is "extraordinary." Under the HD Waiver, ordinary household help for someone the same age without a disability, not needed to keep your relative safe and out of an institution, isn't extraordinary care.

Some HD Waiver services bar a spouse: adult day care, homemaker and home health aide providers can't be the member's spouse. A CCO employee also can't be the budget or employer authority under CCO. For Skilled Attendant Care, the HD Waiver's provider rules for one agency type (chore providers) say providers can't be the member's spouse or guardian, or the parent or stepparent of a member 17 or younger.

On whether a spouse or the parent of a minor can be paid under the HD Waiver, Iowa's documents disagree. An Iowa HHS townhall in June 2024 said spouses and parents of minors may be employed "in extraordinary circumstances as defined by the state." Iowa's rule 441 IAC 79.10(7), effective July 1, 2026, counts payment to a spouse or the parent of a minor child as incorrect, and its carve-out covers only legal representatives, a term that excludes both. Before starting paid work, ask the case manager or MCO: "Does the service plan authorize paying me? Please confirm in writing." See getting paid to care for your spouse in Iowa.

How Iowa Health and Disability Waiver Family Caregiver Pay Works

Iowa Medicaid ended Individual Consumer-Directed Attendant Care (ICDAC), under which individual attendants were enrolled with Iowa Medicaid as ICDAC providers. Iowa HHS's service-code guide set December 31, 2025 as the service end date for individual CDAC service plans, including on the HD Waiver. The HD Waiver amendment approved effective January 22, 2026 removed the Individual CDAC provider type and renamed Consumer-Directed Attendant Care (CDAC) as Attendant Care and Skilled Attendant Care, and it says the service's scope didn't change. It also kept members' ability to self-direct Attendant Care through CCO. That leaves two routes for a family member to be paid for attendant care:

When a legally responsible person, such as a guardian, is the paid caregiver, the HD Waiver says their rate of pay and the care they provide are set in the member's service plan. The waiver states no separate pay rule for other relatives; under CCO, your relative sets your wage within the CCO budget. Under Iowa's HD Waiver rule, a legal representative paid as an attendant care provider can be paid for up to 40 hours a week, at a skill-based rate capped at the median statewide reimbursement rate unless Iowa approves more in advance, with a contingency plan in the service plan., If you're the legal representative and give care around the clock, hours past 40 a week go unpaid under the HD Waiver, so use the service plan meeting to list every task your relative needs and ask early about a higher rate.

Typical pay: about $17.34 an hour (estimate based on home care aide wages in Iowa, BLS, May 2025), not a program rate.

How to Start

1
Step 1

Apply for Iowa Medicaid

if your relative isn't enrolled. A local HHS office can help in person or by phone with an HCBS application. See how to apply for Iowa Medicaid.

2
Step 2

Call Member Services with questions

at 1-800-338-8366 (515-256-4606 in the Des Moines area), Monday to Friday, 8 a.m. to 5 p.m.

3
Step 3

Ask for CCO or an agency

Contact the case manager or your assigned MCO to choose CCO.

4
Step 4

Review the service plan

Ask the case manager which tasks the plan authorizes you to provide. Under CCO, your relative sets your wage within the CCO budget. If you're a guardian or other legally responsible person, the HD Waiver says the plan sets your rate of pay and the care you provide.

Frequently Asked Questions

If I'm my relative's paid attendant, can we still get respite?

Not under the HD Waiver rule, which bars respite for a member whose usual caregiver is their attendant care provider.

My dad is 66. Is this the right waiver?

No. The HD Waiver serves people ages 0 to 64. For an Iowan 65 or older, see the Iowa Elderly Waiver, which also lets relatives be paid.

Learn More

Find personalized help getting paid through the Iowa Health and Disability 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.