Iowa Proposes Key Changes to 1915(i) HCBS Services

Iowa’s Department of Health and Human Services (HHS) recently unveiled a proposed update to its 1915(i) Home and Community-Based Services (HCBS) program, signaling important shifts for providers supporting individuals with intellectual and developmental disabilities (IDD). This update, outlined in State Plan Amendment IA-25-0011, reflects an evolving framework designed to streamline service delivery and modernize provider requirements.

One of the most significant changes involves removing all references to the Integrated Health Home (IHH) program, which is being phased out. The amendment also addresses an internal restructuring by replacing mentions of the Department of Human Services (DHS) with the Department of Health and Human Services (HHS) throughout the plan.

Regarding intensive residential supports, the proposal eliminates region-specific designations for Intensive Residential Service Homes (IRSH) and instead introduces new certification standards for Intensive Residential Service Providers. This shift aims to standardize requirements statewide, offering potentially smoother oversight and consistency. Additional updates include stricter face-to-face contact mandates for case management providers and a renaming adjustment for supported-employment services, reflecting current employment center designations. Eligibility criteria for “Intensive IV” services receive clarification, and the amendment revamps certification and provider eligibility standards to better align with contemporary needs.

Notably, the proposal loosens credential requirements by removing the mandate that direct support professionals (DSPs) working in day or prevocational habilitation must hold a high school diploma or equivalent. This relaxation could have far-reaching effects on workforce recruitment and staff training, potentially easing hiring barriers amid ongoing labor challenges.

The amendment also incorporates technical corrections in the Quality Improvement section, updating performance measurement sampling and eliminating outdated review cycles to ensure more relevant oversight. Financially, no increase in Medicaid fee-for-service spending is expected for fiscal years 2026 and 2027. However, agencies should prepare for administrative efforts related to certifying providers under the new standards.

Stakeholders are encouraged to submit comments on SPA IA-25-0011 by December 30, 2025, at 4:30 p.m. Providers currently involved with IHH or IRSH programs will want to review these changes carefully, as they may require updates to operational policies and practices. For agencies and professionals working closely with IDD and behavioral health populations, these amendments offer crucial insights into how Iowa is recalibrating its HCBS framework to better support individuals and improve service delivery nationwide.