Iowa Department of Health & Human Services Forms

This form is used for providers in Iowa who are applying for the Iowa Medicaid Universal HCBS Waiver.

This Form is used for self-assessment of family child care environments in Iowa, based on the Family Child Care Environment Rating Scale - 3rd Edition.

This document is for improving the Child Development Home Program in Iowa. It outlines a plan to enhance the quality and effectiveness of child development services provided in home settings.

This form is used for Iowa Medicaid recipients to track and claim reimbursement for mileage costs related to medical appointments or treatments.

This document provides instructions for preparing a financial and statistical report for the state of Iowa. It outlines the necessary information and format required for accurately completing the report.

This form is used for requesting managed care wraparound payments in Iowa.

This document is a consent form used in Iowa for the Money Follows the Person program. It is used to grant consent for a proposed transition of an individual to a different living arrangement.

This form is used for obtaining consent from a guardian in Iowa for a person to participate in transition planning under the Money Follows the Person program.

This Form is used for evaluating the functional needs and acuity scores of individuals seeking Early Periodic Screening Diagnosis and Treatment (EPSDT) services in Iowa.

This form is used for Early Periodic Screening Diagnosis and Treatment (EPSDT) in Iowa. It is specifically for assessing social needs acuity using the Scoring Tool (SNAST).

This document is used to provide referral information for the Money Follows the Person program in Iowa. It helps individuals who are transitioning from institutional care to community-based services.

This form is used for consenting to begin transition planning under the Money Follows the Person program in Iowa.

This form is used for the Home- and Community-Based Services (HCBS) Consumer-Directed Attendant Care (CDAC) Agreement in Iowa.

This form is used to authorize the recording and use of multimedia content in Iowa.

This type of document is used for reporting suspected child abuse in Iowa.

This Form is used for individuals in Iowa to apply for the Disaster Assistance Subsidy Program (IIAGP).

This document is for requesting a waiver for the payment of non-essential services in the Iowa Lihwap Program.

This Form is used for the Medicaid/Hawki Review process in the state of Iowa. It helps individuals apply for or renew their eligibility for these healthcare programs.

This Form is used for Medicaid and State Supplemental Review in the state of Iowa.

This form is used for Chronic Condition Health Home Managed Care Organizations (MCOs) to notify the state of Iowa about their services and activities.

This document is used for conducting background checks for evaluation purposes in Iowa.

This Form is used for authorizing the disclosure of information about child or dependent adult abuse in Iowa.

This form is used for reporting changes in Medicaid or Hawki coverage within 10 days in Iowa.