Medicaid Nursing Home Rates by State

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Iowa

Medicaid nursing facility payment · Cost-based · researched October 2026

Iowa’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.

At a glance

Rate method

Cost-based

Case-mix level

Facility average

Classification

PDPM

Rate updates

Twice a year

Managed care (LTC)

Yes

Quality program

None

Paid outside the rate

Small

Bed hold

Not paid

Published rates

Rates only

Assisted living

Covered

Personal needs allowance

$55 / month

Overview

• Iowa calls its method a 'modified price-based case-mix' system, but in practice each home is paid its own audited cost, up to a cap.
• The rate has two parts.
• Direct care = the home's case-mix-neutral nursing cost per day x its Medicaid case-mix index (CMI), capped at 120% of the day-weighted median x CMI (an MSA wage factor applies, capped at $8/day).
• Non-direct care (admin, environmental, property, support, and therapy since 7/1/2025) = the home's own cost per day, capped at 110% of the median (120% with an approved renovation 'enhanced limit').
• The 'excess payment allowance' (a share of savings below the median) is set to 0% in IAC 441-79.1(2), so homes below the median get only their cost.
• On top of the base rate sit the quality assurance (provider tax) pass-through plus a $37/day add-on.
• The 7/1/2026 file covers 376 freestanding homes: median base rate $250.36/day (range $135.62-$337.26); median payment rate with the provider-tax add-ons $304.09 (range $179.13-$397.68).

What matters in Iowa

• Each home gets its own cost, capped at 120% (direct) or 110% (non-direct) of the median; no bonus for low cost.
• $37/day provider-tax add-on plus a tax pass-through lifts the median posted rate from $250.36 to $304.09.
• Case mix uses only the PDPM nursing component, averaged per home by day and updated every January 1 and July 1.
• Most homes (265 of 376) pay the reduced $6.51/day tax; 101 pay $33.90; county and hospital homes are exempt.
• Bed holds are paid at 0% for regular nursing homes, both hospital and home-visit leave.
• Rates are rebased every other year: the last rebase was 7/1/2025 (CY2024 costs, up to $20M state funds); next due 7/1/2027.

Frequently asked

Does Iowa pay nursing homes a price based on the median cost?

No. Despite the 'modified price-based' name, each home gets its own cost per day, capped at 120% (direct, x case mix) or 110% (non-direct) of the median. The excess payment allowance for homes below the median is set to 0%.

Which Iowa nursing homes pay the lower $6.51 provider tax?

Homes with 46 or fewer beds, CCRCs, and homes with 19,000 or more Iowa Medicaid days a year. In the 7/1/2026 rate file, 265 of 376 freestanding homes show the $6.51 pass-through, versus 101 at $33.90.

How does Iowa measure case mix for nursing home Medicaid rates?

Iowa uses only the PDPM nursing component, with its own weights (0.66 to 4.06), averaged by day across Medicaid residents per home. Assessments older than 113 days count at the 0.66 default.

How much is paid outside the posted rate in Iowa?

Small: provider-tax money is inside the posted rate; quality and county-home payments are unfunded or unconfirmed.

What does Iowa Medicaid pay on Medicare coinsurance days?

Lesser-of: Medicaid rate minus Medicare's payment, capped at coinsurance, so usually $0.

Does Iowa require a minimum share of spending on care?

Yes on paper: 35% of net provider-tax gain to aide pay and 60% to all staff pay, but HHS says it cannot enforce it.

How the rate is set

How the method got here

Verified October 11, 2026

Cost basis

Uses cost reports

Yes

Cost report

Iowa Financial and Statistical Report for Nursing Facilities (state form; includes Form 470-4829 Nursing Facility Enhanced Medicaid Payment Report), filed annually for the facility fiscal year.

Base year and rebasing

Rebased every second year (IAC 441-81.5(4), 81.5(16)): medians and per diems are recalculated from the latest completed cost report with a fiscal year end of the preceding December 31 or earlier, inflated to the rate year. Last rebase 7/1/2025, using cost reports for periods ending by 12/31/2024, 'to the extent possible within state funding, including no more than $20,000,000' (2025 Iowa Acts HF 1049 §15). Previous rebase 7/1/2023. Next expected 7/1/2027. Special population and state-operated homes are updated annually.

Components

Component	Method	Notes
direct care	The home's own normalized cost per day (cost / cost-report-period facility CMI) x its Medicaid day-weighted CMI. Capped at 120% of the non-state day-weighted median x CMI (x MSA wage factor, adjustment capped at $8/day). Excess payment allowance: 0% of the gap below 95% of the median (IAC 441-79.1(2)).	Covers RN, LPN, CNA, rehab nursing and contracted nursing salaries and benefits. Hospital-based homes use their own hospital-based median.
non-direct care	The home's own cost per day, capped at 110% of the day-weighted median (120% with an approved enhanced limit for replacement, new construction or major renovation). Excess payment allowance 0% (ceiling 96% of median, limit 8%). Admin, environmental and property costs use the greater of actual days or 85% of licensed capacity (70% for 7/1/2023-6/30/2025).	Admin, environmental, property and support care. From 7/1/2025, inpatient therapy not billed as outpatient is in non-direct care (ARC 9279C, tied to the PDPM move).
capital cost per diem instant relief add-on	Temporary add-on for complete replacement, new construction or major renovation (threshold lowered to $750,000 incl. HVAC, ARC 6935C, 5/1/2023). Equals new depreciation + interest / greater of patient days or 85% of capacity. Added to non-direct care, subject to its limit; ends at the next biennial rebase (max 2 years). Subject to funding.	No separate fair-rental capital system; capital sits in non-direct care cost.
quality assurance assessment pass-through + $37 add-on	Pass-through = the home's QAA Medicaid cost / Medicaid days (in practice equal to its per-day tax tier: $33.90 or $6.51). Plus a flat $37.00/day add-on since 4/1/2023 (4.19-D p.20; IAC 441-81.5(21)).	7/1/2026 file: add-on totals of $70.90 (101 homes), $43.51 (265) and $37.00 (10 tax-exempt public homes).

Inflation

CMS Total SNF Market Basket (latest quarterly publication before July 1), applied from cost-report midpoint to the rate-year start at each rebasing (IAC 441-81.5(18)). Not applied in off years. Rebasing is limited to appropriated funding.

Verified October 11, 2026

Case mix

System

PDPM

Applied at

Facility average

How it works

Each home's direct care component is multiplied by one Medicaid day-weighted CMI from its residents' PDPM nursing groups, so every Medicaid resident in a home gets the same rate (4.19-D p.13a-14; HHS methodology doc).

Classification

PDPM nursing component only (the third HIPPS character, 25 groups), with Iowa-assigned CMIs from 0.66 (Y) to 4.06 (A). Default/delinquent ZZ = 0.66. A new stay ending in discharge only gets group I (1.73) or P (1.34) by discharge status, for up to 14 days. PT/OT, SLP and NTA components are not used.

Applies to

Direct care component (and its cap); non-direct care is not case-mix adjusted.

Acuity measured from

Day-weighted: each assessment's CMI x the days it is active in the quarter. Assessments expire after 113 days (days 114+ count at ZZ 0.66); late admission assessments (ARD more than 14 days after entry) count ZZ until the ARD. Two indices: facility-wide (all residents, used to neutralize cost at rebasing) and Medicaid (residents with a valid Medicaid ID in A0700 on non-PPS OBRA assessments; MCO policy numbers are not recognized). Hospice is not a payer. Quarterly rosters in IMPA; two quarters feed each rate period (e.g. Q1+Q2 2026 rosters -> 1/1/2027 rates).

Updated

Semiannual (January 1 and July 1). The state plan says 'adjusted semi-annually'; IAC 441-81.5(4) still says quarterly.

Move to PDPM

Moved from RUG-III 34-group (index maximizer, quarterly point-in-time) to PDPM nursing component day-weighted CMI. HHS: 'For MDSs with a target date of July 1, 2023, or after, PDPM Nursing Component CMI will be used, for rates going into effect on 7/1/2024.' SPA IA-24-0004 (effective 7/1/2024, approved 9/18/2024); its page 13a text reads 'Effective July 1, 2025'. 2025 Iowa Acts HF 1049 §15 directs CMI 'for the period beginning July 1, 2024' on the PDPM schedule, day-weighted, for the previous semiannual period. The IAC 441-81.5(19) text (IAC 6/10/26) still describes RUG-III and is out of date. HHS posts PDPM weight files from Q3 2023 data onward.

Verified October 11, 2026

Low-acuity residents

Yes, one narrow carve-out. IAC 441-81.8(3)'g': 'Payment for residents determined by utilization review to require the residential level of care will be made at the maximum state supplementary assistance rate', effective from the date of final notice of the lower level of care. This is an RCF-level state supplementary rate, far below the NF rate; the amount was not captured. There is no reduced rate for low PDPM nursing groups: those residents only pull down the home's average CMI (lowest weight 0.66). Checked: IAC 441-81 (6/10/26), 4.19-D, HHS PDPM methodology doc.

Verified October 11, 2026

Capital

Included in the home's non-direct care cost (depreciation, interest, rent, property costs), divided by the greater of actual days or 85% of licensed capacity (70% for 7/2023-6/2025), and capped by the 110% non-direct limit (120% enhanced). No fair rental value system. A temporary capital cost per diem instant relief add-on is available for replacements, new construction and major renovations (>$750,000 incl. HVAC since 5/1/2023), subject to funding.

Verified October 11, 2026

Budget adjustment factor

No across-the-board percentage cut. Budget limits work through (1) rebasing only 'to the extent possible within state funding', capped at $20M state funds for the 7/1/2025 rebase (HF 1049 §15); (2) a 0% excess payment allowance (IAC 441-79.1(2)), removing the old incentive for low-cost homes; (3) P4P paid only when appropriated. The posted median base rate was flat from 7/1/2025 ($250.16) to 7/1/2026 ($250.36), an off year for rebasing.

Verified October 11, 2026

Add-ons and money outside the rate

Paid outside the posted rate

Level

small

Estimate

Under 5% of base, by elimination. The large provider-tax money ($37 add-on + pass-through, about $54/day at the median) is inside the posted 'with QAAF' rate. P4P has no current funding. QIPP (IGT/UPL add-on) is limited to government-owned homes (about 10 freestanding homes exempt from the tax) and its current payments were not found. No NF directed payments exist in IA Health Link SFY2026.

Components

QIPP IGT-funded add-on for NSGO homes: size unknown. P4P: $0 (unfunded). Capital instant relief add-ons: inside the rate.

Source

https://hhs.iowa.gov/media/18120/download?inline

Verified October 11, 2026

Payments by owner type

Applies

yes

Detail

(1) Non-state government-owned homes (county/hospital-owned, e.g. Buchanan County Health Center, Humboldt County Memorial, Palo Alto County Hospital: 10 freestanding homes show only the $37 add-on on 7/1/2026) are exempt from the QAA tax but still receive the $37/day add-on. Private homes pay $6.51-$33.90 per non-Medicare day to get the same add-on. (2) Only NSGO homes can earn the QIPP add-on (Medicaid-to-Medicare UPL gap per day), funded by IGT. Current QIPP participation and amounts not found.

Funding

IGT from the non-state government entity (county/hospital), which must hold the license and full operational responsibility. A management agreement with a private manager is allowed (filed with HHS). A sale to a private owner ends eligibility, and non-qualifying homes must repay all QIPP.

Source

https://www.legis.iowa.gov/docs/iac/chapter/441.81.pdf

Verified October 11, 2026

Quality program

Active

No

Program

Nursing Facility Pay-for-Performance program (IAC 441-81.5(16)'g', since 7/1/2010). Paid only 'in state fiscal years for which funding is appropriated by the legislature'; no FY2026 appropriation found in HF 1049. Separately, 2025 Iowa Acts HF 1049 §16 ordered HHS to propose by 4/1/2026 a new method with a base rate, a QAA pass-through, and a QAA add-on split into a fixed fee and a quality-based payment. Status not confirmed. Earlier 'accountability measures' (up to 3% of medians, 4.19-D p.6, from 7/1/2002) were the predecessor.

Funding

Legislative appropriation when provided (none found for SFY2026). The proposed quality-based payment would come from the QAA add-on, budget-capped at the appropriation (HF 1049 §16.3).

Size

None currently found. When funded, up to 1-5% of the direct + non-direct day-weighted medians per day, by score.

Paid as

Retroactive per diem add-on for the whole state fiscal year, applied by repricing claims after year-end.

Measures

Measure	Source	Weight	How points are earned
Quality of life domain (person-directed care, dining, resident/family satisfaction survey, etc.)	Self-certification / independent survey	points within 100	Per-measure points in IAC 441-81.5(16)'g'(5)
Quality of care domain (deficiency-free survey, staffing, MDS quality measures)	DIAL survey / MDS / cost report	points within 100	Per-measure points in 81.5(16)'g'(6)
Access domain (e.g. Medicaid utilization, special licensure)	Cost report / state	points within 100	81.5(16)'g'(7)
Efficiency domain (e.g. occupancy, administrative cost)	Cost report	points within 100	81.5(16)'g'(8)

Scoring period

Scored per state fiscal year (the payment period); source reports due May 1; paid after year-end.

Payment formula

Score 0-50: none; 51-60: 1%; 61-70: 2%; 71-80: 3%; 81-90: 4%; 91-100: 5% of the direct + non-direct day-weighted medians. Reduced 25% per G-level citation; suspended in months under CMS denial of payment for new admissions; forfeited for any H+ (actual harm/IJ) citation or an uncured G.

Eligibility

Non-state freestanding homes only; not hospital-based, state-operated or special population homes. Must file the Enhanced Payment Report by May 1.

Cadence

Annual, when funded.

Scores published

Rule says HHS will publish results annually; no current results found.

Notes

The QIPP add-on for non-state government-owned homes (see supplemental_payments) has quality gates but is an IGT/UPL payment, not a statewide quality program.

Verified October 11, 2026

Provider tax

Charged

per non-Medicare day

Standard amount

$33.90 per non-Medicare patient day, effective 4/1/2023 (was $12.75 before). Paid quarterly within 30 days of quarter end.

Tiers

Who	Test	Amount
Nursing facilities with 46 or fewer licensed beds (as of June 1 each year)	size	$6.51 per non-Medicare day
Continuing care retirement centers designated by the Iowa Insurance Division (since 7/1/2024 at this level)	ccrc	$6.51 per non-Medicare day
Homes with 19,000 or more annual Iowa Medicaid patient days (most recent cost report as of June 1; threshold was 26,500 in 2019)	medicaid_utilization	$6.51 per non-Medicare day
State-operated homes; non-state government-owned or -operated homes; hospital distinct-part SNF and swing-bed units	public	exempt

Lower for high-Medicaid homes

yes

Returned in the rate

Two per-day additions to the Medicaid rate (4.19-D p.20; IAC 441-81.5(21)). (1) Pass-through = the home's QAA Medicaid cost / Medicaid days, effectively its tier rate. (2) A flat $37.00/day add-on for every Medicaid day, including tax-exempt public homes. In the 7/1/2026 file the add-ons total $70.90 (101 homes on $33.90), $43.51 (265 homes on $6.51) and $37.00 (10 exempt public homes). If the assessment is passed on to non-Medicaid payers, the home loses the QAA reimbursement for a year (Iowa Code 249L.3(7)).

Source

https://www.legis.iowa.gov/docs/iac/chapter/441.36.pdf

Verified October 11, 2026

Provider tax notes

Nursing Facility Quality Assurance Assessment (Iowa Code ch. 249L; IAC 441-36.3). $33.90 per non-Medicare patient day standard, $6.51 reduced tier, effective 4/1/2023. Returned through a Medicaid pass-through plus a $37/day add-on. SFY2026 appropriation from the QA trust fund to Medicaid: $111,216,205 (HF 1049 §12).

Verified October 11, 2026

Supplemental payments

(1) Quality Incentive Payment Program (QIPP) for non-state government-owned (NSGO) homes, IAC 441-81.5(16)'i' (ARC 6934C, effective 5/1/2023). It is a prospective per-diem add-on equal to the gap between Medicaid payments (FFS + MCO claims) and the Medicare upper payment limit, divided by patient days. The non-state government entity funds the state share by IGT. Homes must meet staffing (RN 4+ hours above the CMS 8-hour minimum; CNA and nurse HPRD 0.5 SD above the state mean), infection-control and MDS QM tests. Annual intent-to-participate due 9/30. Whether any home is currently paid, and how much, was not found; QIPP is not among the SFY2026 MCO directed payments. (2) The government-owned proportionate-share pool (4.19-D, from 10/1/1999) ended 6/30/2005. (3) No NF directed payments in IA Health Link for SFY2026.

Verified October 11, 2026

Other add-ons

(1) QAA pass-through + $37/day add-on (see provider_tax_detail). (2) Capital cost per diem instant relief add-on and enhanced 120% non-direct limit for qualifying construction/renovation, temporary and subject to funding. (3) QIPP add-on for qualifying NSGO homes (IGT-funded). (4) Ventilator rate (see special_payment_systems). (5) Hospice room-and-board in a NF is adjusted from the NF rate (IAC 441-79.1). (6) Private room supplementation: families may pay extra above the Medicaid rate for a private room if the home is at least 50% occupied (Iowa Code 249A.4; 2025 HHS report). No COVID-era add-on remains in the rate file.

Verified October 11, 2026

Units paid separately

(1) Ventilator patients (at least 6 hrs/day on a ventilator, skilled level of care, QIO-determined): paid the sum of the Medicare-certified hospital-based direct care limit (120% of median x CMI) plus the hospital-based non-direct limit (110%). This continues for 30 days after weaning if skilled criteria are still met (IAC 441-81.8(3)'h'; 4.19-D). (2) Special population nursing facilities (e.g. brain injury: On With Life, 5 homes in file): annual cost-based rates, capped at the hospital-based medians x percentages; bed hold paid at 42%. (3) State-operated NFs: annual cost-based rates. (4) Medicare-certified hospital-based NFs: same method with their own hospital-based medians (1 active, $684.67/day with QAAF on 7/1/2026). (5) ICF for persons with mental illness (special population): Medicaid pays only for residents 65+.

Verified October 11, 2026

Payment rules

Managed care for long-term care

Status

yes

Detail

IA Health Link MCOs (Wellpoint, Iowa Total Care, Molina) pay long-stay NF care under custodial-care NF capitation rate cells; no day limit. HHS posts NF rates under its 'Iowa Health Link' pages.

Verified October 11, 2026

Who pays

mixed, mostly managed: IA Health Link (since April 2016) enrolls most Medicaid nursing facility residents with MCOs: Wellpoint (formerly Amerigroup), Iowa Total Care and Molina. The SFY2026 capitation includes 'Custodial Care Nursing Facility <65' and '65+' rate cells. Fee-for-service covers the period before MCO enrollment (IAC 441-73.3(4)) and remaining FFS members. The fee-for-service share of NF days was not found.

Verified October 11, 2026

Managed care rate floor

Yes, by contract, with an opt-out. Iowa Total Care contract MEDIOMC26002 §D.1.12 'Mandatory Rates': 'The Contractor shall reimburse in-network direct care Provider types at a rate that is equal to or exceeds the Agency defined Iowa Medicaid fee for service rate, or as otherwise mutually agreed upon by the Contractor and the Provider.' During a change of ownership the MCO must keep paying 'no less than ... the approved rate.' MCOs must load new Agency rates within 30 days of notice. The SFY2026 rate certification lists no NF directed payment (only UIHC physician, UIHC/non-UIHC hospital ACR, and GEMT). Sources: https://hhs.iowa.gov/media/15880/download?inline ; https://hhs.iowa.gov/media/18120/download?inline

Verified October 11, 2026

Included in the daily rate

Routine daily services include room, board, nursing, therapies, supervision, feeding, pharmaceutical consulting, OTC drugs, incontinence supplies and similar (IAC 441-81.5(10)). Inpatient therapy is included in the rate (81.5(15)'q'), and from 7/1/2025 its cost sits in non-direct care. Lab and diagnostic radiology are excluded unless done by facility staff with facility equipment. Prescription (legend) drugs are excluded and billed by pharmacies (81.5(15)'p'). Physician, hospital and outpatient services are billed separately.

Verified October 11, 2026

Bed hold

Hospital stays

Authorized up to 10 days per calendar month but paid at 0% of the per diem for regular, hospital-based and out-of-state NFs since 12/1/2009. Special population and state-operated NFs: 42%.

Leave days

Visits/vacation up to 18 days per calendar year (more if the physician's plan of care says they are rehabilitative), paid at 0% for regular NFs; 42% for special population and state homes.

Occupancy rule

None.

Notes

Reserved days paid by any party are counted as inpatient days on the cost report. Medicaid payment cannot start during reserve days unless the person was a private-pay resident before the hospitalization.

Source

https://hhs.iowa.gov/media/10353/download?inline

Verified October 11, 2026

Personal needs allowance

Per month

55

Effective

2025 Iowa Acts HF 1049 §19 (FY2026) raised Iowa Code 249A.30A from $50 to $55; IAC rule ARC 9859C effective 2026-02-01

Notes

Residents with countable income below $55 get a state-funded supplement up to $55 (IAC 441-81.18). Also applies to ICF/ID, ICF/MI and PMIC residents. Not COLA-indexed.

Source

https://www.legis.iowa.gov/docs/aco/arc/9859C.pdf

Verified October 11, 2026

Medicare coinsurance days

Method

lesser_of

Rule

IAC 441-81.5(20): if Medicare's payment equals or exceeds the Medicaid-allowed amount (Medicaid rate x units, including client participation), Medicaid pays zero. Otherwise it pays the lesser of (Medicaid-allowed minus Medicare payment) or the Medicare coinsurance and deductible. Crossover claims cover all dual eligibles, including QMBs. Treatment of Medicare Advantage cost-sharing was not found.

Effect

Medicare's SNF per diem nearly always exceeds the Iowa Medicaid rate (median about $304 with QAAF), so the home usually receives $0 of the day-21+ coinsurance.

Source

https://www.legis.iowa.gov/docs/iac/chapter/441.81.pdf

Verified October 11, 2026

Required care spending

Applies

yes

Rule

Iowa Code 249L.4(5)(b) / IAC 441-81.5(21)'c': if the QAA pass-through plus add-on exceed the tax a home paid, at least 35% of the difference must go to higher pay and employment costs for direct care workers (CNAs) and at least 60% to all NF staff (excluding administrators, admin and home-office staff). Reported on Form 470-4829 with the cost report. Weak enforcement: HHS's 2024 report says the legislature 'has not provided the Department with any enforcement authority', and 91% (CNA) / 95% (all staff) of 363 required homes complied. P4P money must also go to direct care staff wages, benefits and training; failing to report disqualifies the home for the next P4P period.

Source

https://hhs.iowa.gov/media/14186/download?inline

Verified October 11, 2026

Occupancy rules

Applies

yes

Rule

For freestanding homes, administrative, environmental and property costs per day = cost / the greater of actual inpatient days or 85% of licensed capacity (70% for 7/1/2023-6/30/2025). Homes below 85% lose that share of those costs. Direct care and support costs use actual days. Capital instant relief add-ons also use 85%. Hospital-based homes use actual days for everything.

Source

https://www.legis.iowa.gov/docs/iac/chapter/441.81.pdf

Verified October 11, 2026

Published rates and changes

How often rates change

A home's rate changes

semiannual

When

January 1 and July 1: each home's direct care component is re-multiplied by its new Medicaid day-weighted CMI from the prior two quarters' rosters (e.g. Q1-Q2 2026 rosters -> 1/1/2027). Full rebasing (new cost reports, medians, inflation) every second July 1 (last 7/1/2025). Provider-tax tier set each July 1 from June 1 data.

Verified October 11, 2026

When rates change

July 1 state fiscal year (rebasing in odd years: 2023, 2025, 2027) plus a January 1 case-mix update. Mid-period changes come from capital add-ons (first day of the quarter after assets are placed in service) and new facilities/CHOWs (a new owner keeps the prior owner's rate).

Verified October 11, 2026

Posted rates

Home-level rates published

Yes

Where

https://hhs.iowa.gov/medicaid/plans-programs/iowa-health-link…

Format

xlsx (Cumulative Rate Listing/Posting: separate tabs for freestanding, hospital-based and special population homes, each 'without QAAF' (base) and 'with QAAF' (payment rate)); PDPM weight files by quarter (Medicaid and facility CMI)

Cadence

Semiannual (Jan 1 / Jul 1); quarterly before the PDPM move.

History

Cumulative listings go back to 7/1/2014 rates; case-mix history from 1/1/2004 in older 'Cumulative Case Mix' files; quarterly RUG-era files posted for 2019-2023.

Home identifier

NPI plus provider name (no CCN). Case-mix rosters in IMPA use the Iowa facility ID (IAxxxxx), TIN and NPI.

Verified October 11, 2026

Rate build-ups

Published

No

Where

No per-facility build-up posted. The rate page posts base and with-QAAF totals and PDPM CMI files (Medicaid days, Medicaid avg CMI, facility days, facility avg CMI). Per-resident case-mix rosters are in IMPA (provider login). Older periods had a 'Final Rate Summary' xlsx per quarter.

What they show

Cumulative Rate Posting: base rate and payment rate (with QAAF) per home per period. PDPM weights file: Medicaid/facility days and day-weighted CMIs by quarter. Not shown: per-home cost per day, medians, caps, or the direct/non-direct split.

Format

xlsx

Example file

https://hhs.iowa.gov/media/18975/download?inline

Verified October 11, 2026

Recent changes

Verified October 11, 2026

Assisted living

Medicaid assisted living

Covered

yes

Program

HCBS Elderly Waiver (1915(c); IAC 441-83 Division II, 441-78.37), age 65+, nursing facility level of care. Delivered through IA Health Link MCOs for enrolled members. Assisted living programs are certified providers.

What is paid

Services only: consumer-directed attendant care delivered by an 'assisted living program' provider, plus 'assisted living on-call' service. Room and board are paid by the resident.

Rate

IAC 441-79.1(2): Elderly-waiver assisted living program CDAC is a fee agreed by member and provider: the provider's 6/30/2024 rate + 4.1%, converted to 15-minute units; if no prior rate, $6.02 per 15 minutes, not to exceed $139.18/day (eff. 7/1/2024). Assisted living on-call: $29.31/day.

Limits

Waiver slot limits per the CMS-approved waiver; waiting lists apply when the cap is reached (IAC 441-83). The current Elderly Waiver monthly cost cap was not found in the 2026 rule text.

Source

https://www.legis.iowa.gov/docs/iac/chapter/441.79.pdf

Verified October 11, 2026

Sources

1. Iowa Administrative Code 441-Chapter 81 Nursing Facilities (IAC 6/10/26) · regulation
2. IAC 441-Chapter 79 (79.1(2) provider reimbursement table) (IAC 9/2/26) · regulation
3. IAC 441-Chapter 36 Facility Assessments (NF quality assurance assessment) · regulation
4. Iowa Code chapter 249L Nursing Facility Quality Assurance Assessment Program (Code 2026) · statute
5. Iowa Medicaid State Plan Attachment 4.19-D (NF methods; TN IA-23-0013, IA-24-0004, IA-23-0009) · state plan
6. Iowa Medicaid State Plan Attachment 4.19-C Payments for Reserved Beds · state plan
7. Iowa HHS Nursing Facility Rates page · agency page
8. Cumulative Rate Posting (rates 7/1/2025, 1/1/2026, 7/1/2026; base and with QAAF) · rate file
9. PDPM Rate Weights 3.31.2026 (facility and Medicaid day-weighted CMI by quarter) · rate file
10. Iowa Medicaid QIO: PDPM Day Weighted Methodology for Case Mix Classification · agency page
11. Case Mix Index (CMI) training slides, Sept 17, 2026 · agency page
12. 2026 Case Mix Important Dates · agency page
13. Nursing Facilities Quality Assurance Assessment Fee Usage Report (Aug 2024) · agency page
14. Nursing Facilities Private Room Supplementation Report (May 2025) · agency page
15. 2025 Iowa Acts House File 1049 (HHS appropriations, FY2026): §12 QA trust fund, §15 NF rebase/PDPM, §16 methodology proposal, §§18-19 PNA · statute
16. ARC 9279C (rescind/readopt ch. 81, eff. 7/1/2025; $37 add-on; therapy to non-direct with PDPM) · regulation
17. ARC 6934C (QIPP for non-state government-owned NFs, eff. 5/1/2023) · regulation
18. ARC 6935C (major renovation threshold $750,000; Medicaid utilization calc, eff. 5/1/2023) · regulation
19. ARC 9859C (PNA $50 -> $55, eff. 2/1/2026) · regulation
20. IA Health Link SFY2026 Managed Care Rate Development (CBIZ Optumas) · agency page
21. Iowa Total Care contract MEDIOMC26002 (§D.1.12 Mandatory Rates) · agency page
22. Iowa HHS Contracts & Rates page (MCO contracts, rate certifications) · agency page
23. IAC 441-Chapter 83 HCBS waivers (Elderly Waiver, IAC 5/27/26) · regulation
24. IAC 441-Chapter 73 Managed Care (IAC 5/27/26) · regulation

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