Iowa CCO & CDAC 2026: Get Paid To Care For Family

What are the Consumer Choices Option and CDAC?

Iowa gives Medicaid home- and community-based services (HCBS) waiver members two ways to hire and pay their own caregiver instead of accepting an agency worker. The Consumer Choices Option (CCO) is a self-direction program: the member receives an individualized monthly budget of Medicaid dollars and uses it to hire, train, and supervise their own workers, and even to buy goods and services that support their care. Consumer-Directed Attendant Care (CDAC) is the underlying attendant-care service -- hands-on help with daily activities -- that a member can direct themselves.

In both programs the member (or their guardian or legal representative) is the employer. You find the person you trust, agree on a wage, sign an agreement, and direct the work. The state does not assign you a stranger. This is what makes CCO and CDAC attractive to families: an adult daughter, a brother, a grandson, or a longtime friend who has quietly been providing care can finally be paid for it, as long as the member is on a waiver and the person is not an excluded relative.

A major change took effect at the end of 2025. The federal Centers for Medicare & Medicaid Services notified Iowa that the old Individual (self-employed) CDAC arrangement did not comply with IRS rules on how home-care workers must be treated for federal tax purposes. As a result, Iowa stopped enrolling self-employed Individual CDAC providers and ended ICDAC effective December 31, 2025. Families who were using an individual CDAC provider were moved to one of two compliant options: the Consumer Choices Option (where the member is the household employer and a financial management service handles taxes) or agency-based CDAC (where an enrolled agency employs the worker).

For most families who want to pay a relative directly, CCO is now the primary path. It preserves the member-as-employer model while making the arrangement IRS-compliant, because Veridian Fiscal Solutions -- the state's financial management service -- acts as the payroll and tax agent. CCO is available to Iowans on any HCBS waiver, including the Children and Youth waiver, the Adult and Disability waiver, and the Elderly Waiver.

Iowa CCO & CDAC eligibility requirements

To use CCO or CDAC, the person receiving care must qualify for Iowa Medicaid and be enrolled on an HCBS waiver. The caregiver does not have to meet income or asset limits -- only the member does. Eligibility is about the member's finances and level of care, plus already being on a waiver.

Iowa Medicaid enrollment

The person receiving care must be enrolled in Iowa Medicaid. CCO and CDAC are waiver services, so full Medicaid coverage is the starting point. If the member is not yet on Medicaid, they apply through the Iowa HHS Services Portal or a local HHS office first.

Enrollment on an HCBS waiver

You must already be on an Iowa HCBS waiver to receive CDAC or elect CCO. Waivers that offer these services include the Elderly Waiver, Adult and Disability (formerly Health & Disability / Physical Disability / Brain Injury / Intellectual Disability / AIDS-HIV) waivers, and the Children and Youth waiver. There can be a waitlist for some waivers.

Nursing-facility (or equivalent) level of care

The member must meet the level-of-care standard for their waiver -- for the Elderly Waiver this is a nursing-facility level of care, assessed with the interRAI Home Care tool that looks at activities of daily living and cognition. Other waivers use their own level-of-care criteria (ICF/ID, hospital, etc.).

Income within the waiver limit (2026)

For the Elderly Waiver in 2026, an applicant can have monthly income up to $2,982 (300% of the SSI federal benefit rate). Members above the limit may be able to use a Medicaid income trust. Income rules differ slightly across Iowa's waivers, so confirm the current figure for your specific waiver.

Asset limit (2026)

The asset limit is generally $2,000 for a single applicant on the Elderly Waiver in 2026 (a spouse who remains in the community is allowed a larger, separate resource allowance). Certain assets, such as a primary home within the equity limit and one vehicle, are typically exempt.

Ability to self-direct (or a representative)

Because the member is the employer, the member must be able to direct their own care -- hiring, training, scheduling, and approving time -- or must designate a guardian, legal representative, or trusted unpaid person to manage workers and the budget on their behalf.

Who can -- and cannot -- be paid under CCO and CDAC

Iowa lets the member choose almost any adult they trust, but state rules exclude a spouse and a few legally responsible relatives. The same core exclusions apply whether you go through CCO or agency CDAC: the official CDAC handbook states the provider 'cannot be your wife or husband,' and the CCO handout states 'spouses and legally responsible relatives cannot be hired as employees.'

✓ Who CAN be paid

Adult children (18 or older) of the member
Siblings, grandchildren, nieces, nephews, aunts, uncles, and cousins
In-laws and step-relatives other than a spouse or a parent/stepparent of a minor
A parent of an adult member (the member is 18 or older)
Close friends, neighbors, or members of your faith community
Anyone 18 or older who passes a criminal and dependent-adult/child abuse background check

✕ Who CANNOT be paid

The member's spouse (wife or husband) -- excluded under both CCO and CDAC
A parent or stepparent of a member who is under 18 years old
The member's legal guardian if the member is under 18
Any other legally responsible relative barred by CCO rules from being a paid employee
A provider who is also benefiting from respite services paid through the waiver on the member's behalf

Iowa CCO & CDAC pay, hours, and overtime

Iowa does not fix a single statewide wage. Under CCO and CDAC the member negotiates the hourly wage with the caregiver, within the limits of the member's approved budget and the state's upper reimbursement rate. The state raised waiver rates in 2024-2025 specifically so members could offer caregivers a higher wage.

Hourly pay

The 2026 upper reimbursement limit for attendant care (procedure code S5125) is $6.02 per 15-minute unit -- about $24.08 per hour -- which is the most Medicaid will pay for the service. Under CCO, the caregiver's actual take-home wage is set below that cap because employer costs come out of the same budget: Veridian's financial management service is billed at $77.51 per member per month, and the budget must also cover the employer share of payroll taxes. In practice, family caregivers commonly agree on roughly $13 to $20 per hour, with the exact figure depending on the tasks, the member's monthly budget, and local going rates. Under CCO, workers are treated as employees, so federal and state taxes are withheld from each check.

Hours and scheduling

There is no fixed weekly hour cap; the number of paid hours depends on the member's assessed needs and the size of their individualized monthly budget. A member can spread hours across more than one caregiver -- for example, two adult children splitting the week -- and can hire a backup provider so care continues if the main caregiver is unavailable. Note that CDAC is hands-on assistance only: it does not pay for overnight sleep-in supervision or for simply staying with the member.

Overtime rules

Because CCO makes the arrangement a formal employment relationship, federal Fair Labor Standards Act rules apply, and a worker who exceeds 40 hours in a workweek for one member may be owed overtime at 1.5x. Overtime is paid from the same monthly budget, so many families schedule two caregivers to stay under 40 hours each and stretch the budget further. Veridian, as the financial management service, tracks hours and processes pay.

How to apply for CCO or CDAC in Iowa

Make sure the member is on Iowa Medicaid and an HCBS waiver. If not yet enrolled, apply at the Iowa HHS Services Portal or a local HHS office, or call Iowa Medicaid Member Services at 1-800-338-8366 (Des Moines area 515-256-4606).
Talk to your case manager, community-based case manager, or managed care organization (MCO) about self-direction.
- Say you want the Consumer Choices Option (CCO) so you can hire your own caregiver
- Ask them to confirm your waiver offers CCO/CDAC and to explain the rules and your responsibilities as employer
- If you were on the old Individual CDAC, ask how your case was transitioned after it ended Dec 31, 2025
Complete a needs assessment and get your individualized budget. Your level-of-care assessment (for example, the interRAI Home Care tool) drives the monthly CCO budget you will manage.
Enroll with Veridian Fiscal Solutions, the CCO financial management service.
- Call Veridian CCO at (866) 226-4692 / (319) 226-4692 or email ccoiowa@veridiancu.org
- Veridian sets up payroll, tax withholding, and worker background checks paid from your budget
- You can also choose an Independent Support Broker to help build your budget and recruit workers
Choose your caregiver and complete their paperwork.
- Confirm the person is 18+ and is not an excluded relative (no spouse; no parent/stepparent/guardian of a minor)
- The worker passes a criminal and abuse-registry background check
- You and the worker agree on a wage and sign the employment/CDAC agreement
Start work, submit time sheets, and reassess yearly. The member (or representative) approves hours each pay period; Veridian issues pay. Your waiver eligibility and budget are reviewed at least annually and adjusted if needs change.

Iowa CCO & CDAC frequently asked questions

Can my spouse be paid to care for me in Iowa?

No. A spouse cannot be paid under either the Consumer Choices Option or Consumer-Directed Attendant Care. Iowa's official CDAC member handbook states plainly that the provider 'cannot be your wife or husband,' and the state's CCO handout says 'spouses and legally responsible relatives cannot be hired as employees.' The same rule blocks a parent or stepparent from being paid to care for their own child who is under 18, and blocks a legal guardian of a minor. The good news is that almost every other relationship is allowed: adult children, siblings, grandchildren, nieces, nephews, aunts, uncles, cousins, in-laws, and close friends or neighbors can all be hired and paid, as long as they are at least 18 and pass a background check. If you specifically need a spouse to be paid in Iowa, ask about Veteran-Directed Care (if the member is a veteran), which follows different rules.

How much does CCO or CDAC pay in 2026?

Iowa does not set one statewide wage. Instead, the member negotiates the hourly wage with the caregiver, within the member's approved monthly budget. The state's 2026 upper reimbursement limit for attendant care (code S5125) is $6.02 per 15-minute unit, which works out to about $24.08 per hour -- the maximum Medicaid will pay for the service. Under CCO the caregiver's actual take-home wage is set below that ceiling because the same budget also pays employer costs: Veridian's financial management fee ($77.51 per member per month) and the employer share of payroll taxes. In practice, families commonly agree on roughly $13 to $20 per hour depending on the tasks involved, the size of the budget, and local going rates. Because it is a real job under CCO, taxes are withheld and the worker receives a pay stub.

How long does it take to get approved?

If the member is already on an HCBS waiver, electing CCO and getting set up with Veridian can take just a few weeks -- mostly the time needed for the caregiver's background check and employment paperwork. The longer part is getting onto Medicaid and a waiver in the first place. A new Medicaid or waiver application in Iowa often takes up to about 90 days, and some waivers have a waitlist, which can add more time. You can speed things up by gathering documents in advance: proof of Iowa residency, identification, Social Security numbers, and proof of income and assets for the member. Ask your case manager or MCO to run the level-of-care assessment early, since that assessment is what determines your monthly CCO budget and how many caregiver hours you can pay for.

What training or certification does the caregiver need?

For unskilled attendant care -- help with bathing, dressing, meals, medication reminders, housekeeping, errands, and similar daily tasks -- no license or formal certification is required. Iowa's rule is simply that the person be at least 18, have the training or experience to meet your needs, and pass a criminal and dependent-adult/child abuse background check. That makes CCO and CDAC very welcoming to family members who have been caregiving informally for years. Skilled services are different: tasks that are medical in nature (tube feedings, catheter or colostomy care, injections, recording vital signs) must be supervised by a licensed nurse or therapist, even if a family member performs the hands-on work. The member and caregiver spell out exactly which tasks are covered in the written CDAC agreement that the case manager approves.

What happened to Individual CDAC -- can I still pay a relative directly?

Iowa ended Individual (self-employed) CDAC effective December 31, 2025. The federal Centers for Medicare & Medicaid Services told Iowa that treating individual home-care providers as self-employed did not comply with IRS rules for publicly funded HCBS programs. So self-employed CDAC providers can no longer register with HHS. You can still pay a relative directly, but through a compliant structure: the Consumer Choices Option, where you remain the employer and Veridian acts as your payroll and tax agent, or agency-based CDAC, where an enrolled agency employs the worker. For families who want to keep hiring and directing a specific relative, CCO is now the main route. If you were using an individual CDAC provider, your case manager or MCO should have helped move you to CCO or an agency before the deadline -- contact them if you are unsure which option you are on now.

Who manages the money and the employer paperwork?

Under the Consumer Choices Option, a Financial Management Service (FMS) handles the employer back office so you do not have to. In Iowa that FMS is Veridian Fiscal Solutions. Veridian runs background checks on your workers, withholds and files payroll taxes, issues paychecks from your monthly budget, and keeps the books -- all billed at $77.51 per member per month out of that budget. You still make the real decisions: who to hire, what to pay them (within your budget), the schedule, and whether to let someone go. You can also choose an Independent Support Broker, paid an hourly rate negotiated with you (up to about $18.06 per hour under the 2026 limits), to help you build your budget, organize services, and recruit employees. And you can name a trusted unpaid person, such as a family member, to help manage workers and the budget on your behalf.

Which Iowa Medicaid waivers offer CCO and CDAC?

CCO is available to Iowans on any HCBS waiver, and the state specifically lists the Children and Youth waiver, the Adult and Disability waiver, and the Elderly Waiver. CDAC is offered under most HCBS waivers as well -- historically the Elderly, Intellectual Disability, Ill and Handicapped, Brain Injury, Physical Disability, and AIDS/HIV waivers -- with the Children's Mental Health waiver being the main exception. Iowa has been consolidating some of its older waivers into the newer Adult and Disability and Children and Youth waivers, so the exact waiver name you enroll under may differ from these older labels. The key point is that you must already be on a waiver to elect CCO or receive CDAC; these are services within a waiver, not standalone programs. Your case manager can confirm which waiver you are on and whether it offers self-direction.

Can one caregiver work for more than one person, or can I use more than one caregiver?

Both are allowed. You can hire more than one caregiver -- for example, two adult children who split the week, plus a designated backup provider so your care does not stop if your main caregiver is sick or on vacation. This is also a common way to keep any single worker under 40 hours a week and avoid triggering overtime, which would otherwise be paid at 1.5x out of your monthly budget. A caregiver can also work for more than one member, but each member is a separate employment relationship, and overtime is generally figured per employer. Because CCO makes the caregiver a formal employee, standard wage-and-hour rules apply, so if you plan to have one person work a lot of hours across multiple members, check with Veridian about how overtime and joint-employment rules would apply to your situation.

Iowa CCO & CDAC: Get Paid To Care For A Family Member