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Iowa Health and Wellness Plan
Maddisen Kies,
Communications Analyst
Iowa Medicaid Enterprise
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One Plan, Two Options
Iowa Wellness Plan• For adults age 19 - 64• Income up to and including 100% of the Federal Poverty Level
Marketplace Choice Plan• For adults age 19 - 64• Income 101% to no more than 133% of the Federal Poverty Level
Quick Facts• Administered by Iowa Medicaid
• Uses Iowa Medicaid provider network
• Offers comprehensive set of benefits
• Uses a primary care case management (PCCM) program, referred to as managed care
• Primary Care Patient Manager, or primary care provider (PCP) coordinates care and referrals for the member
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Iowa Wellness Plan: 0-100% FPL
Member Enrollment• Iowa Wellness Plan members have 1,500 primary care
providers available, in addition to other contracted Medicaid providers
• All members have access to local providers (doctors, hospitals, pharmacies, etc.)
• In 87 counties, members will be assigned to a primary care physician of their choice in their county (where approx. 94% of members live)
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Iowa Wellness Plan: 0-100% FPL
Provider Incentives: Physician is contracted similar to MediPASS (current managed care program)• Primary Care Physician (PCP) is eligible to earn four
additional types of payments above the regular fee-for-service payment
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Iowa Wellness Plan: 0-100% FPL
Primary Care Case Manager Monthly
Payment
Wellness Exam Incentive
Wellness Plan Medical Home
Value Index Score Bonus
HRA Incentive for Incorporation Into
Care Plan
$4 Per Member Per Month (PMPM)
$10 Per Member Annually
Up to $4 Per Member Per Month
(PMPM)
$25 Per Member Annually
Quick Facts• Members select a certain commercial health plan
available on the Health Insurance Marketplace
• Medicaid pays the premiums to the commercial health plan on behalf of the member
• Offers comprehensive set of benefits
• Commercial health plans available to members are CoOportunity Health and Coventry Health Care of Iowa
• Uses the commercial plan’s statewide provider network
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Marketplace Choice Plan: 101-133% FPL
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Medically Exempt
• Members who are considered ‘Medically Exempt’ must be given the option of enrolling in regular State Medicaid Plan or Wellness Plan
‘Medically Exempt’ includes individuals with disabling mental disorders (including adults with serious mental illness), individuals with chronic substance use disorders, individuals with serious and complex medical conditions, individuals with a physical, intellectual or developmental disability that significantly impairs their ability to perform 1 or more activities of daily living, or individuals with a disability determination based on Social Security criteria
• Medicaid has a process to screen for Medically Exempt members, both at enrollment, after enrollment, and through provider referral
Healthy Behaviors Program
Healthy Behaviors Program Brand
New branding exclusively for the Iowa Health and Wellness Plan
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Healthy Behaviors Program GoalsEngage providers and develop plan of care with primary care provider
Meet federal requirement (CMS) for program
Healthy Behaviors Program
• Members take active role in their health care
• Helps waive any possible contribution (premium) for the next year of enrollment
Physical Exam
Health Risk Assessment
No Premium in 2015
Healthy Behaviors Program• Members have 12 months to complete Healthy
Behaviorso Enrolled in January 2014, have until January 2015o Enrolled in April 2014, have until April 2015
• Contribution amount if activities not completed:o Wellness Plan (50-100% FPL): $5 per montho Marketplace Choice Plan (101-133% FPL): $10 per
month
• Identify the member’s primary care providero Make sure member keeps appointmento Any wellness exam since the beginning of their eligibility
qualifies, if billed correctly
• If unknown, member can:o Call Iowa Medicaid Member Services at
1-800-338-8366 (8-5, M-F)o Member Services can share provider and phone #
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Wellness Exam
Health Risk AssessmentWellness Plan Members1. Using tool called Assess My Health
• AssessMyHealth.com
2. Can be completed online or by phone• By phone through IME Member Services
3. Member gets 5-digit code from their provider, enters code on assessment
Assess My Health• 8th grade reading level• Available in English or Spanish• Takes 15-40 minutes• Asks questions about health
o Additional questions based on health conditions
Assess My Health
Assess My Health
Health Risk AssessmentMarketplace Choice Plan Members• CoOportunity Health members should use their
assessment: www.cooportunityhealth.com • Coventry members should use their
assessment: www.coventryhealthcare.com • Can also use Assess My Health if the member
prefers
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Comm.
Action Agenc
ies
Community Social Service Agencies
United Way
Public Health Depts / WIC
Counties / Local Health Organizations
Food Banks / Homele
ss Shelters
Agencies Serving Low Income Adults
Churche
sFaith-Based Organizations
CAC’s & Navigators
IME Provides Training and MaterialsCommunity Based Organizations as
Intermediaries
Health and Wellness Plan Members
Accountable Care Organizations & Medical Homes
Healthy Behaviors Outreach Campaign Strategy
Member Campaign• All members received a letter and flyer end of
May• Ongoing communications beginning in
September, continuing throughout the year• Active community outreach, events, educational
forums
Outreach Support• Provider Toolkit Available: http://
dhs.iowa.gov/sites/default/files/Provider%20Healthy%20Behaviors%20Toolkit_05092014_0.pdf
• Stakeholder toolkit and other resources coming• Event ideas, support or collaboration
opportunities, contact: [email protected]
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Application Process
APPLICATION
PROCESS
DHS Contact Center
1-855-889-7985
Federal Health Insurance
Marketplacewww.HealthCare.go
v
DHS websitedhsservices.i
owa.govDHS Local Offices
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Information
Find up-to-date information onthe Iowa Health and Wellness Plan at:
http://dhs.iowa.gov/ime/about/iowa-health-and-wellness-plan
Member Site:www.iahealthlink.gov
