Iowa home care programs

Home health: the medical benefit

In Iowa, skilled home health is Iowa Medicaid Home Health Agency Services. It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.

Only a licensed home health agency enrolled with Iowa Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating, toileting and household tasks is "home care" or personal care. In Iowa the agency route is Attendant Care (CDAC) — agency model. No skilled need is required; the person qualifies on functional need, usually measured by an assessment of daily activities.

The agency recruits, trains, schedules and pays the aides, and it is the employer. Attendant Care (CDAC) — agency model lets the agency hire a family member as the aide, with the agency still the employer.

Consumer-directed care: the person hires their own aide

Iowa's consumer-directed option is Consumer Choices Option (CCO). The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.

This is the route most families use to be paid: Consumer Choices Option (CCO) allows a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.

Structured family caregiving: a paid live-in family caregiver

Iowa has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (Consumer Choices Option (CCO)), by the hour, as the participant's chosen aide.

Other ways Iowa pays for care at home

Waiver in-home services: Home and Community-Based Services Elderly Waiver and Hope and Opportunity in Many Environments (HOME) — Children and Youth (CY) and Adults with Disabilities (AD) waivers. These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.

PACE: Program of All-Inclusive Care for the Elderly (PACE). One PACE organization covers medical care, a day center and home care for people 55 and over who need nursing-home level care.

State-funded: In-Home Health-Related Care (IHHRC). Paid from state funds outside Medicaid, for people who do not qualify for Medicaid or are waiting for it.

Which one fits

• Needs nursing, wound care, injections or therapy at home: home health (Iowa Medicaid Home Health Agency Services).
• Needs daily help and wants an agency to supply and manage the aide: Attendant Care (CDAC) — agency model.
• Wants to choose the aide, including a relative where allowed: Consumer Choices Option (CCO).
• Meets nursing-home level of care and needs more than personal care: Home and Community-Based Services Elderly Waiver and Hope and Opportunity in Many Environments (HOME) — Children and Youth (CY) and Adults with Disabilities (AD) waivers.