Iowa Consumer Choices Option: How to Get Paid as a Family Caregiver

You quit your job eight months ago to take care of your mother full-time. You're bathing her, managing her medications, cooking three meals a day, doing laundry, and driving her to appointments. You're doing the work of a paid home care aide — for free — and your savings are running out.

Iowa has a legal pathway for family members to get paid for this caregiving through Medicaid. But the program structure changed significantly at the end of 2025, and most families are working with outdated information.

What Changed: ICDAC Ended December 31, 2025

The Individual Consumer-Directed Attendant Care (ICDAC) program — where the Iowa Medicaid Enterprise directly managed individual provider enrollment — ended on December 31, 2025, due to federal tax compliance issues. If you've been searching for ICDAC information and hitting dead ends, this is why.

The primary self-directed pathway for 2026 is Consumer Choices Option (CCO). Current CCO onboarding still involves MCO care-plan authorization and may use the HCBS CDAC Agreement, but CCO is the pathway in which the care recipient acts as employer of record.

Current CCO onboarding generally works as follows:

1. The Elderly Waiver recipient requests self-directed care through the MCO case manager
2. The chosen caregiver completes enrollment through Iowa Medicaid Enterprise and passes a mandatory background check through the Direct Care Worker Registry
3. The care recipient and caregiver complete Form 470-3372 (HCBS CDAC Agreement) when the MCO requires it
4. The MCO approves the agreement and authorizes hours based on the care plan
5. Veridian Fiscal Solutions handles CCO payroll, taxes, and workers' compensation

CCO: The Self-Directed Employer Model

The Consumer Choices Option gives the care recipient more control — they act as the employer of record. A fiscal management service (currently Veridian Fiscal Solutions in Iowa) handles payroll, tax withholding, and compliance.

Under CCO, the recipient receives a monthly budget allocation based on their assessed needs. They decide:

• Who to hire (including family members, excluding spouse)
• What hours they work
• What tasks they perform (within the care plan scope)

The 2026 caregiver rate under CCO is $4.03 per 15-minute unit (billing code T1019). That works out to approximately $16.12 per hour before taxes. Veridian handles payroll deductions, workers' comp, and tax filings.

How to Enroll

For CCO:

1. Request CCO enrollment through the MCO case manager
2. Complete the caregiver's IME enrollment and mandatory Direct Care Worker Registry background check
3. Complete Form 470-3372 if the MCO requires the HCBS CDAC Agreement
4. Complete Veridian Fiscal Solutions' employer orientation and training
5. Set up the employer-employee relationship with your chosen caregiver
6. Veridian processes payroll based on submitted time records

The MCO case manager guides the enrollment, authorizes the care-plan hours, and coordinates the transition to Veridian. CCO is the primary self-directed pathway for 2026.

What You Need to Know About Taxes

Under CCO, Veridian handles payroll withholding, workers' compensation, and tax filings. The caregiver should still keep records and seek tax advice if their circumstances are unusual.

Some family caregivers qualify for the "difficulty of care" income exclusion under IRS Notice 2014-7 if the care recipient lives in the caregiver's home. Consult a tax professional — this exclusion can significantly reduce your tax burden.

Ongoing Requirements

Once enrolled, caregivers must:

• Record daily services using the applicable CCO record; the MCO may require Form 470-4389 (CDAC Daily Service Record)
• Submit timesheets monthly (payment is processed the month after services are rendered)
• Participate in annual care plan reviews with the MCO case manager
• Maintain current background checks

Missing timesheets or late submissions delay payment. Set a monthly schedule for paperwork to avoid gaps.

The Iowa home care guide includes the complete CCO enrollment checklist, the CDAC Agreement walkthrough used in CCO onboarding, and a billing and timesheet guide for family caregivers.

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