Iowa HOME Waiver Redesign: What Families Need to Know in 2026

What the HOME Project Actually Changes

Iowa Health and Human Services has been restructuring the state's Home and Community-Based Services system since 2022 through the Hope and Opportunity in Many Environments (HOME) project. The core change: six diagnosis-based 1915(c) waivers are merging into two needs-based, age-aligned programs.

The Children and Youth (CY) waiver serves individuals from birth through age 20. The Adults with Disabilities (AD) waiver covers individuals aged 21 and older. Instead of qualifying under a specific diagnosis category (intellectual disability, brain injury, physical disability), eligibility now hinges on functional need as measured by standardized assessment tools.

This is a fundamental shift. Under the old system, a family applied for the waiver that matched their child's diagnosis. Under HOME, everyone goes through the same intake pipeline and gets assessed on what support they actually need, regardless of diagnostic label.

How the Assessment System Changed

The legacy Supports Intensity Scale (SIS-A for adults, SIS-C for children) is gone. Iowa now uses the interRAI suite of assessment tools — the interRAI-ID for adults 18 and older, and the ChYMH-DD for youth transitioning out of children's services.

As of July 1, 2026, CareStar, Inc. conducts all Core Standardized Assessments statewide, replacing Telligen, which concluded its operations on June 30, 2026. CareStar operates as an independent assessor — they evaluate functional need but do not deliver services, eliminating the conflict of interest that existed when service providers also conducted assessments.

CareStar began scheduling assessments due on or after July 1 starting in early June 2026. If your family has an assessment coming up, you should be hearing from CareStar directly. The interRAI tools use clinical inquiry windows ranging from 3 to 90 days, so document behaviors, medical needs, and support requirements within those timeframes before your interview.

What Happens at Age 21

If a young adult is enrolled in the Children and Youth waiver, they automatically transition to the Adults with Disabilities waiver in the month they turn 21. No new application is required. No re-evaluation happens solely because of the age crossover, as long as the member continues meeting financial and clinical eligibility criteria.

This is one of the cleaner elements of the redesign. Under the old system, transitioning between age-specific waivers sometimes created enrollment gaps. The HOME structure eliminates that by building the age transition directly into the program architecture.

The Waitlist Reality Under HOME

The waiver consolidation does not eliminate waitlists. Iowa's HCBS waivers operate under a fixed number of slots authorized by the federal Centers for Medicare and Medicaid Services. The Intellectual Disability waiver waitlist alone historically holds over 7,000 individuals with wait times stretching to five years.

What HOME changes is how waitlist priority works. The Waiver Priority Needs Assessment (WPNA) screens for emergent need (caregiver death, homelessness, founded abuse or neglect) and urgent need (primary caregiver over 55 with chronic health conditions, or when the caregiver requires support within 60 days to prevent institutionalization). Families can resubmit the WPNA when circumstances change to request priority reclassification.

During the wait, families can access Short-Term Supports and Services through their district Disability Access Point, which are non-Medicaid-funded respite and crisis services.

What Families Should Do Now

If you are currently on a legacy waiver, monitor communications from Iowa HHS about your transition timeline and confirm how your services will carry over during the consolidation.

If you are on the waitlist or just entering the system, understand that the new AD waiver is your target program. Prepare for a CareStar assessment by documenting your family member's support needs on their most difficult days, not their best ones. The interRAI tool captures functional need — underreporting limits the tier rating, which directly determines your funding level.

For families navigating both the waiver system and the SSI age-18 redetermination simultaneously, the sequencing matters. Our Iowa SSI at 18 & Adult Disability Benefits Guide walks through the exact order of federal and state applications so you do not create gaps in coverage during the transition.

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