Long Term Services and Supports (LTSS)

Long Term Services and Supports (LTSS) are available for Medicaid members to help them maintain a good quality of life in settings such as their home or, if needed, in a facility. Services are intended to help people reach the highest degree of independence possible. Additional LTSS information can be found in Your Guide to Medicaid.

List of Long Term Services and Supports

A. Home- and Community-Based Services (HCBS)
Home- and Community-Based Services (HCBS) are Medicaid programs that give you more choices about how and where you receive services and are for people with disabilities and older Iowans who need supports to live in their home and community instead of in an institution. There are several programs that provide HCBS supports.

• HCBS Waivers Program (there are seven waivers)
• Habilitation Services
• Program of All-inclusive Care for the Elderly (PACE)
• Home Health Services
• Private Duty Nursing/Personal Cares Program
• Hospice Services
• Targeted Case Management
• Money Follows the Person
• Training for LTSS Providers and Case Managers

To be eligible for HCBS you must be:

1. Eligible for Medicaid
2. Need a certain level of care
3. Meet the specific requirements of the HCBS waiver for which you are applying

B. Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/ID)
Intermediate Care Facilities for Persons with Intellectual Disabilities (ICF/ID) provide 24-hour active treatment and services for persons with intellectual disabilities and other related conditions.

C. Residential Care Facilities (RCF)
Residential Care Facilities (RCF) provide organized continuous 24-hour care and services for persons who need supports other than nursing care.

D. Nursing Facilities and Skilled Nursing Facilities (NF and SNF)
Nursing facilities provide 24-hour care for individuals who need nursing or skilled nursing care. Medicaid helps with the cost of care in nursing facilities, but you must be medically and financially eligible for care in a nursing facility.

E. Community-Based Neurobehavioral Rehabilitation Services (CNRS)
CNRS is a specialized category of neuro-rehabilitation provided by a multidisciplinary team of allied health and support staff that have been trained in, and deliver, services individually designed to address cognitive, medical, behavioral, and psychosocial challenges, as well as the physical manifestations of an acquired brain injury. The service is provided to adults with brain injury and co-occurring mental health diagnosis.

F. Medical Assistance Income Trust (MAIT)
People with income in excess of 300 percent of the Supplemental Security Income (SSI) benefit for one person may qualify for Medicaid payment LTSS care using a medical assistance income trust (MAIT). A person with such a trust qualifies for LTSS payment only if the person's total gross monthly income does not exceed 125 percent of the statewide average change for the type of facility or level of care the person meets.

Effective July 1, 2023

G. Transfers of Assets (TOA)
Transfer of Assets (TOA) occurs when a person transfers resources or countable income for less than fair market value in order to become eligible or maintain eligibility for Medicaid. Transfers made within 60 months before the Medicaid application is filed or after the date of application is made disqualifies the applicant or member for Medicaid payment of LTSS. To determine the penalty period, the value of assets transferred is divided by the statewide average cost of NF services at the time for the application.