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Iowa Medicaid HCBS Supported Community Living Provider
Iowa Medicaid HCBS SCL Provider
Home
About Us
Services
Our Planning Process
Quality Assurance
Intake & Onboarding Process
Referral
Home
About Us
Services
Our Planning Process
Quality Assurance
Intake & Onboarding Process
Referral
Contact Us
Refer a Client
First Name
Last Name
Date of Birth
PMI Number
Phone Number
Email
On Medical Assistance (MA)?
YES
NO
On a Waiver? (CADI, EW, DD, BI)
YES
NO
NOT SURE
Care Needs & Preferences
Describe Functional or Cognitive Support Needs
Is the client currently in a facility?
YES
NO
NOT SURE
Current Facility Name (if any)
Desired Move-in Date
Furnished Unit Needed?
YES
NO
Case Manager Information
Full Name
County or Agency
Phone Number
Email Address
Will this Case Manager remain involved in ongoing care coordination?
YES
NO
NOT SURE
Submit Application
