The Iowa Department of Health and Human Services (DHHS) is accepting public comments on the proposed waiver redesign. The public comment period is open until this Friday, Feb. 13, 2026, at 11:59 p.m. CST.
Click here to view the public notice. Click here to view all public comment information.
Overview
As part of the Hope and Opportunity in Many Environments (HOME) project, DHHS is redesigning its Medicaid home- and community-based services (HCBS) waiver system. The goal is to make services easier to understand, help people remain in their homes and communities and better connect them with the supports they need.
While keeping the Elderly Waiver, DHHS plans to replace the current six disability-based HCBS waivers with two new age-based waivers: the Children and Youth Waiver and the Adults with Disabilities Waiver.
The Children and Youth Waiver would provide extra Medicaid services for children and youth with disabilities, special health care needs and mental health needs up to age 21. The waiver program is intended to help children live at home with family, rather than in an institution (e.g., a hospital or nursing facility).
An Adults with Disabilities Waiver would provide extra Medicaid services for adults with disabilities aged 21 and older. The waiver program is intended to help adults live at home, rather than in an institution.
These updates would:
- Make the system easier to use and understand
- Help people get services based on their needs
- Improve the assessment process across the state
Before these new waivers can take effect, they must be approved by CMS. As part of this process, DHHS is gathering public comments on the draft waivers before submitting them to CMS for approval.
Timeline
DHHS is proposing a phased approach for moving people on current HCBS waivers to the new HOME waivers. People who are on a waiver now will not need to re-apply to move onto the new waiver. People who are not on a waitlist now will not be placed on a waitlist. This approach includes two phases:
- Phase 1: Starting later in 2026, all members on the AIDS/HIV, Health and Disability, Physical Disability and Children’s Mental Health Waivers will transition to the new HOME waivers. Members on the Brain Injury and Intellectual Disability Waivers will remain on their current waivers but will continue to have access to all current services on those waivers.
- Phase 2: In 2027, all members on the Brain Injury and Intellectual Disability waivers will transition to the new HOME waivers.
See the HOME Public Comment webpage for quick guides with more information on eligibility criteria, waitlists, services and how current HCBS members will access the new HOME waivers.
The public comment period
CMS requires states to have a public comment period for changes to waivers. This process makes sure that people who may use the services, as well as their families and communities, get a chance to share their thoughts and concerns. Anyone can provide a public comment.
The public comment period entails a few steps:
- Once the waiver applications are ready, Iowa DHHS will put the document online and notify Iowans. The public will have five weeks to review the waiver amendments and comment. The waiver amendments are lengthy; therefore, DHHS has made several quick guides to provide details on key changes.
- During the public comment period, anyone — including people who need or use HCBS, families, providers and advocates — can share thoughts on the waiver amendments and proposed changes. They can submit feedback by mail or email.
- Once the public comment period ends, Iowa DHHS will review all the input. DHHS may revise parts of the waiver applications based on feedback.
DHHS will not respond to each individual question but will summarize the public feedback and explain any response to the comments. DHHS will send this summary to CMS along with the new HOME waiver applications. CMS will either approve the changes or ask for updates. If needed, DHHS will make further changes and send the waiver applications back to CMS for final approval.
While CMS conducts its review of the new HOME waiver applications, DHHS will continue its efforts to align systems and processes in preparation for a smooth launch of the new HOME waivers.
How to participate
In order to help DHHS better understand your point of view, public comments should:
- Suggest changes, identify challenges or highlight positive elements in the proposed new waivers
- Be clear and specific
- Provide an example and explanation for why the change matters to you
- Focus on what is most important for you, families or your community
The public comment period is open from Monday, Jan. 12, 2026, through Friday, Feb. 13, 2026, at 11:59 p.m. CST.
DHHS has extended the public comment period from the usual 30 days to five weeks to give Iowans more time to share their thoughts. Comments can be emailed or sent by mail.
Email comments can be sent to [email protected] with the subject line, “HCBS new HOME Waivers.”
Comments can also be mailed to the Long-Term Services and Supports (LTSS) Policy Team at this address:
Iowa Department of Health and Human Services
Iowa Medicaid
312 East 12th Street
Des Moines, IA 50319