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Title 8: Medicaid Page 68 Iowa Department of Health and Human Services Employees’ Manual Chapter E: Income Non-MAGI-Related Deductions Revised May 22, 2026 Deduction for Impairment-Related Work…  Rentals or leases. Deduct the actual monthly rental or lease charge. Attendant Care Services Legal reference: 20 CFR 416.976(c)(1) Deduct payments made for attendant care services if those services are needed in the work setting or to help the impaired person travel to and from work. “Attendant care services” are types of physical assistance that help an impaired person meet essential personal needs at home or at work. Deduct the payments made for attendant care services in the home only when the services relate to preparations for going to or returning from work. Examples include services relating to bathing, dressing, cooking, eating, administering medications, or arranging medical devices right before or after the impaired person’s workday. The services generally require no more than one or two hours each morning or evening. Do not deduct payments made to family members for attendant care services unless:  The client can show that the family member has suffered economic loss by reducing or terminating employment to provide the care, and  The payment to the family member is made in cash. A family member is anyone related by blood, marriage, or adoption, whether or not the person lives with the impaired person. An attendant assists a client in getting ready and traveling to work for approximately one hour per day and assists the client with laundry, housecleaning, and other non-work-related services for approximately three hours per day. The worker deducts only one-fourth of the total payment to the attendant as an impairment-related work expense.