Enrolling as an Iowa Medicaid provider in the Waiver program


Consumer-Directed Attendant Care (CDAC) Services for Providers: 
In the Home- and Community-Based Services (HCBS) waiver program of Iowa Medicaid, there is an opportunity for people to have help in their own homes. Consumer-Directed Attendant Care (CDAC) services are designed to help people do things they normally would for themselves if they were able. People may reach a point where they need help to remain in their own home. This may happen because of an accident, a lengthy illness, disability, or aging problems. A person may consider hiring a CDAC assistant. Do you have the patience, caring, dependability, and training or experience it takes to help someone in his or her own home? If so, you can enroll and become a CDAC provider. Read more about being a CDAC provider by accessing the CDAC Provider Handbook. This Handbook provides a better understanding of the guidelines governing becoming and being a CDAC provider.

Learn more about being a CDAC provider by downloading the CDAC training video. You will be downloading a .zip file and when the download is complete, you will be able to view the training video. The training video is divided into six video segments: 

  1. Introduction
  2. The CDAC Agreement
  3. Daily Service Record (DSR)
  4. Claim for Targeted Medical Care (TMC)
  5. CDAC Procedures
  6. Audits and Reviews
If you wish to enroll as an INDIVIDUAL CDAC provider

You may already have someone in mind that you would like to provide services for or you may simply enroll as a provider in order to get on a list of approved providers. To enroll as a CDAC provider, you may contact the Iowa Medicaid Enterprise (IME) at:

IME Provider Enrollment
P.O. Box 36450
Des Moines, IA 50315
515-256-4609 (in the Des Moines area only)

Relevant forms for enrolling as a NEW INDIVIDUAL CDAC PROVIDER

  1. Iowa Medicaid HCBS Waiver Provider Application (pages 4-5 only) (Form 470-2917)
  2. Individual CDAC Disclosure (Form 470-4612)
  3. Provider Agreement (Form 470-2965)
  4. W-9 Form (IRS Tax Form W-9)
  5. Record Check Consent (Form 470-4227)
  6. Atypical Provider Declaration (Form 470-4457)
  7. Electronic Funds Transfer (EFT) (Form 470-4202)
  8. Proof of Age (e.g. copy drivers license, birth certificate, State-issued ID, passport)
If you are already a CDAC provider

As an active CDAC provider, the following resources, information, and CDAC-relevant forms will help you in the administrative process when filing claims for the services that you provide to the consumer.


Targeted Medical Care (TMC) Claim Form

DHS Administrative Rules and Policy
To access the DHS Administrative Rules and Policies, please follow this link to the DHS Office of Policy Analysis

If you wish to enroll as a WAIVER provider (for agencies and businesses)

Waiver providers are eligible to participate in the Iowa Medicaid Health and Community-Based Services (HCBS) Waiver program if they meet the standards for the service to be provided. Qualifications are defined on the enrollment application. Your agency or business must meet one of the enrollment qualifications under each service for which you are enrolling.

Necessary forms for enrolling as a WAIVER PROVIDER

  1. Iowa Medicaid HCBS Waiver Provider Application (Form 470-2917)
  2. Provider Agreement (Form 470-2965)
  3. W-9 Form (IRS Tax Form W-9)
  4. Atypical Provider Declaration (Form 470-4457)
  5. Electronic Funds Transfer (EFT) (Form 470-4202)

Provider Manual for the Waiver Services Program
Link to the revised provider manual to come.

NB: For the Brain Injury Waiver only: Providers involved in direct consumer service must have training regarding or experience with consumers who have a brain injury.