Iowa seeks input on HCBS waiver redesign

Iowa Health and Human Services has opened a public comment period on a proposal to redesign the state’s Home and Community Based Services (HCBS) system under Section 1915(c) of Medicaid. The proposal focuses on restructuring how waiver services are organized, with the goal of creating a simpler and more consistent waiver framework. The comment period began on January 12, 2026, and remains open through February 13, 2026 at 11:59 p.m. Central Time. Input submitted by individuals, families, providers, and advocates will be reviewed before final waiver submissions are sent to the Centers for Medicare & Medicaid Services (CMS).

Waivers proposed for consolidation

Under the proposal, Iowa would replace four existing disability based waivers:

• Health and Disability

• Children’s Mental Health

• AIDS/HIV

• Physical Disability

These four waivers would be consolidated into two age-based waivers:

• Children & Youth (ages 0–21)

• Adults with Disabilities (ages 21+)

The redesign is positioned as a structural change that shifts waiver organization from disability based categories to age based categories.

HOME initiative and stated goals

Iowa’s proposal is part of the Hope and Opportunity in Many Environments (HOME) initiative. The HOME initiative is intended to simplify access, improve service delivery, and create a more consistent waiver structure across populations. As part of the redesign summary, the State of Iowa estimates a $2.4 million state fiscal impact resulting from the consolidation.

Public comment window and next steps

The public comment period runs from January 12, 2026 through February 13, 2026 at 11:59 p.m. Central Time. Iowa Health and Human Services will review feedback from individuals, families, providers, and advocates before final waiver submissions are sent to CMS.