The Iowa Department of Health and Human Services published a public notice on May 1, 2026 announcing it will replace four disability-based Home and Community-Based Services (HCBS) waivers with two new age-based waivers effective October 1, 2026. Families enrolled in any of the four waivers being replaced have until May 31, 2026 at 4:30 PM CT to submit public comments on the proposed changes.

The consolidation affects an estimated fiscal impact of $2.4 million in state dollars and represents the second phase of Iowa's HOME (Hope and Opportunity in Many Environments) project.

Which Waivers Are Changing

Four current waivers will be replaced:

• Health and Disability waiver
• Children's Mental Health waiver
• AIDS/HIV waiver
• Physical Disability waiver

Two new waivers will replace them:

• Children and Youth Waiver for individuals ages 0-21 with disabilities, special health care needs, or mental health needs
• Adults with Disabilities Waiver for adults 21 and older with disabilities

The Brain Injury and Intellectual Disability waivers aren't part of this October transition. Those members will move to the new HOME waivers in 2027.

What This Means for Families Currently on Waivers

If you're enrolled in one of the four waivers being replaced, you won't lose your waiver slot. Iowa HHS has guaranteed that "if you are on a waiver now, you will stay on a waiver."

You won't need to reapply. The transition happens automatically.

But services may be renamed or reorganized. Iowa HHS says "nearly all current services will still be available," though some may shift to the Medicaid state plan or EPSDT (Early and Periodic Screening, Diagnostic and Treatment) instead of appearing on the waiver itself.

Starting in 2026, funding will be based on "assessed level of need" rather than the current structure. That means some families may see their service levels change. If your funding doesn't match what you need, you can work with your case manager to adjust services or request a review through the mySPL process.

Youth aging out of the Children and Youth waiver at 21 will have reserved slots on the Adults with Disabilities waiver, so there won't be a gap in coverage.

Why the Public Comment Period Matters

This is the second public comment period for these waivers. Iowa HHS first posted the applications on January 12, 2026, with a comment period that closed February 13. The state made no substantive changes between the first and second notice, so if you already submitted comments during the January period, you don't need to submit identical remarks again.

But if you have new concerns or didn't comment the first time, this is your opportunity to weigh in before the waivers are finalized and submitted to the Centers for Medicare & Medicaid Services (CMS).

Public comments give families a chance to flag services that matter to them, point out potential gaps in coverage, and make sure the state understands how current services are being used. CMS requires states to hold public comment periods for waiver changes, and Iowa HHS must summarize and address all comments received before finalizing the waivers.

How to Submit Comments

Deadline: May 31, 2026 at 4:30 PM CT

Email: HCBS_Public_Comment@hhs.iowa.gov

Mail:

LTSS Policy Team, Iowa Department of Health and Human Services, Iowa Medicaid, 321 East 12th Street, Des Moines, IA 50319

You don't need to be currently enrolled in a waiver to comment. Anyone can participate, including family members, providers, and advocates.

What Families Should Include in Comments

Your comment doesn't need to be formal or long. Focus on specifics:

• Which services your child or family member relies on most
• How those services allow them to live at home instead of in an institution
• Any concerns you have about services being renamed, reorganized, or moved to a different funding source
• Whether the "assessed level of need" funding model raises questions about whether your current services will be fully funded

If you're worried about a specific service disappearing or being harder to access under the new structure, name it. The state needs to know what families are using, not just what looks good in a policy document.

Where to Find More Information

The full waiver applications and additional details are available on the Iowa HHS public notice page. Iowa HHS has also published a Waiver Redesign FAQ that addresses common questions about the HOME project.

If you have questions about how the changes will affect your family specifically, contact your case manager or call Iowa Medicaid Member Services at 1-800-338-8366.