Iowa CareStar Assessment: How the interRAI-ID Evaluation Works

What Changed: Telligen to CareStar

Iowa completely overhauled its HCBS assessment system. The previous contractor, Telligen, Inc., concluded operations on June 30, 2026. As of July 1, 2026, CareStar, Inc. is the sole entity conducting all Core Standardized Assessments for HCBS waiver eligibility in Iowa.

This is more than a contractor swap. Iowa simultaneously retired the legacy Supports Intensity Scale (SIS-A for adults, SIS-C for children) and replaced it with the interRAI Intellectual Disability (interRAI-ID) assessment tool for adults aged 18 and older, and the ChYMH-DD tool for youth in transition.

The shift to an independent assessor model also eliminated a structural conflict of interest. Under the old system, service providers sometimes influenced assessment outcomes because the same organizations delivering services were involved in the evaluation process. CareStar operates independently from service providers.

How the interRAI-ID Assessment Works

The interRAI-ID is a structured clinical interview covering multiple domains of the individual's daily life. The assessor — a CareStar employee trained on the tool — meets with the individual and their family member or caregiver either in person or virtually.

The assessment covers:

• Cognitive patterns — memory, decision-making, comprehension
• Communication — ability to express needs and understand others
• Self-care — bathing, dressing, eating, personal hygiene
• Behavioral symptoms — aggression, self-injury, wandering, resistance to care
• Medical complexity — medications, treatments, health conditions requiring monitoring
• Social engagement — participation in activities, relationships, isolation
• Support needs — overnight supervision, one-on-one staffing, crisis intervention frequency

Each domain uses specific clinical inquiry windows — timeframes ranging from 3 days to 90 days that define the period the assessor evaluates. If a behavioral incident happened 100 days ago, it may fall outside the look-back window and not factor into the score. If it happened 15 days ago, it counts.

This is why preparation timing matters. Families should track and document behaviors, medical events, and support needs continuously — not scramble to recall them when the assessment is scheduled.

How Tiers Are Assigned

The interRAI-ID produces a standardized score that feeds into a decision-tree algorithm. The algorithm assigns the individual to a Supported Community Living tier (Tiers 1 through 5 for the ID waiver, with higher numbers reflecting greater need).

Higher tiers mean higher daily reimbursement rates for providers. This has a direct practical impact: providers are more willing to accept individuals at Tier 4 or 5 because the funding covers staffing costs. At Tier 1 or 2, the reimbursement may not cover the cost of the support the person actually needs, making it harder to find a willing provider.

If the family believes the tier assignment does not accurately reflect the individual's needs, they can request a reassessment. They can also appeal through Iowa's managed care appeal process or, if the appeal involves Medicaid eligibility, through a State Fair Hearing.

How to Prepare for the CareStar Interview

The single most common mistake families make is underreporting. Parents often describe their child's abilities on a good day rather than documenting what happens on the worst days. The assessment captures the level of support needed, not the level of independence achieved.

Before the assessment:

Compile a behavior log covering at least the past 90 days. Include every incident of challenging behavior, every night that required overnight supervision, every medical appointment or medication change, and every time the individual needed one-on-one support for a routine activity.

Bring medical records from the past year, including any ER visits, psychiatric evaluations, therapy notes, and medication management records. Have the current list of medications and dosages ready.

If the individual receives services through a Targeted Case Manager, ask the TCM for a copy of the current service plan and any incident reports on file.

During the assessment:

Answer every question based on the individual's most supported state, not their most independent. If someone can dress themselves on a calm morning but needs physical help when anxious, report the need for physical help. If they eat independently at home but refuse to eat in unfamiliar settings, report the refusal.

When the assessor asks about behaviors, give specific frequencies: "aggressive episodes four times per week on average," not "sometimes gets upset." The interRAI scoring relies on frequency and severity data — vague answers produce lower scores.

Scheduling and Timeline

CareStar began scheduling assessments due on or after July 1, 2026, starting June 1, 2026. For individuals already on a waiver, assessments occur annually around the waiver anniversary date. The assessment must be completed within 14 days before that anniversary to avoid a lapse in waiver funding.

For new applicants, the assessment is scheduled when a waiver slot becomes available. CareStar contacts the family directly to arrange the appointment.

If you are preparing for a CareStar assessment alongside the SSI redetermination and other transition tasks, the Iowa SSI at 18 & Adult Disability Benefits Guide includes assessment preparation checklists and documentation templates designed to capture exactly the information the interRAI-ID tool evaluates.

See more Iowa guides →