Iowa Medicaid Long Term Care Eligibility in 2023

Iowa Long Term Care


Iowa is an income cap state, meaning that in order to be eligible for Medicaid long term care benefits there is a hard income limit. Non income cap states allow applicants to spend down money for their care, whereas income cap states require the amount to be no higher than their limit at time of application.

Home and community based services (HCBS) waiver programs: HCBS waivers provide services in the home and community if an applicant is eligible and wishes to remain home rather than transfer to a medical facility. Iowa has seven HCBS waiver programs:

  • AIDS/HIV waiver; Brain injury waiver; Children’s mental health waiver; Elderly waiver;
  • Health and disability waiver; Intellectual disability waiver; Physical disability waiver.
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Eligibility in 2023:

1. Residency and Citizenship – the applicant must be an Iowa resident and be a U.S. citizen or have proper immigration status.

2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled and can receive care in home or at a facility. The applicant must meet certain medical requirements consistent with the level of care requested.

3. Income Limitations – the applicant’s income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, IRAs, etc.) must be less than $2,742 per month. There is a personal needs allowance of $50/month that is not factored into the total countable income.

4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits.


Exempt Assets in 2023 for an applicant in Iowa include:

i. $2,000 or less in cash/non-exempt assets if single.

ii. Personal effects and household goods

iii. One home (equity value limited to $688,000) if a spouse, or a child under 21, or a disabled person resides in it.

iv. One motor vehicle if the vehicle is used for the long term care recipient’s medical treatment, employment, modified to accommodate a disability, or the primary vehicle of the community spouse—no matter the value.

v. Life insurance is considered income in the month it is received, but dividends from life insurance fall into the asset category, to be no higher than $1,500. Note that interest on dividends from a life insurance policy is not exempt. If life insurance has a face value of $10,000 or less and the beneficiary is the policy holder’s estate or the funeral home it is exempt.

vi. Burial spaces and irrevocable pre-paid burial trusts if tied to specific funeral or burial services.

Spousal Rules for 2023

Amount of assets community spouse may retain: The community spouse can keep one-half of all non-exempt resources owned by one or both spouses with a minimum of $29,724 and a maximum of $148,620. All non-exempt resources of both spouses are available to pay for the costs associated with long term care.

Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has an income of less than $3,715.50 per month.

  • The nursing home spouse must contribute all income except for $50 per month towards their long term care costs.

Iowa long term care insurance partnership in 2023:

This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used you may apply for Medicaid with $155,000 worth of assets exempted.