How to Pay for In-Home Care
How to Pay for Home Care in Iowa
Jump to a state to see its Medicaid programs, waivers, and other ways to help pay for in-home care.
This directory lists Iowa-specific and federal payment sources that can pay for, reimburse, offset, or help plan for home care. Some are direct payment sources; others are indirect supports that reduce the amount of private home care a family must buy. Iowa's strongest state-specific pathways include the Elderly Waiver with Attendant Care, the Consumer Choice Option (CCO) self-direction budget, PACE in participating counties, State Supplementary Assistance, Money Follows the Person transition funding, and AAA/ADRC caregiver and in-home supports, and VA benefits are broken out because they can be one of the strongest payment pathways for eligible Iowa veterans and surviving spouses.
Updated August 2026
Reviewed by Valerie VanBooven, RN, BSN
Iowa Medicaid / Older Adults
Elderly (E) Waiver
YesHelps pay for: Medicaid HCBS alternative to nursing-facility care for adults 65+; can authorize a broad package of in-home and community supports.
Who qualifies: Age 65+; Medicaid financial eligibility; nursing-facility level of care; assessed need and an approved person-centered plan. Waiting-list/capacity rules may apply.
How to start: Apply for Medicaid/HCBS and request Elderly Waiver screening through HHS/MCO or ADRC.
Good to know: Family caregiver payment: Sometimes
Iowa Medicaid / Elderly Waiver
Elderly Waiver Attendant Care (formerly CDAC)
YesHelps pay for: Hands-on and supportive assistance with ADLs/IADLs and other authorized tasks that help a member remain at home.
Who qualifies: Must be enrolled in the Elderly Waiver and have attendant care authorized in the plan; worker qualification, EVV and service limits apply.
How to start: Ask the case manager/MCO to assess attendant-care need and discuss agency vs. self-directed delivery.
Good to know: Family caregiver payment: Yes, subject to worker/relationship rules
Home Maintenance Support / Homemaker & Chore
Yes / supportiveHelps pay for: Help with essential household tasks such as cleaning, shopping, meal-related tasks and heavier chores when authorized.
Who qualifies: Elderly Waiver eligibility and assessed need; current service definitions/rules apply.
How to start: Ask the case manager to include appropriate home-maintenance supports in the plan.
Good to know: Family caregiver payment: Potentially through self-direction
Elderly Waiver Respite
Yes - respiteHelps pay for: Short-term relief for an unpaid caregiver through authorized respite services.
Who qualifies: Elderly Waiver eligibility, caregiver need and plan authorization; provider rules apply.
How to start: Ask the case manager/AAA about waiver respite and backup-care options.
Good to know: Family caregiver payment: No direct ongoing wage
Elderly Waiver Adult Day Care
Offsets care costHelps pay for: Daytime supervision, activities and assistance that may reduce the number of paid in-home hours needed.
Who qualifies: Elderly Waiver eligibility, assessed need, service authorization and provider availability.
How to start: Ask the case manager about adult day care under the waiver.
Good to know: Family caregiver payment: No
Elderly Waiver Home-Delivered Meals
Offsets care costHelps pay for: Meal delivery can reduce food costs and caregiver time spent shopping/cooking when included in the service plan.
Who qualifies: Elderly Waiver eligibility and plan authorization; service frequency is based on assessed need.
How to start: Ask the case manager whether home-delivered meals can be authorized.
Good to know: Family caregiver payment: No
Home & Vehicle Modification / Assistive Devices
Offsets care costHelps pay for: Can help pay for approved accessibility modifications and assistive devices that support safe community living.
Who qualifies: Elderly Waiver eligibility; item/project must meet waiver definitions, need and authorization requirements.
How to start: Discuss accessibility barriers before purchasing or starting construction.
Good to know: Family caregiver payment: No
Personal Emergency Response (PERS)
Offsets care costHelps pay for: Emergency response technology can support independent living and may reduce supervision needs.
Who qualifies: Elderly Waiver eligibility and plan authorization.
How to start: Ask the case manager whether PERS is appropriate and covered.
Good to know: Family caregiver payment: No
Companion / Senior Companion
Yes / supportiveHelps pay for: Companion-type support can provide supervision, social support and selected assistance under current waiver definitions.
Who qualifies: Elderly Waiver eligibility, assessed need and authorized service plan.
How to start: Ask the case manager about companion services and current provider options.
Good to know: Family caregiver payment: Potentially, subject to worker rules
Elderly Waiver Transportation
Offsets care costHelps pay for: Non-medical transportation under the waiver can reduce caregiver driving burden for approved community activities.
Who qualifies: Elderly Waiver eligibility and service-plan authorization; medical transportation is handled separately.
How to start: Ask the case manager which transportation benefit fits the trip.
Good to know: Family caregiver payment: No
Iowa Medicaid / Self-Direction
Consumer Choice Option (CCO)
YesHelps pay for: Self-directed HCBS option giving a member control over a targeted Medicaid budget to directly hire employees and purchase approved goods/services.
Who qualifies: Must be enrolled in an HCBS waiver and choose CCO; an approved budget is required and a Financial Management Service pays workers.
How to start: Tell the case manager/MCO you want to explore CCO; select an Independent Support Broker if desired.
Good to know: Family caregiver payment: Yes, subject to rules
CCO Paid Family Caregiver Pathway
YesHelps pay for: CCO can allow qualified relatives to be hired as paid support workers when program and waiver rules are met. Iowa has also authorized parent-of-minor or spouse payment in extraordinary circumstances for specified waiver services.
Who qualifies: Relationship restrictions, background checks, service definitions, budget limits and extraordinary-circumstance approval may apply; never assume a spouse/parent can be paid without written approval.
How to start: Ask the case manager/MCO to verify the proposed worker relationship before employment paperwork is completed.
Good to know: Family caregiver payment: Yes, case-specific
Iowa Medicaid / HCBS
Agency Attendant Care
YesHelps pay for: An enrolled agency can provide attendant-care staff for approved HCBS waiver services without the member serving as the direct employer.
Who qualifies: Waiver eligibility, assessed need, agency enrollment and service authorization apply.
How to start: Ask the case manager/MCO for enrolled attendant-care agencies.
Good to know: Family caregiver payment: Possibly if agency hires relative
Iowa Medicaid / Transition
Former Individual CDAC (ICDAC) - Transitioned to CCO/Agency
Historical / transitionHelps pay for: Iowa ended the former individual CDAC provider model effective December 31, 2025; affected members were required to move to CCO or an agency provider.
Who qualifies: Do not start a new plan around the former ICDAC model; use CCO or agency attendant care under current rules.
How to start: Ask the case manager/MCO which current attendant-care delivery option applies.
Good to know: Family caregiver payment: No new ICDAC enrollment
Money Follows the Person (MFP)
Offsets transition/care costHelps pay for: Provides transition services and enhanced supports during the first year after eligible institutional residents move into the community.
Who qualifies: Current program targets eligible people with intellectual disability or brain injury and may include some nursing-facility/other institutional residents; qualifying stay and transition criteria apply.
How to start: Ask the facility/case manager or Iowa HHS MFP team about transition eligibility.
Good to know: Family caregiver payment: No direct ongoing wage
Iowa Medicaid / Integrated Care
PACE
YesHelps pay for: Combines Medicare/Medicaid medical care, long-term care and prescription coverage to help qualifying adults age 55+ remain in the community.
Who qualifies: Age 55+; nursing-facility level of care; live in a participating PACE service area; able to live safely in the community with PACE support.
How to start: Contact a PACE organization serving the county or Iowa Medicaid Member Services.
Good to know: Family caregiver payment: No direct cash
Iowa Medicaid / Disability Waiver
Health and Disability (HD) Waiver
YesHelps pay for: Current waiver for qualifying people who are blind or disabled and under 65; includes attendant care, respite, home health, meals, modifications and other supports.
Who qualifies: Medicaid eligibility, waiver level of care and current HD rules; scheduled for transition into HOME age-based waivers beginning October 2026.
How to start: Apply through HHS/MCO and request HCBS waiver screening.
Good to know: Family caregiver payment: Sometimes through CCO
Brain Injury (BI) Waiver
YesHelps pay for: HCBS for people with qualifying brain injury; services include attendant care, respite, supported community living, modifications, equipment and behavioral supports.
Who qualifies: Qualifying brain injury, Medicaid/waiver eligibility, level of care and approved plan; waitlist may apply.
How to start: Request BI waiver screening through HHS/MCO.
Good to know: Family caregiver payment: Sometimes through CCO
Intellectual Disability (ID) Waiver
YesHelps pay for: HCBS for people with qualifying intellectual disability; can fund attendant care, supported community living, respite, home health, nursing, modifications and more.
Who qualifies: Qualifying intellectual disability, Medicaid/waiver eligibility, level of care and plan; waitlist may apply.
How to start: Request ID waiver screening through HHS/MCO.
Good to know: Family caregiver payment: Sometimes through CCO
Physical Disability (PD) Waiver
YesHelps pay for: Current waiver for adults 18-64 with qualifying physical disability; includes attendant care, modifications, PERS, equipment and transportation.
Who qualifies: Age 18 to under 65, qualifying disability, Medicaid/waiver eligibility and approved plan; scheduled for HOME transition beginning October 2026.
How to start: Request PD waiver screening through HHS/MCO.
Good to know: Family caregiver payment: Sometimes through CCO
AIDS/HIV (AH) Waiver
YesHelps pay for: Current HCBS waiver for people diagnosed with AIDS or HIV; can include attendant care, homemaker, home health aide, meals, nursing and respite.
Who qualifies: Qualifying diagnosis plus Medicaid/waiver eligibility and approved service plan; scheduled for HOME transition beginning October 2026.
How to start: Request waiver screening through HHS/MCO.
Good to know: Family caregiver payment: Sometimes through CCO
Iowa Medicaid / Children
Children’s Mental Health (CMH) Waiver
Yes / supportiveHelps pay for: HCBS for children with serious emotional disturbance; may fund family/community support, in-home family therapy, respite and adaptive supports.
Who qualifies: Child meets CMH clinical/level-of-care and Medicaid waiver criteria; scheduled for HOME transition beginning October 2026.
How to start: Apply through HHS/MCO and request CMH waiver screening.
Good to know: Family caregiver payment: Limited; service-specific
Private Duty Nursing / Personal Cares (EPSDT)
Yes - skilled/personal careHelps pay for: In-home private duty nursing and personal care for medically eligible children through age 20, delivered by Medicare-certified home health agencies.
Who qualifies: EPSDT program; prior authorization, physician certification and medical necessity required; up to 16 hours/day may be authorized based on need.
How to start: Ask the child’s clinician/MCO about PDN/Personal Cares authorization.
Good to know: Family caregiver payment: No
Iowa Medicaid / System Change
HOME Waiver Redesign - October 2026 Transition
YesHelps pay for: Iowa plans two new age-based waivers—Children and Youth and Adults with Disabilities—while keeping the Elderly Waiver. First-phase transitions are planned for October 1, 2026.
Who qualifies: As of August 2026 this is an active transition. HD, PD, HIV/AIDS and CMH members are planned to move first; follow HHS notices for final implementation details and member-specific timing.
How to start: Ask the case manager how HOME affects the member’s current waiver and assessment.
Good to know: Family caregiver payment: Self-direction remains available
Iowa Medicaid / Mental Health
1915(i) Habilitation Services
Yes / supportiveHelps pay for: State-plan HCBS for Iowans with long-term mental health challenges; supports independent living through case management, home-based habilitation, day habilitation and employment services.
Who qualifies: Must meet Habilitation program needs-based, financial and clinical criteria; not the same as a 1915(c) waiver.
How to start: Ask Medicaid/MCO or disability-services staff for Habilitation eligibility screening.
Good to know: Family caregiver payment: Service-specific
Iowa Medicaid / Habilitation
Home-Based Habilitation
Yes / supportiveHelps pay for: Skill-building and support in the person’s home/community for qualifying Habilitation members, helping with daily living, social and coping skills.
Who qualifies: Habilitation eligibility, assessed need and authorized plan; providers must meet current certification requirements.
How to start: Ask the case manager/MCO about home-based habilitation providers.
Good to know: Family caregiver payment: Possibly through approved provider arrangements
Iowa Medicaid / Residential Support
Supported Community Living / Host Home
Yes / supportiveHelps pay for: Supported Community Living can help eligible BI/ID waiver members live in the community; a Host Home is an agency-supported model where the host lives with the member and provides authorized supports.
Who qualifies: Waiver/service eligibility, provider certification and setting rules apply; a family home is generally not considered a Host Home, although SCL may be delivered in the family home under separate rules.
How to start: Discuss SCL and Host Home options with the case manager/provider agency.
Good to know: Family caregiver payment: A relative may sometimes be paid under provider rules
Iowa Medicaid / Medical
Medicaid Home Health Services
Yes - skilled careHelps pay for: In-home skilled nursing, home health aide and therapy services through Medicare-certified home health agencies when medically necessary.
Who qualifies: Medicaid eligibility, medical need, face-to-face certification and plan of care; Medicaid does not cover needs that can be met by unpaid resources.
How to start: Ask the treating clinician and Medicaid/MCO about a home-health referral.
Good to know: Family caregiver payment: No
Iowa Medicaid / End of Life
Medicaid Hospice
Yes - hospiceHelps pay for: Hospice can be provided in the home for qualifying full-Medicaid members with a terminal illness and includes nursing, hospice aide, homemaker, respite and other end-of-life services.
Who qualifies: Terminal illness with physician certification of six months or less if illness follows its normal course; hospice election and plan requirements apply.
How to start: Ask the physician/MCO or a Medicaid hospice provider for evaluation.
Good to know: Family caregiver payment: No
Iowa Medicaid / Transportation
Non-Emergency Medical Transportation (NEMT)
Offsets care costHelps pay for: Eligible full-benefit Medicaid members may receive rides to routine medical appointments or reimbursement of certain travel expenses.
Who qualifies: Coverage depends on Medicaid eligibility/program; some Iowa Health and Wellness Plan transportation rules differ.
How to start: Call Member Services/MCO before the trip to arrange approved transportation.
Good to know: Family caregiver payment: No
Iowa Medicaid / Eligibility Planning
Medical Assistance Income Trust (MAIT)
Unlocks Medicaid LTSSHelps pay for: A qualifying income trust can help some people with income above the usual Medicaid LTSS limit qualify for Medicaid payment of long-term services and supports.
Who qualifies: Strict trust, income, eligibility and administration rules apply; this is not a general-purpose trust.
How to start: Ask HHS/elder-law counsel about MAIT before moving or spending income.
Good to know: Family caregiver payment: No
Iowa State / Cash & In-Home Support
State Supplementary Assistance - In-Home Health-Related Care
Cash/supportiveHelps pay for: State-funded SSA can help eligible aged, blind or disabled Iowans with approved in-home health-related care needs that are not met by the basic SSI benefit.
Who qualifies: Must meet SSA eligibility and category-specific standards; services/providers must meet Iowa requirements.
How to start: Apply through Iowa HHS and ask specifically about In-Home Health-Related Care assistance.
Good to know: Family caregiver payment: Potentially, depending on approved arrangement
Iowa State / Family Care
State Supplementary Assistance - Family Life Home
Direct family paymentHelps pay for: SSA includes Family Life Home assistance. Effective January 1, 2026, the published standard lists a $1,026 “Payment to Family” plus a personal-needs allowance.
Who qualifies: SSA eligibility and Family Life Home rules must be met; payment is not an automatic caregiver stipend for every family member.
How to start: Ask Iowa HHS whether the person qualifies for the Family Life Home category.
Good to know: Family caregiver payment: Yes, in approved Family Life Home arrangement
Iowa Medicaid / Working Disabled
Medicaid for Employed People with Disabilities (MEPD)
Offsets health/care costsHelps pay for: Allows some working Iowans with disabilities to keep Medicaid coverage, which can preserve access to medical and qualifying HCBS while earning wages.
Who qualifies: Disability, employment, income/resource and premium rules apply; Iowa proposed premium-schedule updates in 2026.
How to start: Apply through Iowa HHS and ask about MEPD eligibility.
Good to know: Family caregiver payment: No
Medicare Cost Reduction
Qualified Medicare Beneficiary (QMB)
Offsets household/medical costHelps pay for: Can pay Medicare Part A/B premiums and Medicare deductibles/coinsurance for qualifying low-income beneficiaries, preserving income for care.
Who qualifies: Must have/qualify for Medicare Part A and meet current Iowa income/resource limits.
How to start: Apply through HHS or get free help from SHIIP-SMP.
Good to know: Family caregiver payment: No
Specified Low-Income Medicare Beneficiary (SLMB)
Offsets household/medical costHelps pay for: Pays the Medicare Part B premium for qualifying beneficiaries, freeing monthly income for care expenses.
Who qualifies: Meet Medicare and current Iowa income/resource limits.
How to start: Apply through HHS or SHIIP-SMP.
Good to know: Family caregiver payment: No
Expanded SLMB / Other Medicare Savings Help
Offsets household/medical costHelps pay for: Iowa offers additional Medicare Savings assistance above the SLMB level and QDWP for a narrow group of working people with disabilities.
Who qualifies: Program-specific Medicare, income and resource rules apply and limits change annually.
How to start: Ask SHIIP-SMP to screen for all Medicare Savings Programs and Extra Help.
Good to know: Family caregiver payment: No
Iowa Aging / Navigation
Aging & Disability Resource Center (ADRC) / Iowa Compass
Navigation / accessHelps pay for: No-Wrong-Door navigation connecting older adults and people with disabilities to AAAs, disability access points, Medicaid/waiver screening and local supports.
Who qualifies: Open information/referral service; program eligibility is determined by the receiving benefit.
How to start: Call the statewide ADRC line and ask for options counseling.
Good to know: Family caregiver payment: No
Iowa Aging / In-Home Services
AAA Homemaker, Personal Care & Chore Supports
Yes / subsidizedHelps pay for: Local aging programs may subsidize homemaker, personal care, chore assistance, material aid and related supports to help older adults remain independent.
Who qualifies: Generally aimed at adults 60+; assessment, local funding, priority and cost-share policies vary by AAA.
How to start: Contact the local Area Agency on Aging through the ADRC.
Good to know: Family caregiver payment: Usually no direct wage
Iowa Aging / Caregiver Support
Family Caregiver Support & Respite
Partial / respiteHelps pay for: AAAs provide caregiver information, counseling, support groups, respite navigation and help finding resources to pay for respite.
Who qualifies: Caregiver/care-recipient eligibility follows Older Americans Act and local program rules; funding varies.
How to start: Contact the local AAA and request a caregiver-support assessment.
Good to know: Family caregiver payment: No continuous caregiver wage
Iowa Aging / Nutrition
Home-Delivered Meals
Offsets care costHelps pay for: Local aging nutrition programs provide meals and safety/social contact for eligible homebound older adults, reducing food costs and caregiver meal-preparation time.
Who qualifies: Generally age 60+ with local assessment/priority criteria; availability varies by area.
How to start: Contact the local AAA or nutrition provider.
Good to know: Family caregiver payment: No
Congregate Meals
Offsets household costHelps pay for: Community meal programs provide nutritious meals and socialization for older adults, reducing food costs and isolation.
Who qualifies: Generally age 60+; local sites and eligibility rules apply.
How to start: Contact the local AAA for meal sites.
Good to know: Family caregiver payment: No
Iowa Aging / Transportation
AAA Assisted Transportation / Transportation
Offsets care costHelps pay for: Local aging programs can subsidize transportation and assisted transportation, reducing caregiver driving burden.
Who qualifies: Generally age 60+; local service area, assessment and funding rules apply.
How to start: Ask the local AAA about general and assisted transportation.
Good to know: Family caregiver payment: No
Iowa Aging / Home Safety
AAA Material Aid / Home Modification Support
Offsets care costHelps pay for: Local aging services may provide or help obtain limited items such as grab bars, smoke detectors, medical equipment or ramps.
Who qualifies: Availability and amount depend on local funding, assessment and program priorities.
How to start: Ask the local AAA about material aid/home-safety resources before purchasing.
Good to know: Family caregiver payment: No
Food Cost Reduction
Commodity Supplemental Food Program (CSFP)
Offsets household costHelps pay for: Provides supplemental foods and nutrition education at no cost for qualifying adults age 60+ in participating Iowa service areas.
Who qualifies: Age 60+ plus income and service-area requirements; current Iowa coverage is limited to specified counties.
How to start: Check Iowa HHS CSFP service-area and application information.
Good to know: Family caregiver payment: No
Senior Farmers Market Nutrition / Local Produce Benefits
Offsets household costHelps pay for: Seasonal senior nutrition benefits and local produce programs can reduce food spending, preserving cash for care.
Who qualifies: Age, income, seasonal funding and local participation rules apply.
How to start: Ask the local AAA about current Senior Farmers Market Nutrition availability.
Good to know: Family caregiver payment: No
SNAP
Offsets household costHelps pay for: Monthly food benefits can reduce household grocery spending and preserve income for home-care expenses.
Who qualifies: Income, household and other SNAP eligibility rules apply.
How to start: Apply through Iowa HHS benefits portal or local office.
Good to know: Family caregiver payment: No
Medicare Counseling
Iowa SHIIP-SMP
Offsets medical/household costHelps pay for: Free, objective and confidential Medicare counseling; can screen for Medicare Savings Programs, Extra Help and plan choices.
Who qualifies: Available to Medicare beneficiaries, families and caregivers; benefit eligibility varies.
How to start: Call SHIIP-SMP or find a local counselor.
Good to know: Family caregiver payment: No
Energy Cost Reduction
LIHEAP
Offsets household costHelps pay for: One-time seasonal heating assistance for qualifying low-income Iowa households can preserve income for care.
Who qualifies: Income, household and program-season rules apply; administered locally through community action agencies.
How to start: Apply through the local community action agency.
Good to know: Family caregiver payment: No
Home Cost Reduction
Iowa Weatherization Assistance Program
Offsets household costHelps pay for: Energy-efficiency improvements can reduce heating/cooling costs for qualifying low-income households, especially older adults and people with disabilities.
Who qualifies: Income and housing eligibility; funding is limited and eligible demand exceeds annual capacity.
How to start: Apply through Iowa’s Weatherization/LIHEAP network.
Good to know: Family caregiver payment: No
Property Tax Relief
Iowa Property Tax Credit for Senior & Disabled Citizens
Offsets household costHelps pay for: Property-tax or rent-related relief for qualifying older or totally disabled Iowans can preserve cash for care.
Who qualifies: Age 65+ or totally disabled plus annual household-income rules; filing deadlines apply.
How to start: File with the county treasurer using the current Iowa claim form.
Good to know: Family caregiver payment: No
Iowa 65+ Homestead Exemption
Offsets household costHelps pay for: Eligible homeowners age 65+ receive an additional homestead exemption; 2026 law also converted the general homestead credit to a percentage-based exemption.
Who qualifies: Must own/occupy a qualifying homestead and meet filing/age rules.
How to start: File the homestead exemption form with the county assessor if needed.
Good to know: Family caregiver payment: No
Veteran Cost Offset
Iowa Disabled Veteran Homestead Property Tax Credit
Offsets household costHelps pay for: Qualifying disabled veterans and certain surviving spouses may receive a credit equal to the entire property tax levied on the qualifying homestead.
Who qualifies: Qualifying service-connected disability/DIC and ownership/occupancy/documentation requirements apply; 2026 acreage rules changed for new applicants after July 1.
How to start: Apply with the county assessor by the applicable deadline.
Good to know: Family caregiver payment: No
Private Insurance
Iowa Long-Term Care Insurance Partnership
Yes, policy-dependentHelps pay for: Partnership-qualified LTC insurance may pay for home care and can provide Medicaid asset-disregard protection equal to qualifying benefits paid.
Who qualifies: Must own a qualifying partnership policy and satisfy its benefit triggers, elimination period and coverage terms.
How to start: Review policy with insurer/SHIIP and confirm partnership status before relying on asset protection.
Good to know: Family caregiver payment: Yes, if policy permits
Traditional Long-Term Care Insurance
Yes, policy-dependentHelps pay for: Existing LTC insurance may reimburse home care, personal care, respite or other covered services after benefit triggers and elimination periods are met.
Who qualifies: Coverage depends entirely on policy language, benefit trigger, daily/monthly limits, inflation protection and exclusions.
How to start: Request the policy and claim packet; confirm home-care definitions and licensed-provider requirements.
Good to know: Family caregiver payment: Possibly
Medicare
Medicare Home Health
Yes - limited skilled/home healthHelps pay for: Medicare can cover intermittent skilled nursing, therapy and qualifying home health aide services when federal eligibility requirements are met.
Who qualifies: Must meet Medicare home-health eligibility, need part-time/intermittent skilled services and use a Medicare-certified agency.
How to start: Ask the treating clinician for a home-health order/certification.
Good to know: Family caregiver payment: No
Medicare Caregiver Training Services
Offsets care costHelps pay for: Medicare may cover training for caregivers who help with a beneficiary’s treatment plan, which can reduce paid training/support needs.
Who qualifies: Training must be medically necessary and ordered/connected to the beneficiary’s treatment; Medicare coverage rules apply.
How to start: Ask the treating clinician whether caregiver training can be billed to Medicare.
Good to know: Family caregiver payment: No direct wage
Medicare / Dementia
GUIDE Model Dementia Care
Offsets care cost / respiteHelps pay for: Participating GUIDE organizations provide coordinated dementia care, caregiver education/support and may offer respite benefits for eligible beneficiaries.
Who qualifies: Beneficiary must meet GUIDE eligibility and receive care from a participating GUIDE organization; availability is organization/service-area specific.
How to start: Use CMS GUIDE resources or ask the clinician/AAA about participating organizations.
Good to know: Family caregiver payment: No direct wage
Prescription Cost Reduction
Medicare Part D Extra Help
Offsets household costHelps pay for: Federal subsidy can reduce Part D premiums, deductibles and prescription copays, preserving income for care.
Who qualifies: Medicare and income/resource rules apply; some people qualify automatically through Medicaid/MSP.
How to start: Apply through Social Security or ask SHIIP-SMP for help.
Good to know: Family caregiver payment: No
Home Equity / Private Pay
Reverse Mortgage / HECM
Cash / indirectHelps pay for: Eligible older homeowners may convert home equity to cash that can be used for home care, subject to loan costs and repayment obligations.
Who qualifies: Generally homeowner age 62+ for FHA HECM; counseling, equity, occupancy and financial-assessment rules apply.
How to start: Use HUD-approved HECM counseling before committing to a loan.
Good to know: Family caregiver payment: Yes, indirectly
Workers Compensation
Workers Compensation Home / Attendant Care
SometimesHelps pay for: For a qualifying work-related injury, workers-compensation benefits or settlement may cover medically necessary home health or attendant services.
Who qualifies: Must arise from a compensable work injury and be medically/legal authorized under the claim.
How to start: Ask the workers-comp carrier/attorney about attendant-care coverage.
Good to know: Family caregiver payment: Sometimes, case-specific
Auto / Liability
Liability or Accident Settlement
Cash / indirectHelps pay for: Settlement proceeds from an accident or injury may be structured or reserved to pay future home-care expenses.
Who qualifies: Depends on claim, settlement terms, liens and tax/legal issues.
How to start: Coordinate with attorney, insurer and financial adviser before spending settlement funds.
Good to know: Family caregiver payment: Yes, indirectly
VA Benefits
VA Homemaker & Home Health Aide
YesHelps pay for: VA may pay an authorized community aide to help an eligible Veteran with ADLs and selected daily tasks.
Who qualifies: VA enrollment/community-care eligibility, clinical need and local availability; copay may apply.
How to start: Ask VA primary care/social work for assessment and authorization.
Good to know: Family caregiver payment: No
Veteran-Directed Care
YesHelps pay for: Flexible self-directed budget for eligible Veterans needing personal care; workers may include family or neighbors subject to local program rules.
Who qualifies: Enrolled Veteran; community-care eligibility; clinical need; VDC must be available locally.
How to start: Ask the VA social worker specifically about Veteran-Directed Care.
Good to know: Family caregiver payment: Yes
VA Aid & Attendance Pension Add-On
Cash / indirectHelps pay for: Additional monthly VA pension amount for qualifying Veterans/survivors who need help with daily activities or meet other Aid & Attendance criteria; cash can help pay for care.
Who qualifies: Must first qualify for VA Pension and meet Aid & Attendance medical/functional criteria.
How to start: Apply through VA or an accredited representative/VSO.
Good to know: Family caregiver payment: Yes, indirectly
VA Homemaker & Home Health Aide
YesHelps pay for: VA may pay an authorized community aide to help an eligible Veteran with ADLs and selected daily tasks.
Who qualifies: VA enrollment/community-care eligibility, clinical need and local availability; copay may apply. Ask VA primary care/social work for assessment and authorization.
How to start: Ask the VA social worker or care team about VA Homemaker & Home Health Aide.
Good to know: Family caregiver payment: No
Veteran-Directed Care (VDC)
YesHelps pay for: Flexible self-directed budget for eligible Veterans needing personal care; workers may include family or neighbors subject to local program rules.
Who qualifies: Enrolled Veteran; community-care eligibility; clinical need; VDC must be available locally. Ask the VA social worker specifically about Veteran-Directed Care.
How to start: Ask the VA social worker or care team about Veteran-Directed Care (VDC).
Good to know: Family caregiver payment: Yes
VA Skilled Home Health
Yes - skilled careHelps pay for: VA may purchase skilled nursing, therapy and related home-health services from authorized community providers.
Who qualifies: Clinical need, VA eligibility and authorization/local provider availability. Ask the VA care team for skilled home-health assessment/referral.
How to start: Ask the VA social worker or care team about VA Skilled Home Health.
Good to know: Family caregiver payment: No
VA Respite Care
Yes - respiteHelps pay for: VA may arrange in-home, adult-day or nursing-home respite to give an eligible caregiver a break.
Who qualifies: Clinical need, VA enrollment and local availability; authorization may apply. Ask the caregiver support coordinator/social worker.
How to start: Ask the VA social worker or care team about VA Respite Care.
Good to know: Family caregiver payment: No
VA Aid & Attendance
Cash / indirectHelps pay for: Additional pension amount for qualifying Veterans/survivors who need help with daily activities, are bedridden, have severe visual impairment or meet nursing-home criteria.
Who qualifies: Must be eligible for VA Pension and meet Aid & Attendance criteria. Apply through VA or an accredited representative/VSO.
How to start: Ask the VA social worker or care team about VA Aid & Attendance.
Good to know: Family caregiver payment: Yes, indirectly
Program of Comprehensive Assistance for Family Caregivers (PCAFC)
Direct caregiver stipendHelps pay for: May pay an approved primary family caregiver a monthly stipend and provide training, counseling, respite and other supports.
Who qualifies: Veteran and caregiver must meet PCAFC eligibility and complete VA assessment/enrollment. Apply jointly through VA Caregiver Support.
How to start: Ask the VA social worker or care team about Program of Comprehensive Assistance for Family Caregivers (PCAFC).
Good to know: Family caregiver payment: Yes
VA Community Care Network - Region 2
Pays authorized providerHelps pay for: VA-authorized community care can include home health and other approved services. Iowa is in CCN Region 2, administered by Optum.
Who qualifies: VA referral/authorization and community-care eligibility generally apply. Obtain VA authorization before routine community care; do not assume reimbursement after private hire.
How to start: Ask the VA social worker or care team about VA Community Care Network - Region 2.
Good to know: Family caregiver payment: No
VA Pension
Cash / indirectHelps pay for: Monthly needs-based pension for qualifying wartime Veterans with limited income/net worth; pension cash can help fund care.
Who qualifies: Wartime service, age/disability, discharge, income/net-worth and other VA pension rules apply. Apply through VA or an accredited VSO.
How to start: Ask the VA social worker or care team about VA Pension.
Good to know: Family caregiver payment: Yes, indirectly
Home Improvements and Structural Alterations (HISA)
Offsets care costHelps pay for: VA HISA grants may pay for medically necessary home changes that improve access to essential areas or permit treatment at home.
Who qualifies: Eligibility, medical justification, lifetime limit and project requirements apply. Ask VA prosthetics/primary care about HISA before construction.
How to start: Ask the VA social worker or care team about Home Improvements and Structural Alterations (HISA).
Good to know: Family caregiver payment: No
VA Adult Day Health Care
Offsets care cost / day careHelps pay for: VA may provide or purchase adult day health services, including supervision, activities and health-related care, reducing in-home caregiver hours.
Who qualifies: VA enrollment, clinical need and local availability/authorization. Ask the VA social worker or geriatric care team.
How to start: Ask the VA social worker or care team about VA Adult Day Health Care.
Good to know: Family caregiver payment: No
VA Hospice & Palliative Care
Yes - hospice/palliativeHelps pay for: VA can provide or purchase hospice/palliative services, including symptom management and caregiver support in the home or other settings.
Who qualifies: VA enrollment, clinical criteria and care-team authorization. Ask VA physician/social worker for palliative or hospice evaluation.
How to start: Ask the VA social worker or care team about VA Hospice & Palliative Care.
Good to know: Family caregiver payment: No
Program of General Caregiver Support Services (PGCSS)
Support / respite navigationHelps pay for: Provides education, coaching, peer support, respite/navigation and other support for family caregivers of enrolled Veterans without requiring PCAFC stipend eligibility.
Who qualifies: Caregiver supports an eligible Veteran enrolled in VA health care; specific services vary. Contact VA Caregiver Support.
How to start: Ask the VA social worker or care team about Program of General Caregiver Support Services (PGCSS).
Good to know: Family caregiver payment: No direct stipend
Where Iowa Families Can Start
Not sure where to begin? Match your situation to a contact below.
Best first call for aging, disability, caregiver and long-term-care options; connects to AAAs and Disability Access Points
Iowa ADRC / Iowa Compass
Medicaid eligibility, HCBS waivers, PACE, LTSS and managed-care questions
Iowa Medicaid Member Services
Elderly, HD, BI, ID, PD, HIV/AIDS and CMH waiver screening and service-plan questions
HCBS Waiver / Case Manager or MCO
Self-direction, individual budgets, hiring workers and Financial Management Service questions
Consumer Choice Option (CCO)
Current attendant-care provider enrollment/form questions
Attendant Care Provider Enrollment
Institution-to-community transition planning and enhanced first-year supports
Money Follows the Person
Integrated medical + LTSS program for eligible adults 55+ in participating counties
Iowa PACE
Caregiver support, homemaker/personal care, meals, transportation, material aid and respite navigation
Iowa Area Agencies on Aging
Free Medicare counseling, MSP/Extra Help screening and plan questions
Iowa SHIIP-SMP
SNAP, State Supplementary Assistance, LIHEAP, weatherization and other assistance
Iowa HHS Assistance Programs
Senior/disabled property-tax credit, homestead exemption and disabled-veteran credit questions
Iowa Department of Revenue
PCAFC, PGCSS, respite, VDC navigation and caregiver resources
VA Caregiver Support
Before You Rely on Any Payment Source
Planning Point
Why It Matters
Elderly Waiver is the first Medicaid HCBS screen for many adults 65+
Iowa’s Elderly Waiver can authorize attendant care, respite, meals, home/vehicle modifications, PERS, companion and other supports when nursing-facility level of care and Medicaid rules are met.
CCO is Iowa’s central self-directed paid-worker route
CCO lets an eligible waiver member control an individual Medicaid budget and directly hire employees, with a Financial Management Service handling payroll.
Family caregiver payment is possible, but relationship rules matter
Qualified relatives may be paid under CCO/current HCBS rules. Spouses and parents of minors are not automatically eligible; Iowa has allowed payment in extraordinary circumstances for specified services/waivers, so written case-manager/MCO approval is essential.
The old individual CDAC model is no longer a new option
ICDAC ended December 31, 2025. New planning should use CCO or an agency attendant-care provider rather than relying on older CDAC guidance.
Iowa is in an active waiver redesign in 2026
The HOME project plans Children and Youth and Adults with Disabilities waivers, while retaining the Elderly Waiver. The first transition phase is scheduled for October 1, 2026 and includes HD, PD, HIV/AIDS and CMH members.
Money Follows the Person is transition funding, not a permanent stand-alone care benefit
MFP can help eligible institutional residents move to the community and fund enhanced first-year supports; ongoing services generally need to be sustained through Medicaid HCBS or other benefits.
State Supplementary Assistance is unusually relevant in Iowa
SSA includes In-Home Health-Related Care and Family Life Home categories; the 2026 standards specifically list a “Payment to Family” under Family Life Home, but the arrangement must meet SSA rules.
PACE depends heavily on county/service-area availability
A person can meet age and nursing-facility level-of-care criteria but still be ineligible if no PACE organization serves the home address.
AAA programs are useful gap-fillers, not guaranteed entitlements
Homemaker, personal care, respite, meals, transportation and material aid are valuable, but local assessment, priority, funding and cost-share policies can limit availability.
Medicaid estate recovery belongs in the planning conversation
Iowa may seek recovery of certain Medicaid costs after death, including some managed-care capitation payments; families using LTSS should understand estate-recovery and hardship rules before transferring assets.
Do not confuse Medicaid home health with long-term custodial home care
Iowa Medicaid home health is medically necessary skilled/aide care through certified agencies and expressly excludes needs that can be met by unpaid resources; long-term personal assistance is usually a waiver/attendant-care question.
VA and Iowa benefits can sometimes be layered, but authorization comes first
Veterans may have VA VDC, Homemaker/Home Health Aide, Aid & Attendance or PCAFC options alongside Iowa programs. Avoid duplicate payment for the same service/time and obtain required VA/Medicaid authorization before hiring privately.
Program rules, income limits, and availability change over time and can vary by county. Confirm current details with the program directly, or ask a home care provider in Iowa to help you navigate the application process.
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