Medicaid for nursing home and home care in Iowa

Who qualifies

Iowa HHS looks at three things: your need for care, your income, and your assets.

• Need for care: You must need the level of care a nursing facility gives. An assessor does a Level of Care assessment after you apply.
• Age or disability: For nursing home Medicaid you must be 65 or older, blind, or disabled. The Elderly Waiver is for people 65 and older.
• Length of stay: The rules that protect a spouse apply when you are expected to stay in a facility for 30 days in a row or more.

If your income is over the limit

You can still qualify by setting up a Medical Assistance Income Trust. This is a trust that cannot be undone. Only your income goes into it, and the State of Iowa is paid back from what is left in it after you die, up to what Medicaid paid. Income that goes into a trust that meets the rules does not count. Income paid out of the trust does count. If your total income is so high that it is more than 125% of the statewide average charge for nursing home care, you cannot get facility Medicaid even with a trust.

What counts and what does not

Income

Iowa counts your gross income for the month, before anything is taken out. That includes Social Security (before the Medicare premium is taken out), pensions and other payments. Some small items are not counted, such as $20 of income each month.

Assets

Iowa does not count:

• Your home and the land around it (but see the home equity limit above)
• One vehicle, whatever its value
• Household goods and personal things
• Burial spaces
• Burial funds up to $1,500, made smaller by some life insurance and burial contracts
• Life insurance with a total face value of $1,500 or less for each spouse

Money in checking and savings, stocks and most other property counts.

What a spouse at home can keep

If you are married and your spouse stays at home, Iowa adds up what you both own on the first day of the month you entered the facility (or met level of care for the Elderly Waiver). Your spouse can keep half, but no less than $32,532 and no more than $162,660.

Your spouse can also get part of your income, so that their own income reaches $4,066.50 a month. Money can also be set aside for a dependent family member who lives with your spouse.

What you pay toward your care

In a nursing home, you keep $50 a month for personal needs, plus $65 more if you have earnings. After money for your spouse, dependents and health insurance premiums, the rest of your income goes to the nursing home. This is called your client participation.

Help at home: the Elderly Waiver and PACE

The Elderly Waiver pays for services that help you stay at home. They include case management, adult day care, assisted living services, attendant care, home-delivered meals, home health aide services, home and vehicle changes, personal emergency response, respite, transportation and more. Some services can be self-directed, so you choose your own worker.

• You must be 65 or older, eligible for Medicaid, and need nursing-home-level care.
• Income must be under $2,982 a month and assets under $2,000.
• As of January 2026, there was no waiting list, but Iowa HHS says this could change.

PACE covers all your medical and long-term care through one team, for people 55 and older in some parts of Iowa. See all benefits in Iowa for the areas served.

How to apply

1. Fill out the Application for Health Coverage and Help Paying Costs (form 470-5170). You can apply online at the Iowa HHS Benefits Portal (hhsservices.iowa.gov), get a form at a local Iowa HHS office, or apply by phone at 1-855-889-7985.
2. Say what help you need. For a nursing home, write "NURSING FACILITY MEDICAID" on page 1. For the Elderly Waiver, in Appendix A (form 470-5433) check "Services to remain in your home" and the Elderly waiver.
3. Send it in. Paper forms for nursing home Medicaid go to the HHS Centralized Facility Eligibility Unit: Imaging Center 1, Iowa Department of Health and Human Services, 417 E Kanesville Blvd, Council Bluffs, IA 51503. Fax: 515-564-4040.
4. Send proof. Include your Medicare card, Social Security numbers, proof of income and assets, health insurance policy numbers, and power of attorney papers if someone signs for you. If you get VA benefits, a VA release form is needed. If you are married, a form about your resources when you entered the facility (470-2577) may be needed.
5. Level of care. The nursing home or an assessor completes the level of care form.

Start early. The process can take time. If you need more time to send papers, contact your Iowa HHS worker before the due date.

After you apply

• Report changes. Tell Iowa HHS when your income, expenses or living situation changes. Your share of the nursing home cost is updated when your income changes.
• Appeals. You have 90 calendar days from the date of a Medicaid decision to appeal. To keep your benefits during the appeal, file within 10 days of getting the notice. Appeal online at hhs.iowa.gov/programs/appeals, by mail to HHS, Appeals Bureau, 321 E. 12th St., Des Moines, IA 50319, in person, or by phone. HHS Appeals: 1-888-723-9637. A judge holds a hearing, often by phone.

Things people miss

• Gifts can delay coverage. Iowa looks back 60 months for gifts or sales for less than value. A penalty is figured by dividing the amount given away by the average cost of nursing home care. For applications from July 1, 2026 to June 30, 2027, that is $9,838.96 a month.
• The home counts in a gift. Giving your home away can cause a penalty, even though the home does not count while you live in it.
• Married couples should ask about the resource form. If your spouse stays home and Iowa has not yet split your resources, form 470-2577 records what you owned when care began. That date sets what your spouse can keep.

Free help

• LifeLong Links, Iowa's Aging and Disability Resource Center: 866-468-7887. It explains care options and how to pay for them.
• SHIIP (free Medicare counseling): 1-800-351-4664.
• Iowa HHS general line: (800) 972-2017.

For costs Medicare does and does not pay, read paying for a nursing home and Medicare Part A. For other programs, see all benefits in Iowa.

Phone numbers: Free help lines for Iowa agencies

Check what you may qualify for