Seniors in Iowa make up 17.1% of the population – a slightly higher proportion compared to the nation – and this has increased by over 2% in the last decade. The state’s low population density and high scores on important health metrics may be contributing to the longevity of its residents. Iowa has a higher air quality rating than surrounding states and the country as a whole, which significantly reduces the risk of respiratory illness and cancer, and its water quality index is also above average.

Many Iowans will require residential care at some point, and there are an increasing number of facilities available to provide it. Iowa is moderately priced in terms of senior living. For example, assisted living, with a monthly average cost of $4,078 is close to the United States average of $4,051, according to the Genworth Cost of Care Survey 2019.

This guide is intended to help seniors in Iowa discover the costs of senior living and other long-term care in the state. It also covers financial assistance programs, facility regulations and common questions.

The Cost of Senior Living in Iowa

Note: There currently isn’t authoritative data on the average cost of Independent Living Facilities nationwide, so instead, we use the cost of Assisted Living to estimate it. Since the cost of Independent Living is typically 30-40% lower than the cost of Assisted Living, the numbers below were calculated by subtracting 35% from the cost of Assisted Living.

Note: Memory care is typically provided in communities licensed as assisted living facilities, and in general, costs 20-30% more than standard assisted living services. No authoritative cost data is available for this type of care, so we estimated memory care rates by adding 25% to assisted living fees in the Genworth 2021 Cost of Care Survey.

Seniors have many options for affordable care in the Hawkeye State. Independent living communities have the lowest costs but may not be adequate for seniors who require some type of assistance with their daily activities. Assisted living facilities fulfill this role by employing caregivers who offer help with everything from light housekeeping and medication reminders to bathing and grooming. Meals, activity programs, transportation and other amenities are usually included as well. 

A higher level of care focused on residents with Alzheimer’s disease and other cognitive impairments is available within memory care settings, which may be part of an assisted living facility. Nursing homes are for seniors who require a high level of supervision and medical attention around the clock. This requirement makes nursing homes the most expensive type of care at $6,874 per month. Cost information comes from the Genworth 2021 Cost of Care Survey.

The Cost of Assisted Living in Iowa

The median rate for assisted living in Iowa is $133 less than the national average of $4,500. Many other states in the region have costs similar to the national average, including Minnesota, Illinois and Wisconsin. The average price for this type of care in Missouri is $3,000 per month, making it the least expensive state bordering Iowa. In the Cornhusker State, Nebraska, families pay an average of $4,076 for assisted living. 

The Cost of Nursing Home Care in Iowa

Nursing homes in Iowa have an average cost of $6,874, which is about $1,000 less than the national average. There is a wide variation in nursing home costs among the states bordering Iowa. Missouri has a median rate of $5,262, and Minnesota has an average of $11,601, a difference of $6,339 per month. Wisconsin ($9,022) and Nebraska ($7,483) both have more expensive nursing homes than Iowa. Illinois is less expensive, but not by a large margin. 

Can You Use Medicaid to Pay for Senior Living in Iowa?

Despite Iowa’s affordable senior living costs, it can be difficult for seniors and families to pay for long-term care. Medicaid helps individuals and families access the care they need by covering the cost of many important services. Since Medicaid is designed to cover health expenses, it does not reimburse the cost of room and board except in some specific circumstances, such as in nursing facilities. That’s why seniors will not be able to use Medicaid to cover residency in an independent living community. 

Iowa Medicaid does not cover the complete cost of assisted living in Iowa. It can reduce the overall cost burden by helping pay for some of the services within these communities, such as assistance with daily activities. While Medicaid does not explicitly cover memory care services, many of the supports offered in these settings may be funded by PACE or the Elderly Waiver. 

Iowa Medicaid is obligated to directly pay for nursing home care, including room and board, that residents are not able to cover with their own income or assets. There are no coverage limits for skilled nursing facilities. 

	Medicaid Coverage Level	Type of Medicaid Coverage	Entitlement?*
Assisted Living	Partial	Medicaid Waivers	No
Independent Living	None	N/A	N/A
Memory Care	Partial	Medicaid Waivers	No
Nursing Home Care	Full	Medicaid	Yes

*Note: Entitlement programs mean that everyone who qualifies will receive coverage and be accepted into the programs. If the program is not “entitlement,” then participant caps could be in place, and there may be a waiting list.

Medicaid’s Coverage of Assisted Living & Memory Care in Iowa

Iowa Medicaid can cover some services provided within assisted living and memory care through PACE and Home- and Community-Based Services. PACE is a joint operation funded by Medicare and Medicaid, while HCBS waivers are part of Medicaid. In both programs, residents of assisted living facilities and memory care units will be responsible for paying for room and board.

Program of All-Inclusive Care for the Elderly (PACE)

PACE is a managed care program provided by IA Health Link, one of the three main branches of Iowa’s Medicaid system. PACE members must be at least aged 55 or older, live in a PACE-designated county and must require a nursing home level of care. If the applicant is already a member of Medicare, they do not need to sign up for Medicaid. This program covers long-term care services when necessary, but the main goal is to give seniors health care at PACE Centers. Therapists who work with seniors who have cognitive impairments may be available to provide service in a community setting. The enrollment process for PACE is provided by a PACE enrollment coordinator.

Elderly Waiver

The Home- and Community-Based Services Elderly Waiver funds supportive services for older adults so they can stay in their community setting, such as an assisted living facility or memory care unit, rather than institutionalization. Apart from Iowa Medicaid eligibility, applicants must demonstrate a need for a nursing home level of care through an assessment. The waiver can cover the following services:

• Assisted living service and devices
• Emergency response systems
• Case management
• Mental health outreach
• Senior companions
• Transportation
• Nursing care
• Consumer-directed attendant care (CDAC)

The services provided for the Medicaid beneficiary are determined by an interdisciplinary team consisting of case managers, community organizations, community-based case managers, service providers and family. To apply for services, a senior or representative must contact DHS personnel to arrange an assessment. The process may involve income maintenance workers or DHS case managers. Applicants can call Medicaid Members Services at (800) 338-8366 for assistance.

DHS requires that these services must be cost-effective, which translates to $1,365.78 per month for nursing level of care and $2,792.65 per month for skilled level of care.

Medicaid’s Coverage of Nursing Home Care in Iowa

IA Health Link Managed Care Programs help cover the cost of nursing home care that the resident is unable to afford. Residents are required to use most of their income to cover the cost of care, but a small monthly allowance can be used for some personal needs. This may not be true for income earned from other benefits, such as the Family Investment Program (FIP). PACE may also cover some of the costs of nursing homes in Iowa.

Eligibility for Medicaid in Iowa

Iowa Medicaid is intended for low-income residents, so eligibility is largely determined by income and asset limits. A single person can own $2,000 in assets and earn $30,276 per year or less. When only one person in a married couple applies, they have the same limitations. When a couple applies for benefits, they can earn $60,552 per year and own $3,000 in assets. Applicants who already receive SSI benefits are automatically eligible for Medicaid.

2022 Iowa Medicaid Income Limits 

	Income Limits*	Asset Limits
Single Person	$30,276	$2,000
Two-Person Household(Only one applicant)	$30,276	$2,000 for the applicant$137,400 for non-applicant
Two-Person Household(Two applicants)	$60,552	$3,000

*per year

If an applicant meets income eligibility, they must also meet the following requirements to get approved for Medicaid:

• US citizenship or legal resident status
• Iowa residency
• Be blind or disabled if under the age of 65

Applying for Medicaid in Iowa

Seniors in Iowa have several ways to apply for Medicaid. The state encourages families to apply online through the DHS Services Portal, which offers a quick application process and eligibility prescreening. Residents can apply in person by visiting any local DHS office or other organizations that provide application assistance. They can print a paper application and mail it to the address in the instructions. The application can also be faxed or emailed to DHS. Seniors who want to apply over the phone can call (855) 889-7985.

Before You Apply

Before applying for Medicaid, applicants must demonstrate their economic and medical need for coverage. You may need some of the following documents or pieces of information when applying:

• Social Security card
• Financial records
• Title XIX card
• Personal information, such as addresses and phone numbers
• Existing insurance information
• Verification of Supplemental Security Income (SSI), if applicable

How to Get Help

Seniors in the Hawkeye State can get help with their Medicaid benefits by contacting the following organizations. These organizations assist with applications, appeals of unfair claim denials and locating supplemental benefits. 

	Contact	What You Should Know
Benefits.gov	Online Only	This federally run website provides detailed information about Medicaid in Iowa, including eligibility criteria, covered services and application information. Families can also use this site to find benefits that cover care not offered by Medicare or Medicaid.
Iowa Legal Aid	(800) 532-1275	Iowa Legal Aid helps seniors and families understand their rights within the Medicaid system and in long-term care communities. Iowa Legal Aid may be able to offer pro bono legal representation to seniors who have been unfairly denied government benefits, including Medicaid.
DHS Contact Center	(855) 889-7985	Seniors can call the DHS Contact Center to begin their application for PACE or the Elderly Waiver. They can also use the number to get updates about their application status and get answers to any questions they might have about their benefits.

Can You Use Medicare to Pay for Senior Living in Iowa?

Unfortunately, Medicare does not cover the cost of assisted living, independent living, or memory care. Unlike nursing homes, these care types are not considered to be “clinical settings” and so are not eligible for Medicare coverage. That being said, those who live in these communities can still use Medicare to cover the cost of approved medications, doctor visits, medical equipment, etc.

When it comes to nursing home care, it gets much more complicated. Medicare does provide limited coverage for a qualified stay in a nursing home,but there are strict rules and requirements of which you should be aware. This benefit is available to seniors who have been hospitalized for at least three days, excluding the date of discharge.

Once you’ve met the hospitalization requirement, Medicare will pay for up to 100 days in a skilled nursing facility (per benefit period). While the first 20 days are covered in full, there is a daily coinsurance rate that must be paid starting on day 21. After day 100, seniors are responsible for the entire cost.

	Medicare Coverage	Medicare Coverage Duration	Coinsurance Requirement?
Assisted Living	None	N/A	N/A
Independent Living	None	N/A	N/A
Memory Care	None	N/A	N/A
Nursing Home Care	Limited	100 Days Per Benefit Period	Yes – After 20 Days

What Nursing Home Care Services Does Medicare Cover?

Medicare covers a number of specific services, including:

• Meals
• A semiprivate room
• Medications
• Skilled nursing services
• Physical therapy
• Occupational therapy
• Speech therapy
• Audiologist care
• Medical supplies
• Medical social services
• Nutritional counseling
• Ambulance transportation

What Nursing Home Care Services Aren’t Covered by Medicare?

Medicare does not cover long-term custodial care that addresses seniors’ day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.

Medicare Support & Resources in Iowa

Medicare is a complex benefits system that can be hard to navigate, but the following resources are available for free assistance with everything from applications to supplemental coverage options.

Resource	Contact	What You Should Know
Senior Health Insurance Information Program (SHIIP)	Office Locations	The Iowa Insurance Division operates SHIIP, a free, unbiased and confidential service that helps seniors in the state with their Medicare benefits. The services are delivered by trained and certified volunteers. The Insurance Division also runs the Senior Medicare Patrol (SMP). SHIIP and SMP counselors are located throughout the state.
Iowa State University Extension and Outreach	(800) 447-1985	The Finances of Caregiving is an educational workshop that helps Iowa families plan for long-term care. It includes information about getting the most out of Medicare and other public benefits. It also covers legal topics, such as wills, trusts, long-term care directives and living wills. The university hosts a Financial Concerns Hotline to help seniors and families with urgent financial matters.
Medicare.gov	(800) 633-4227	Seniors in independent living, assisted living and other long-term care communities can find health care providers that accept Medicare in their area through this federal website. Information about supplemental coverage, prescription drug plans and local services is available on the website and Medicare hotline.

Are There Other Financial Assistance Options for Senior Living in Iowa?

Depending on your unique situation, there may be other financial assistance options to partially or fully cover the cost of senior living in Iowa. Below, we cover some of the common ways that seniors can make senior living options such as assisted living or memory care more affordable.

	Contact	What You Should Know
Aid and Attendance	Apply online at va.gov.	If you are a veteran and you receive a VA pension, you may also be eligible for the Aid and Attendance benefit. This benefit takes the form of a monthly cash allowance that you receive in addition to your standard pension. This benefit is used by veterans who need long-term care services, including care received at an assisted living facility.
Reverse Mortgages	Research and learn about the different types at ftc.gov.	If you own a home, you may be able to use a reverse mortgage to access some of the equity in your home. Like traditional loans, reverse mortgages do need to be repaid with interest, typically within 12 months, so seniors should carefully weigh this option alongside other financing methods.
Long-Term Care (LTC) Insurance	Learn about how to receive LTC insurance benefits at acl.gov.	While those who currently need assisted living will typically not be eligible, if you purchased an LTC insurance policy in the past, you may be able to use it to help pay for assisted living. While most policies cover at least a portion of the cost, you still need to check the specific terms of your policy.

Free Senior Living Resources for Seniors in Iowa

The following organizations offer free assistance and services to seniors throughout Iowa who need help with assisted living, memory care, nursing homes and other types of long-term care.

	Contact	What You Should Know
AARP Iowa	(866) 554-5378	AARP Iowa advocates for the rights and interests of older adults in senior living by supporting age-friendly communities and hosting educational and charitable events. The Iowa Advocacy Action Dashboard keeps seniors up to date on issues affecting their lives. AARP offers low-cost membership that includes rewards and discounts, but membership is not necessary to access many of the organization’s valuable resources.
Iowa Department of Veterans Affairs	(515) 252-4698	VA pensions help many veterans pay for senior living, and benefits specialists at the state’s Department of Veterans Services help clients access those pensions. Specialists can also help older vets obtain Aid & Attendance and state programs when eligible. The department has offices in every Iowa county.
Office of the State Long-Term Care Ombudsman	(866) 236-1430	The objective of the Ombudsman Office is to improve care and quality of life for seniors in long-term care throughout Iowa. It resolves complaints for residents, educates seniors and families about long-term care, promotes volunteering in assisted living and advocates for the interests of long-term care residents at the government level. It also promotes the creation of resident councils and citizen organizations. Ombudsman services are delivered locally by Area Agencies on Aging.
Illinois Iowa Center for Independent Living	(309) 793-0090	This nonprofit organization advocates for residents who have physical and cognitive disabilities, including people who live in assisted living and memory care. It can help seniors apply for disability benefits, obtain housing and SNAP benefits, get free assistive devices and transition from a nursing home to a community or other independent setting.
Easter Seals Iowa	(515) 289-1933	Easter Seals is a nonprofit social services organization that can provide case management services for seniors who need long-term care in Iowa. The 24-Hour Supported Community Living program provides services that can help seniors stay in the community when at risk for institutionalization. Easter Seals offers brain health services that can supplement therapies and activities provided in memory care settings.

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 cms.gov. These rules apply to nursing homes and other types of senior living facilities. We’ve most recently updated this data on 2/8/2022, 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.

Visiting Loved Ones

Can I visit my relative in person if he/she wants emotional support from me?	Yes (Conditions Apply)
Can I visit my relative in person for end-of-life compassion care?	Yes
Will my loved one be required to self-quarantine after I visit him or her?	No
Do I need to wear PPE and/or a cloth mask if I do visit my relative in person?	Yes
Are Hairdressers and other non-medical contractors still allowed in senior living facilities?	Yes
Does the state recommend or require that senior living facilities assist families with setting up virtual visit alternatives?	Yes
Are visitors being screened for elevated temperatures?	Yes
Are visitors being asked questions about health, travel, and potential virus contact?	Yes

Outings and Group Activities

Are residents allowed to leave the facility for non-medical reasons?	Yes
Are residents of senior living facilities who leave and return required to self-quarantine?	No (Conditions Apply)
Are senior living facilities required to cancel all group outings?	No
Are residents still eating together in the dining hall?	Yes (Conditions Apply)
Are facilities still allowed to host group activities within the community?	Yes (Conditions Apply)

Safety Measures for Staff & Contractors

Are staff members and contractors being screened for elevated temperatures?	Yes
Are staff members and contractors being tested for Coronavirus?	Yes (Conditions Apply)
Are staff members and contractors being asked questions about health, travel, and potential virus contact?	Yes

Senior Living Laws and Regulations in Iowa

Note: All these rules typically apply to non-clinical senior living facilities, such as independent living, assisted living, and memory care facilities. Nursing homes and other senior living facilities with a clinical setting may have additional or slightly different requirements and regulations.

Senior living facilities in Iowa are regulated by the Department of Inspections and Appeals, Health Facilities Division (DIA-HFD). The rules governing senior living programs in the state can be read in full in Iowa Code chapter 231C, and a summary of important points is provided below.

Scope of Care

Senior living facilities help residents with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). This includes help with mobility, hygiene, eating and other everyday tasks. Medical care is also provided, either temporarily or intermittently, and only by appropriate health care staff. Senior living facilities cannot provide an excess of 28 hours of medical care in one week.

Occupancy Agreement

Staff must assess new residents within one month and develop an in-depth service plan, which is also known as an occupancy agreement. This agreement contains information on the resident’s cognitive and physical health, their specific needs and an individualized plan of care. Residents are monitored for changes and a review must be conducted at least once per year.

Memory Care Specific Regulations

Iowa facilities that care for people with dementia and memory loss must gain additional certification from the DIA-HFD to show accordance with state and national standards. The occupancy agreement of each resident must include a description of dementia-specific services and activities that are appropriate for their social and physical abilities. Staff must receive ongoing training that covers dementia.

Staffing Levels

Facilities must employ suitable staff to provide supervision, safety and security, and the staffing plan must factor in unscheduled needs. There is no specific ratio of caregivers to residents required. Staff must be able to respond to call lights and emergency systems at all times, and there must be at least one member on duty assigned to monitor residents. The senior living program must be managed by a registered nurse.

Staff Screening and Training

Employees of senior living facilities in Iowa must receive a satisfactory criminal background check, with proof kept on file. Nursing services may only be provided by relevant staff that are licensed by the state. Staff must be able to assist residents with activities of daily living and implement emergency procedures. Caregivers must be trained by a registered nurse employed by the facility within one month.

Prescriptions and Other Medication

By default, residents are allowed to manage their own medication, which includes storage and self-administration. Residents may be deemed unfit to self-administer by their legal representative or health care professional, or they may voluntarily delegate this responsibility to staff at any time. Senior living facilities that administer medications must employ a registered nurse to monitor for adverse reactions.

Medicaid in Senior Living

The Iowa Medicaid HCBS Elderly Waiver covers personal care received in a senior living facility, which can be arranged through the recipient’s managed care organization. The State Supplementary Assistance program may cover some senior living costs if the maximum funding on the HCBS Elderly Waiver has been met.

Frequently Asked Questions

How much does assisted living cost in Iowa?

The cost of assisted living in Iowa as of 2020 is an average of $4,078 per month, which is almost identical to the national average of $4,051. Sioux City is one of the more affordable cities, with a monthly average cost of $3,700, and Iowa City is one of the most expensive at $4,500.

Does Iowa Medicaid pay for assisted living?

Yes. Medicaid may help cover the cost of personal care provided to residents in assisted living if eligible for the HCBS Elderly Waiver, but it won’t cover the room and board portion of the bill. The State Supplementary Assistance (SSA) program detailed in this guide may provide additional Medicaid funding.

What are “Activities of Daily Living”?

Activities of daily living (ADLs) are regular everyday tasks that most people take for granted. It’s a broad category that covers mobility, such as getting in and out of bed or transferring to a wheelchair, as well as showering, toileting and eating.

What is the difference between assisted living and nursing homes?

In Iowa, and in most states, assisted living facilities aren’t licensed to provide permanent medical care. Nursing or skilled nursing facilities can provide permanent medical care, and they’re staffed appropriately to do so. Residents in assisted living are generally healthier and more active than those who require nursing care.

What types of amenities are commonly in assisted living communities?

The most common amenities in Iowa’s assisted living communities include housekeeping, laundry and linen, massage and physical therapy, library and computer rooms, as well as theaters and other entertainment areas.

Learn More About Senior Living in Iowa

For more information about specific types of senior living in Iowa read our Guide to Assisted Living and Independent Living.

The Top Cities for Senior Living in Iowa

Learn more about the cost of senior living in the top Iowa cities. Additionally, find reviews and information about assisted living facilities and other senior living communities across the state.