Iowa

What Is Iowa Medicaid Long-Term Care?

Medicaid, also known as Title 19, is a healthcare program designed for low-income individuals of all ages. This guide focuses specifically on long-term care Medicaid eligibility for Iowa seniors aged 65 and older. Beyond nursing home care, Iowa Medicaid also provides services and supports that enable frail seniors to remain at home or in assisted living facilities. There are three primary types of long-term care Medicaid programs available to Iowa seniors.

What Are the Three Types of Iowa Long-Term Care Medicaid?

1) What Is Institutional / Nursing Home Medicaid?

This is an entitlement program, meaning all individuals who meet the eligibility criteria are entitled to receive benefits. Coverage is limited to services provided in nursing homes.

2) What Are Medicaid Waivers / Home and Community Based Services (HCBS)?

These waivers are not entitlements. Enrollment is capped, and waiting lists may exist. Services are aimed at helping seniors delay or avoid institutionalization by receiving care at home, in adult day care centers, or assisted living.

3) What Is Regular Medicaid / Aged Blind and Disabled (ABD)?

Also an entitlement program, this option provides various long-term care services—such as personal assistance or adult day care—for seniors who meet eligibility requirements.

What Are the Income and Asset Limits for Iowa Medicaid Long-Term Care?

Each Medicaid long-term care program has distinct medical and financial eligibility criteria. These requirements can vary depending on marital status, change annually, and offer multiple qualification pathways.

What Are the 2025 Eligibility Requirements for a Single Nursing Home Applicant?

• Monthly income under $2,901
• Assets below $2,000
• Medical need for Nursing Home Level of Care

Even if not all criteria are met, an individual may still qualify through other pathways.

What Are the 2025 Iowa Medicaid Financial Limits for Long-Term Care?

How Is Income Counted for Iowa Medicaid?

What Types of Income Are Counted?

Almost all income types are included, such as wages, pensions, Social Security benefits, annuities, and investment returns. However, specific exclusions exist, like Holocaust restitution payments and additional VA benefits (Aid & Attendance or Housebound).

How Is Income Treated for Married Couples?

For Nursing Home Medicaid or HCBS Waivers, only the applicant’s income is considered. The non-applicant spouse’s income is excluded and they may receive a Monthly Maintenance Needs Allowance (MMNA), up to $3,948/month in 2025. For Regular Medicaid, both spouses’ incomes are combined for eligibility and no MMNA applies.

How Are Assets Counted for Iowa Medicaid?

What Are Countable and Non-Countable Assets?

Countable assets include cash, bank accounts, stocks, bonds, and real estate not used as a primary residence. Exempt assets include personal belongings, household goods, one vehicle, a burial contract, and the applicant’s home (with conditions). 401Ks and IRAs are countable in Iowa.

How Are Assets Treated for Married Couples?

Married couples’ assets are considered jointly owned. For Nursing Home Medicaid and Waivers, a Community Spouse Resource Allowance (CSRA) allows the non-applicant to retain up to $157,920 (or 100% if the share is below $31,584). No CSRA applies to Regular Medicaid.

What Is the Look-Back Period in Iowa?

Iowa enforces a 60-month Medicaid Look-Back Period for Nursing Home Medicaid and Waivers. Asset transfers made during this time are reviewed to prevent gifting or undervalued sales, which can trigger a penalty period of ineligibility. This does not apply to Regular Medicaid.

Note: The federal gift tax exclusion (e.g., $19,000 per recipient in 2025) does not protect against Medicaid look-back violations.

What Are the Home Exemption Rules in Iowa?

A home is exempt if the applicant or their spouse resides in it. If not, the applicant must show “Intent to Return” and not exceed the home equity interest limit of $730,000 (2025). Regular Medicaid does not impose an equity limit. However, Medicaid may recover costs from the estate, including the home, after the beneficiary’s death unless appropriate planning has occurred.

What Are the Medical / Functional Requirements?

Eligibility also depends on functional needs:

• Nursing Home Medicaid and HCBS Waivers require a Nursing Facility Level of Care (NFLOC).
• Regular Medicaid requires assistance with Activities of Daily Living (ADLs) but not necessarily NFLOC.

How Can Iowa Seniors Qualify If They Exceed Income or Asset Limits?

What Is the Medically Needy Pathway?

The “Spenddown” program allows applicants with income above the limit to qualify by spending excess income on medical expenses. In 2025, the income limit is $483/month. Asset limit is $10,000 per household.

What Is a Medical Assistance Income Trust (MAIT)?

MAITs (also called Miller Trusts) allow applicants to place excess income into a restricted, irrevocable trust to qualify for Medicaid. The income cap is $11,713.75/month as of July 1, 2025.

What Is Asset Spend Down?

Applicants may convert countable assets into exempt ones by paying off debts, prepaying burial costs, or making home modifications. Gifting assets within 60 months of application is prohibited under the Look-Back Rule.

What Is Medicaid Planning?

Working with a Medicaid Planning Professional can help over-income or over-asset individuals qualify while protecting important assets like the family home from estate recovery.

What Specific Long-Term Care Programs Does Iowa Medicaid Offer?

HCBS Elderly Waiver

Provides services like personal care, adult day care, and home modifications. Self-directed care options (CDAC and CCO) allow hiring of family caregivers.

PACE

The Program of All-Inclusive Care for the Elderly (PACE) combines Medicaid and Medicare benefits into one program.

Money Follows the Person (MFP)

This program helps eligible individuals transition from institutions back into community-based living.

How Can Seniors Apply for Iowa Medicaid?

Iowa residents can apply:

• Online via the Iowa HHS Services Portal
• By phone: 855-889-7985
• In person at local DHS offices
• By submitting an Application for Health Coverage and Help Paying Costs

Area Agencies on Aging and the HHS Contact Center can provide additional assistance. Because the process is often complex, it is recommended to confirm eligibility beforehand or seek Medicaid Planning support.