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Iowa Health and Wellness Plan
Rachel Johnson, MS, CHES
Member Communications
Iowa Medicaid Enterprise
2
Background
• Began January 1, 2014
• Iowans age 19 - 64
• Income up to and including 133% of the Federal Poverty Level (FPL)
• New, comprehensive program replaced the IowaCare program, which ended December 31, 2013
The Iowa Health and Wellness Plan was enacted to provide comprehensive health coverage for low-income adults
3
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
4
Goals and Objectives
Health/improved outcomes
Incentives for healthy behaviors
Emphasis on care coordination
Local access to care
GOALS
5
Member Eligibility
Member eligibility
12 months of covered benefits
Income re-verified for eligibility after a 12-month
period
6
Iowa Wellness Plan: 0-100% FPL
Family of one
$11,670
Family of two
$15,730
Individuals up to
100% FPL
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Iowa Wellness Plan: 0-100% FPL
Administered by Iowa Medicaid
Provides comprehensivehealth services
Coverage is equal to the benefits provided to state employees
Benefit Categories Covered
Physician services, including primary care
Outpatient services
Emergency room services and transportation
Hospitalization
Mental health and substance use disorder
Rehabilitative and habilitative services and devices
Lab services, x-rays, imaging (MRI, CT, etc.)
Preventive and wellness services
Home & community-based services
Prescription drugs
Dental services
8
Iowa Wellness Plan: 0-100% FPL
Access to the same providers currently
available with Medicaid
Ability to choose primary care physician
Primary care physician coordinates care for
member
Lyon Osceola Dickinson Emmet Winnebago Worth Mitchell Howard Winneshiek Allamakee
Sioux O’Brien Clay Palo Alto Hancock Cerro GordoFloyd Chickasaw
Fayette Clayton
Plymouth Cherokee Buena Vista Pocahontas Humboldt Wright Butler Bremer
Woodbury Sac CalhounWebster
Hamilton Hardin Grundy
Black Hawk
Buchanan Delaware Dubuque
Monona Crawford Carroll Greene
Dallas
Story Marshall Tama Benton Linn Jones
Harrison Shelby Audubon Guthrie
Boone
Polk Jasper Poweshiek
Kossuth
Franklin
Ida
Jackson
Clinton
Iowa Johnson Cedar
Scott
Pottawattamie
Cass Adair Madison Warren Marion Mahaska Keokuk WashingtonMuscatine
Louisa
Mills Montgomery Union Clarke Lucas Monroe Wapello Jefferson
Des Moines
HenryAdams
Fremont Page Taylor Ringgold Decatur Wayne Appanoose Davis Van Buren
Lee
Iowa Wellness Plan Managed Care Map: As of June 2014
• Counties in light blue are Iowa Wellness Plan Managed Care• Counties in dark blue can have Iowa Wellness Plan Managed Care or HMO• Counties in white are non-managed care (Fee-for-service)
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Marketplace Choice Plan: 101-133% FPL
Family of one
$11,671-$15,521
Family of two
$15,731-$20,920
Individuals 101% FPL
up to133% FPL
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Marketplace Choice Plan: 101-133% FPL
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 –often referred to as “premium assistance”
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Marketplace Choice Plan: 101-133% FPL
Commercial health plans available to members:• CoOportunity Health• Coventry Health Care of Iowa
Uses the commercial plan’s statewide provider network – includes primary care, specialists, hospitals
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Marketplace Choice Plan: 101-133% FPL
Provides comprehensive health services
Coverage includes the qualified health plan required essential health benefits
Benefit Categories Covered
Physician services, including primary care
Outpatient services
Emergency room services and transportation
Hospitalization
Mental health and substance use disorder
Rehabilitative and habilitative services and devices
Lab services, x-rays, imaging (MRI, CT, etc.)
Preventive and wellness services
Home & community based services
Prescription drugs
Dental services
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Plan Summaries
Wellness Plan
0-100% FPL
Benefits equivalent to State Employee Benefit Plan
Plan managed by Iowa Medicaid
Uses Medicaid provider network
Marketplace Choice
101-133% FPL
Marketplace Plan benefits, at least equivalent to State Employee Benefit Plan
Plan managed by commercial insurer
Uses commercial insurer’s provider network
Dental Wellness Plan• Began May 1, 2014
• Operated by Delta Dental of Iowa
• Members use an earned benefits model, beginning with core set of benefits, earning additional benefits for preventive care maintenance
• Unique network of dental providers15
Iowa Health and Wellness Plan
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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
New branding exclusively for the Iowa Health and Wellness Plan
Healthy Behaviors Program Brand
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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 Assessment
Wellness 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
Health Risk Assessment
Marketplace 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
Outreach Support• New website launched specific to Iowa Health
and Wellness Plan and Healthy Behaviors:www.iahealthlink.gov
• Provider Toolkit available: http://www.iahealthlink.gov/sites/default/files/ProviderHealthyBehaviorsToolkit.pdf
• Stakeholder Toolkit available: http://www.iahealthlink.gov/sites/default/files/Stakeholder%20Toolkit_07012014.pdf
Lyon Osceola Dickinson Emmet Winnebago Worth Mitchell Howard Winneshiek Allamakee
Sioux O’Brien Clay Palo Alto Hancock Cerro GordoFloyd Chickasaw
Fayette Clayton
Plymouth Cherokee Buena Vista Pocahontas Humboldt Wright Butler Bremer
Woodbury Sac CalhounWebster
Hamilton HardinGrundy
Black Hawk
Buchanan Delaware Dubuque
Monona Crawford Carroll Greene
Dallas
Story Marshall Tama Benton Linn Jones
Harrison Shelby Audubon Guthrie
Boone
Polk Jasper Poweshiek
Kossuth
Franklin
Ida
Jackson
Clinton
Iowa Johnson Cedar
Scott
Pottawattamie
Cass Adair Madison Warren Marion Mahaska Keokuk WashingtonMuscatine
Louisa
Mills Montgomery Union Clarke Lucas Monroe Wapello Jefferson
Des Moines
HenryAdams
Fremont Page Taylor Ringgold Decatur Wayne Appanoose Davis Van Buren
Lee
395
115 104 360 257
284
195
1,561
6,499 2,633
1,956
8,4373,406
278 213 415 230
391346 242 172 221
191
156 193 190357 309
359651
241561
300 193 358
550 3141924644361,8072761761323,800
309 688 252 624 1,579 1,426 561 558 9,474 442633
404391 198 135 207 1,003 21,842 1,121 452 969
1,736
351
6425,291 362 141 327 905 715 764 360
274 980383 86 411 326 265 204 1,767 6951,806
161 364 142 134 292 176 521 223 225
1,612
Overall Iowa Health and Wellness Plan Enrollment: As of August 29, 2014
• Map represents overall program enrollment, which include the Iowa Wellness Plan and the Iowa Marketplace Choice Plan.
• Total Enrollment as of August 29, 2014: 107,425
329
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APPLICATION
PROCESS
DHS Contact Center
1-855-889-7985
Federal Health Insurance
Marketplacewww.HealthCare.go
v
DHS websitedhsservices.i
owa.govDHS Local Offices
Application Process
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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
