American Rescue Plan Act (ARPA) 2021

Section 9817 Home- and Community-Based Services (HCBS) Enhanced Funding

On March 11, 2021, President Joe Biden signed the American Rescue Plan Act (ARPA). Section 9817 of the ARPA provides qualifying states with a temporary 10 percentage point increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures for HCBS programs from April 1, 2021, through March 31, 2022. States must use these federal funds to supplement existing state funds for Medicaid HCBS in effect as of April 1, 2021.

In addition, states must use state funds equal to the amount of federal funds attributable to the increased FMAP to implement or supplement one or more activities to enhance, expand, or strengthen HCBS under the Medicaid program. States will be permitted to use the  increased FMAP funds through March 31, 2024, on activities aligned with the goals of section 9817 of the ARPA and as listed in the Centers for Medicare and Medicaid Services (CMS) guidance. Under ARPA, states can implement a variety of activities, including enhancements to HCBS services, eligibility, infrastructure, and reimbursement methodologies, to enhance, expand, or strengthen Medicaid HCBS.


Iowa Medicaid ARPA HCBS Spending Plan and Narrative

Preliminary Iowa Medicaid ARPA HCBS Spending Plan and Narrative

Iowa Medicaid ARPA HCBS Spending Plan and Narrative Quarter 1 Update (October 2021)

Iowa Medicaid ARPA HCBS Spending Plan and Narrative Quarter 2 Update (February 2022)

Iowa Medicaid ARPA HCBS Spending Plan and Narrative Quarter 3 Update (April 2022)

Attachment A Iowa Medicaid ARPA HCBS Spending Plan 4-18-22 Submission

Centers for Medicare and Medicaid Servics (CMS) Conditional Approval

CMS Quarter 3 Approval


Iowa Medicaid Projects

HCBS Community-Based Neurobehavioral Rehabilitation Services (CNRS) for Children pilot

The CNRS for Children pilot project is specifically intended to build infrastructure within the state by developing and implementing a CNRS residential service model to serve children in Iowa with complex neurobehavioral needs to prevent hospitalizations and out-of-state placement; and enable children who are receiving treatment out of state to return to Iowa to receive residential neurobehavioral treatment. To learn more about CNRS, visit the CNRS webpage.

Iowa Medicaid will be holding listening sessions to gain stakeholder feedback on the development of the guidelines, criteria, standards and intended outcomes of a CNRS residential service pilot project. Information on joining a listening session follows. Read Informational Letter 2292-MC-FFS for more details.


One-time Recruitment and Retention Provider Payments

Iowa Medicaid is distributing funds to eligible providers from the ARPA HCBS Recruitment and Retention grant. The provider payments will serve the purpose of retaining essential individual Consumer-Directed Attendant Care (CDAC) and Consumer Choices Option (CCO) employees and assisting qualified HCBS agency providers to fund recruitment and retention of direct care staff. Grant funds must be used to cover costs related to recruitment and retention incentive payments to direct care staff.

Eligible HCBS Providers Include:

  •  HCBS Waiver Individual Consumer-Directed Attendant Care (ICDAC) providers
  •  HCBS Waiver Agency CDAC
  •  HCBS Waiver CCO employees
  •  HCBS Waiver Day Habilitation providers
  •  HCBS Waiver Supported Community Living (SCL) providers
  •  HCBS Waiver Respite providers
  •  State Plan HCBS Habilitation Home-Based Habilitation (HBH)
  •  State Plan HCBS Habilitation Day Habilitation providers

To be eligible for grant funds, the HCBS Waiver agency, habilitation agency, and ICDAC providers must meet these requirements:

  •  They billed a Managed Care Organization (MCO) or FFS Medicaid for health related services provided between July 1, 2020, and June 30, 2021.
  •  They continued to provide patient care after April 1, 2021.
  •  They have not permanently ceased providing patient care directly or indirectly.
  •  With respect to Medicare, any state Medicaid program, and any Federal health care program, the recipient is not:
    • suspended or excluded from participation
    • suspended from receiving payments.
    • under any other sanction or penalty.
    • Individual CDAC and HCBS Agency providers have until February 18, 2022, to submit an application. See IL 2309-MC-FFS for additional information on how to apply.

ARPA HCBS Recruitment and Retention Grant Frequently Asked Questions (FAQ)

ARPA HCBS Recruitment and Retention Grant Amended Terms and Conditions

CCO ARPA Recruitment and Retention Grant Terms and Conditions




ARPA Information and Resources

ARPA 2021

Centers for Medicare and Medicaid Services (CMS) Letter to State Medicaid Directors

CMS LTSS Rebalancing Toolkit

PUBLIC NOTICE: Feedback Requested for Iowa Medicaid's American Rescue Plan Act Funds