Self-Direction and FMS in Iowa

All states: self-direction map

Iowa self-direction at a glance

Last verified against state sources: 2026-10-13.

Which Medicaid programs in Iowa offer self-direction?

Iowa has one Medicaid self-direction program, the Consumer Choices Option (CCO). It is not a separate waiver. It is an option inside six of the state's home and community based services (HCBS) waivers. A member who chooses CCO gets both employer authority and budget authority.

• Consumer Choices Option (CCO): serves members of the AIDS/HIV, Brain Injury, Elderly, Health and Disability, Intellectual Disability and Physical Disability waivers. The Iowa Department of Health and Human Services (Iowa HHS, through Iowa Medicaid) runs it. Most members receive it through an IA Health Link managed care organization, and the rest through fee-for-service. The member has employer authority and budget authority. CCO is not offered on the Children's Mental Health Waiver today.
• Consumer Directed Attendant Care (CDAC) through a provider agency: an attendant care service for HCBS waiver members, overseen by Iowa HHS and the managed care organizations. The name says consumer directed, but the worker is employed by an enrolled CDAC provider agency. The member has neither employer authority nor budget authority, and no FMS is involved.

Employer authority means the member recruits, hires, schedules and supervises the workers. Budget authority means the member also manages a set amount of money. Under CCO the member receives a monthly individual budget to hire employees and to buy approved goods and services. Iowa's CCO consent and risk agreement says the member personally pays if that budget is overspent. A member can hand budget authority to another person with a Delegation of Budget Authority form.

The list of six waivers comes from a 2019 state rulemaking notice. The current Iowa HHS self-direction page says CCO is available on most current HCBS waivers and that the Children's Mental Health Waiver is the exception.

Who handles financial management services (FMS) in Iowa?

One organization handles financial management services for the Consumer Choices Option: Veridian Fiscal Solutions, part of Veridian Credit Union. Iowa uses a vendor fiscal/employer agent model, which means Veridian runs payroll and taxes while the member or legal guardian stays the legal employer of the workers. With one FMS in place today, members do not pick among vendors.

A fiscal/employer agent is the organization that handles the paperwork side of being an employer. It pays the workers and withholds and files payroll taxes on the member's behalf. Iowa's Financial Management Service Agreement defines the FMS this way and says that neither Iowa Medicaid nor the FMS is the employer.

• Legal employer: the member or legal guardian is the common law employer and the employer of record.
• Vendor: the Iowa HHS CCO page lists Veridian Credit Union as the Financial Management Service. Veridian says it has been the CCO FMS provider, in partnership with Iowa Medicaid, since 2007.
• Hiring: CCO employees do not have to be Medicaid providers. Veridian runs background checks, which Iowa HHS says can take 5 to 6 weeks, and an employee may not start work until Veridian approves them.
• Pay: overtime is not available. The employer may not schedule an employee for more than 40 hours a week and may not authorize overtime pay.
• Rates: an Iowa Medicaid rate increase for some CCO services took effect August 1, 2025, and Veridian says it applied the increase to eligible services and pay rates already on file.

Iowa also has a role called the Independent Support Broker, a person who can help the member build the budget. The current Iowa HHS self-direction page says using a broker is optional. Older CCO forms that are still posted say a broker is required. We did not find a statement that settles which applies, so ask the member's case manager or Veridian before assuming either one.

Who can be a paid caregiver under self-direction in Iowa?

Family members can be paid under the Consumer Choices Option, with limits that depend on the member's age. A parent can be the paid employee of an adult child. A parent or other legally responsible adult of a minor can be paid only for intermittent Supported Community Living, up to 52 hours a month. We did not find a published rule on whether a spouse can be paid.

• Parent of an adult member: may be an employee of the member under CCO and provide Supported Community Living to their adult child.
• Parent or other legally responsible adult of a minor: may be a CCO employee and provide intermittent Supported Community Living up to 52 hours a month. More hours need approval from the member's managed care organization, or an Exception to Policy for fee-for-service members.
• No double role: a legally responsible person who is the paid CCO employee may not also act as the employer or hold budget authority. Those roles must be delegated to someone who is not an employee of the member.
• Spouses: we did not find a state source that says whether a spouse can be a paid CCO employee. Ask Iowa Medicaid Member Services at 1-800-338-8366 or the member's case manager.

These rules come from an Iowa HHS question and answer document dated April 2024. The same document sets the 40 hour weekly limit for each employee, with no overtime, and that limit applies to family employees too.

Does EVV apply to self-directed workers in Iowa?

Partly. Electronic visit verification (EVV) applies to CCO employees who serve managed care members. They record personal care visits (billing code T1019) in the CareBridge mobile app or by phone. EVV is not in place for fee-for-service, so fee-for-service CCO employees still use paper timesheets.

• Managed care members: CCO employees use the CareBridge mobile app or its phone line (IVR), under the Veridian provider ID, and the member attests to the visit. Veridian Fiscal Solutions manages the setup. Iowa HHS EVV guidance for CCO says there is no alternate EVV path for CCO.
• Alerts: CareBridge flags CCO visits with alerts, for example a missing member attestation. Iowa HHS guidance from May 2026 says an unresolved alert may keep the visit from being accepted for claims.
• Fee-for-service members: Iowa HHS says EVV is not implemented for fee-for-service. CCO employees of these members keep using paper timesheets.

Two points could not be confirmed. We did not find a published EVV exemption for live-in caregivers in CCO. We also did not find a statement that a worker's paycheck is held when a visit is not recorded in EVV. The sources say only that unresolved alerts may keep a visit from being accepted for claims. For either question, ask Veridian Fiscal Solutions at 866-226-4692.

What is changing next for self-direction in Iowa?

Iowa HHS plans two new age-based waivers under its HOME project: a Children and Youth Waiver and an Adults with Disabilities Waiver. HHS says both will keep the Consumer Choices Option, and that it plans to add more approved FMS providers. Approval from the federal Medicaid agency (CMS) is pending, and no start date has been announced.

The plan would replace Iowa's diagnosis-based disability waivers with the two new waivers. The Children and Youth Waiver would serve members from birth through age 20, and the Adults with Disabilities Waiver would serve adults 21 and older. The Elderly Waiver would stay separate. HHS says CCO would be part of the Children and Youth Waiver, which would open self-direction to eligible children who are on the Children's Mental Health Waiver now.

• Timing: a May 1, 2026 public notice gave October 1, 2026 as the intended start. When we checked on October 13, 2026, the HOME eligibility and enrollment page said the start date has not been announced and that the current waivers stay in place until the new ones launch.
• More FMS providers: HHS says it plans to add approved FMS providers for CCO, subject to CMS approval. This has not happened. We did not find a procurement or enrollment notice, or the names of any organizations.
• Services: HHS says it will publish the list of services that can be self-directed before the new waivers launch.

Until the new waivers start, CCO works as described on this page and Veridian Fiscal Solutions remains the one FMS. Watch the Iowa HHS self-direction page and HOME project pages for a start date.

Iowa self-direction sources

• Iowa HHS: Consumer Choice Option (CCO)
• Iowa HHS: Self-direction
• Iowa HHS: CCO and host home questions and answers (April 2024)
• Iowa HHS: Financial Management Service Agreement (form 470-4428)
• Iowa HHS: CCO Informed Consent and Risk Agreement (form 470-4289)
• Iowa HHS: EVV guidance for CCO (June 23, 2025)
• Iowa HHS: EVV guidance on CareBridge alerts for CCO visits (May 18, 2026)
• Iowa HHS: HOME project eligibility and enrollment
• Iowa Administrative Rules: Notice ARC 4288C (CCO, February 13, 2019)

Related reading

• Self-Directed Medicaid Home Care Services in 2026
• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
• Self-direction in every state (map)
• Iowa EVV requirements

Other states with one statewide FMS vendor

Arkansas, Connecticut, District of Columbia, Indiana, New Mexico, North Dakota, Oklahoma, South Carolina, Tennessee, Vermont, Washington, West Virginia, Wyoming. See every state on the self-direction map.

Page history

• October 13, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.