Iowa has long been known as a senior-friendly state, so it’s easy to see why it ranked 7th on our 2022 Senior Living Report. Between the relatively low median assisted living rates and the lack of state income tax on Social Security benefits, the Hawkeye State is ideal for retirees looking for a welcoming, affordable place to settle down. 

Iowa is home to just under 3.2 million people, and seniors aged 65 and older make up about 17.5% of the state’s population. Not only does Iowa lead the nation in corn and pork production, but it also has excellent health care facilities. The University of Iowa Hospitals and Clinics are nationally ranked in four specialties including cancer care, and MercyOne in Des Moines offers comprehensive cardiac, neurological and outpatient services. 

This guide provides an overview of assisted living in Iowa, including the average care costs and information on financial aid programs for seniors who require long-term care. We also summarized Iowa’s assisted living regulations, and included a number of free resources for seniors, such as legal services and veterans’ aid programs.

The Cost of Assisted Living in Iowa

The Genworth 2021 Cost of Care Survey shows that the statewide average rate for assisted living care in Iowa is $4,367, which is just below the nationwide median of $4,500. Monthly rates in neighboring states range from just $3,000 in Missouri to $4,508 in Minnesota. The average cost is $4,076 in Nebraska, and $4,488 per month in Illinois. 

$4367

Iowa

$4500

The United States

$3000

Missouri

$4076

Nebraska

$4488

Illinois

$4508

Minnesota

Average assisted living rates within Iowa vary slightly depending on the location. Sioux City, located in the northwestern corner of the state, has the lowest average cost at $4,148 per month, while the median rate is highest in Des Moines, where assisted living care costs about $4,803. In Davenport, monthly rates run around $4,350, and in Iowa City, the same type of care costs about $4,410. Seniors in Dubuque pay $4,525, on average, while those in Cedar Rapids pay the second-highest rates statewide at $4,748 per month.

$4148

Sioux City

$4350

Davenport

$4410

Iowa City

$4525

Dubuque

$4748

Cedar Rapids

$4803

Des Moines

Assisted living is just one of the many long-term care services available to seniors in Iowa. The least-expensive option is adult day health care, which costs around $1,353 per month. Seniors who want to age in place in their own homes can expect to pay around $5,529 per month for home care, and $5,577 for home health care, and these rates are based on 44 hours of care per week. Nursing homes offer the costliest type of long-term care because it includes around-the-clock medical supervision in a specialized residential facility. In Iowa, a semiprivate nursing home room costs about $6,874, while private accommodations average $7,452 per month.

$4367

Assisted Living

$5529

Home Care

$5577

Home Health Care

$1353

Adult Day Health Care

$6874

Nursing Home Care (semiprivate)

$7452

Nursing Home Care (private room)

Does Medicaid Cover Assisted Living in Iowa?

Iowa’s Medicaid program doesn’t cover assisted living services directly, but instead offers the Elderly Waiver, a Home and Community Based Services Waiver. Enrollment in this waiver program is capped, so Medicaid beneficiaries who meet the enrollment criteria can expect to be placed on a waitlist for services. It’s also important to note that services funded through this waiver must be provided in an approved assisted living facility. 

What Assisted Living Services Are Covered by Medicaid in Iowa? 

Iowa’s Medicaid program only covers assisted living services through the Elderly Services Waiver. Assisted living residents who aren’t enrolled in this waiver qualify for all standard Medicaid-funded benefits, including:

  • Occupational, speech and physical therapy
  • Home health care
  • Primary physician services
  • Hearing services
  • Hospice care
  • Transportation to Medicaid-funded appointments and programs 

Assisted Living Waiver Programs in Iowa

Iowa’s Elderly Services Waiver, also known as HCBS Elderly, funds non medical and medical services for Medicaid beneficiaries who are at risk of placement in a nursing home. Waiver services are assigned based on the needs of each beneficiary, and may include: 

  • Assisted living care
  • Adult day health care
  • Case management
  • Emergency response device
  • Home-delivered meals
  • Home health aide and skilled nursing services
  • Homemaker and companion services
  • Nonemergency medical transportation
  • Mental health counseling
  • Home accessibility modifications and assistive devices

To qualify for enrollment in the HCBS Elderly Services Waiver, seniors must: 

  • Be aged 65 or older
  • Be an Iowa resident and either a U.S. citizen or legal resident
  • Be assessed by Iowa’s Medical Services Unit as needing the level of care normally provided in a nursing home
  • Meet the financial eligibility requirements for Medicaid benefits

How To Know If You’re Eligible for Medicaid in Iowa 

In Iowa, individuals who are qualified to receive Supplemental Security Income (SSI) benefits are automatically eligible for Medicaid. Those aged 65 and older who don’t qualify for SSI must be approved by the Iowa Department of Human Services. 

All Medicaid applicants must: 

  • Be at least 65 years of age, or
  • Be blind or meet Medicaid’s permanent disability criteria, and
  • Meet current income and asset limits that are adjusted on an annual basis

As of 2022, single applicants can earn a maximum pre-tax income of $18,075 and have no more than $2,000 in countable assets. Couples who are both applying may earn up to $24,353 and have up to $3,000 in assets. If only one spouse applies, the maximum income remains the same, and the applicant can have $2,000 in assets. The non-applicant may be entitled to a portion of the applicant’s income as a minimum monthly maintenance needs allowance. They may also be able to keep up to $137,400 in jointly owned assets.    

2022 Medicaid Income Limits for Seniors in Iowa

Income Limits* 

Asset Limits

Single Applicant

$18,075

$2,000

Two-Person Household

(Only One Person Applying)

$24,353

$2,000 applicant

$137,400 non-applicant

Two-Person Household
(Both People Applying)

$24,353

$3,000

*Per year

How To Apply for Medicaid in Iowa 

Individuals can apply for Medicaid using the digital DHS Services Portal. Alternatively, applicants can call Iowa Medicaid Member Services at (800) 338-8366 to request a paper application.

Information You Will Need 

In order to apply for Medicaid, seniors must provide the following: 

  • Government-issued proof of age
  • Verification of residency in Iowa
  • Proof of being either a U.S. citizen or national; a legal permanent resident or a qualified alien 
  • Current statements from all bank accounts, investments and sources of income, including government benefits and wages
  • Documentation related to all insurance policies held by the applicant, including life insurance and Medicare
  • Social Security number

How To Get Help Applying for Medicaid 

Seniors who need help completing their Medicaid application and navigating their health insurance options can contact one of the following resources for assistance.

Resource 

Contact 

Description 

(866) 236-1430

The Managed Care Ombudsman Program advocates for Medicaid managed care members and applicants who reside in long-term care facilities. Seniors who need information about managed care services, have complaints about their Medicaid-funded care or have been declined coverage can contact the ombudsman program for assistance. 

(515) 281-3094 

Individuals who wish to appeal a decision made by Iowa's Department of Human Services can request a hearing adjudicated by an administrative law judge through the Appeals Section. There's no cost to file an appeal.

(866) 468-7887

Iowa seniors can access free health insurance counseling services through their local Area Agency on Aging. The state has six AAAs serving specific regions of the state. Seniors can locate the AAA serving their area through the Iowa Department of Aging website, or by calling the Department's toll-free number. 

Does Medicare Cover Assisted Living in Iowa?

The short answer is that no, Medicare does not cover the cost of assisted living in Iowa. Assisted living facilities are considered to be a “residential setting” and not a “clinical setting,” (think nursing homes). While Medicare doesn’t cover the cost of care received in an assisted living community, it does still cover things like approved medications, doctor visits, medical equipment, etc., just like it would if you lived at home.

For more information about when Medicare can be used to pay for senior living in a nursing home, and for Medicare-related resources, see our guide to Nursing Homes in Iowa.

Other Financial Assistance Options for Assisted Living in Iowa

Seniors who are not eligible (due to location, financial situation, or other factors) for other types of financial assistance, do still have some options. See the table below for an overview of some of the most common ways to make Assisted Living affordable.

 

How to Apply

How It Works

Aid and Attendance

Learn more and apply online at va.gov.

Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for Assisted Living.

Reverse Mortgages

Learn more about your options and how to apply at ftc.gov

If you own a home, you may be able to use a reverse mortgage to help pay for Assisted Living. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.

Long-Term Care (LTC) Insurance

Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov.

Seniors who already have long-term care insurance may be able to use it to pay for Assisted Living. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of Assisted Living will not typically be eligible to sign up for a LTC insurance policy.

Free and Low-Cost Resources for Seniors in Iowa

There are a number of government agencies and nonprofit organizations that offer free services to seniors in Iowa. These include case management, help with securing VA benefits and assistance in locating long-term care services. 

Resource 

Contact 

Service 

(515) 252-4698

or 

(800) 838-4692

The Iowa Department of Veteran Affairs employs veteran service officers who work directly with veterans and their eligible dependents. VSOs provide up-to-date information on county, state and federal benefits and services for veterans. They can help VA pension beneficiaries apply for enhanced cash benefits through the Aid and Attendance and Housebound Allowance programs, which can be used to help cover assisted living expenses. 

(866) 468-7887

Iowa's Long-Term Care Ombudsman program is designed to ensure that the rights of all long-term care residents are protected. Staff working with the state's six local ombudsman districts provide information about long-term care to seniors and their families; help organize resident councils at assisted living facilities; and investigate concerns about long-term care conditions levied by residents, caregivers and facility administrators. 

(800) 772-1213

Staff members at Iowa's Social Security field offices process applications for federal benefit programs such as Medicare and Supplemental Security Income. Seniors can schedule an appointment at their nearest Social Security office by calling the national toll-free number

(800) 992-8161 

Iowa Legal Aid, a statewide nonprofit legal services firm that assists low-income Iowans, operates the Legal Hotline for Older Iowans. Those aged 60 and older can call the hotline for free legal advice on matters related to seniors, such as elder abuse, fraud, estate planning and access to public benefits. 

(515) 725-3333

Iowa seniors who can't make their own legal, financial or health care decisions may be assisted by a guardian through the Office of the Public Guardian. To qualify for these services, a senior must be unable to pay for a substitute decision-maker, and/or have no suitable relative or other responsible individual who can act on their behalf. 

COVID-19 Rules for Assisted Living in Iowa

The following information is based on research done on several government websites, including idph.iowa.gov and cdc.gov. These rules apply to nursing homes and other types of senior living facilities. We’ve most recently updated this data on 4/23/22, but since COVID-19 is a rapidly evolving pandemic, contact your local senior living facility or Area Agency on Aging for more specific and up-to-date information.

Visitation Policies

Rules for Iowa Communities

Are loved ones allowed to visit to provide emotional support?

Yes (Conditions Apply)

Are relatives allowed to visit for end-of-life care?

Yes

Are residents required to quarantine after visiting with a loved one?

No

Are visitors required to wear PPE (including masks) in order to visit residents?

Yes

Are non-medical contractors (such as hairdressers and entertainers) allowed in senior living facilities?

Yes

Are visitors checked for elevated temperatures?

Yes

Are visitors required to answer questions about health, travel, and potential virus contact?

Yes

Outings & Social Activities

Rules for Iowa Communities

Are residents allowed to leave (errands, visiting family, etc.) for non-medical reasons?

Yes

Are residents who leave required to quarantine when they return?

No (Conditions Apply)

Are senior living communities required to cancel all group outings?

No

Are residents allowed to eat meals together in a common area?

Yes (Conditions Apply)

Are residents allowed to gather in common areas for group activites?

Yes (Conditions Apply)

COVID-19 Safety Measures for Staff and Residents

Rules for Iowa Communities

Are staff members regularly required to do a temperature check?

Yes

Are staff members regularly tested for COVID-19?

Yes (Conditions Apply)

Are staff members members regularly required to do a health and safety screening, including questions about travel, contact with positive cases, etc?

Yes

Are residents regularly screened for COVID-19 symptoms?

Yes

Are residents regularly checked for elevated temperatures?

Yes

Are residents regularly tested for COVID-19?

Yes (Conditions Apply)

Assisted Living Laws and Regulations in Iowa

Assisted living facilities in Iowa must comply with state rules and regulations related to staffing, services and facility maintenance. Staff members from Iowa’s Department of Inspections and Appeals conduct regular and surprise inspections of licensed facilities throughout the state. 

IOWA LAWS AND REGULATIONS

Assisted Living Service Plan Requirements 

Assisted living facilities must assess each resident's physical and cognitive functioning on a regular basis in collaboration with the resident and their care team, and develop personalized service plans based on these assessments.

Assisted Living Admission Requirements 

Assisted living facilities may admit and retain residents who require assistance with three or fewer activities of daily living. 

Individuals who need total assistance with four or more ADLs for more than 21 consecutive days; who have an unmanaged mental illness; who display aggression towards others; who are in the acute stage of substance abuse disorder; or who have ongoing, unmanaged incontinence can't be admitted or retained by an ALF. 

Assisted Living Scope of Care 

Assisted living facilities provide accommodations and at least one hot meal daily; personal care services; organized social and recreational programming; and medication management to three or more residents. ALFs must also ensure that residents have access to an emergency response system that's monitored on a 24/7 basis. 

Assisted Living Medicaid Policy 

Assisted living services at participating facilities are covered under the Elderly Waiver, a Medicaid Home and Community-Based Services Waiver program administered by Iowa's Department of Health and Social Services. 

Assisted Living Facility Requirements 

In Iowa, assisted living accommodations may consist of a single- or double-occupancy room with an en suite bathroom equipped with a toilet, sink and bathtub or shower. 

Assisted Living Medication Management

Residents may self-administer their prescription or over-the-counter medications. Licensed nurses employed by the facility may delegate medication management duties to unlicensed facility staff, and these duties can include assisting with self-administration. 

ALF staff may only administer medications under the direct supervision of a registered nurse. Residents who receive medications directly from a facility staff member must be monitored for adverse reactions by an RN for at least 90 days following the start of the course of medication, or whenever the resident experiences a major change in their physical health. 

Staffing Requirements 

All licensed ALFs need to have a full-time manager who's responsible for the day-to-day operation of the facility. If medications are administered, or health-related services are offered, there must be a registered nurse on staff. 

There are no state-mandated minimum staffing ratios for Iowa ALFs. Facility managers are required to ensure that enough awake staff members are on-site at all times to meet the needs of residents.

Staff Training Requirements 

ALF managers hired after January 1, 2010 and their delegates must complete an approved assisted living management or nursing course within 6 months of their hire date. Unlicensed caregivers may be hired, however, all ALF direct care staff need to be trained in the facility’s fire safety and emergency procedures.

Background Checks for Assisted Living 

AFL managers need to request a Department of Public Safety criminal record check, and a Department of Human Services child and dependent adult abuse record check on all prospective employees. Candidates with a record on either registry may only be hired with the approval of the DHS.

Requirements for Reporting Abuse 

Everyone employed in an Iowa assisted living facility is deemed a mandated reporter who is legally obligated to report any concerns related to the abuse, neglect or mistreatment of a resident. Allegations must be reported to the Iowa Department of Inspections and Appeals, Health Facilities Division or to the Iowa Office of the Long-Term Care Ombudsman.