100%

HOME Expression of Interest

Questions marked with a * are required
HOME Expression of Interest
We want your input! Participate in a feedback session about HOME 
Iowa HHS is rebuilding its community-based services (CBS) to support Medicaid members in finding Hope and Opportunity in Many Environments (HOME). 

Our goal is to enhance services, allowing people to remain in their communities with their loved ones, and making it easier for them to access the help they need. 

Who We Want Input From 
We want input from various groups of Iowans, including: 
- People who receive CBS, caregivers, and advocates 
- CBS service providers 
- Case managers and supervisors 
- Community-based organizations and advocacy groups 

Together, we can make a difference and create a HOME that supports health, social connection and quality of life. 
If you would like to provide feedback, please fill out this form about topics that matter to you, when and how you prefer to give your feedback and the best way for us to contact you about next steps. 
1. Which topics are you most interested in discussing? Check all that apply.
2. Which ways would you be willing to provide feedback? Check all that apply.

For virtual meetings, you will need access to a phone (at a minimum) or access to an internet connection that can handle video (preferred).  
For in person meetings, you will need to arrange transportation. 
For online surveys or public comment, you will need access to an internet connection. 
3. In addition to us collecting feedback, HHS may travel to your community to provide updates on our work. If HHS leadership, like Iowa Medicaid Director - Elizabeth Matney or Behavioral Health and Disability Services Director - Marissa Eyanson, traveled to your community for an in-person update, would you be interested and able to attend in person?
4. When are you most available to participate in a feedback session? Check all that apply. 
We will aim to schedule activity during time(s) that meet the needs of most Iowans. 
5. What is your perspective? I am a(n) _______.  Check all that apply.
6. If you selected "Other" what perspective do you bring related to HCBS or CBS? Provide a brief answer. 
7. If you are a provider, please tell us the name of your organization.
8. If you are a case manager or case management supervisor, please tell us the name of your organization.
9. If you are a person who uses a Medicaid HCBS waiver, or a caregiver for someone who uses one, which waiver(s)? Check all that apply. 
10. If you are on a waitlist for an HCBS waiver, which waiver(s)?
11. Please let us know if it is ok to contact you about a feedback session(s) or other updates about our work by providing contact information below. Checkall that apply. Note, we will only use contact information to contact you about participation in feedback sessions and other HOME updates.
12. What is your first and last name?
13. What is your email address?
14. What is your phone number (###-###-####)? 
15. What is your zip code?
Powered by QuestionPro