In August, 2017 the state submitted a waiver amendment request to CMS seeking a waiver of retroactive coverage. The amendment is currently awaiting federal approval.
The Iowa Health and Wellness Plan was began January 1, 2014 and is approved through December 31, 2019. The state was granted an amendment December, 2015 to its original program on that made significant changes to the original waiver. In 2017, the state asked to waive retroactive eligibility. That request was approved effective November 1, 2017.
The Iowa Health and Wellness Plan covers childless adults in the Medicaid expansion population (19-64) who make less than 138 percent of the federal poverty level, or about $16,000 per year for a single person.
Premium Assistance (Private Option)
Initially, the Iowa waiver included a premium assistance component, where enrollees over 100 percent of poverty were able to choose between a Qualified Health Plan in the marketplace (paid for by the state) or coverage through the traditional Medicaid program. The state’s 2015 amendment removed the marketplace options, with all enrollees receiving coverage through traditional Medicaid. Learn more and get advocacy strategies to combat the private option.
All enrollees with incomes above 50 percent of poverty are required to pay monthly premiums. The premium is $5 per month for those between 50 and 100 percent of poverty and $10 per month for those above poverty. Enrollees who do not pay premiums within a 90 day non-payment grace period will be disenrolled, and unpaid premiums will be considered a collectable debt owed to the state. Individuals can re-apply for coverage at any time. Those between 50 and 100 percent of poverty cannot be disenrolled, but unpaid premiums can be considered as a collectible debt owed to the state. Enrollees who do not pay premiums cannot be disenrolled. Learn more and get advocacy strategies to combat premiums.
Iowa received approval to waive non-emergency medical transportation benefits. Learn more and get advocacy strategies.
Enrollees who complete certain healthy behaviors in their first year of enrollment will have premiums waived the following year. For every year of enrollment, enrollees who complete the specified healthy behaviors will have premiums waived the following year. Learn more and get advocacy strategies to combat wellness programs.
- Impact on oral health: Adults with incomes over 50 percent of poverty pay additional premiums for comprehensive dental coverage starting in their second year of enrollment. If they adhere to oral health specific healthy behaviors (like getting preventive dental care) in the prior year, however, they are not charged premiums in the second or later years; if they owe unpaid premiums, they receive more limited dental benefits.
Effective 11/1/17 CMS approved the state’s request to waive 3-month retroactive eligibility except for pregnant women and infants under 1 year of age. Learn more and get advocacy strategies to combat retroactive eligibility.