Alerts
New Senate Human Resources Committee Chair
11.05.19
Iowa Senate Republicans announced a new Chair of the Senate Human Resources Committee, which addresses issues like disability services, health care,... Read More...
Deadline to Request Satellite Democratic Caucus Locations is November 18
10.31.19
The Iowa Caucuses will be held on Monday night, February 3, 2020.  Democrats can find their neighborhood caucus locations, candidate contacts, and... Read More...
2020 Caucus Guide Available
10.30.19
Our 2020 Guide to the Iowa Caucuses is now available!  Read More...
Miller-Meeks Enters Congressional Race
10.01.19
First term State Senator Marianette Miller-Meeks announced today that she'll run for Congress in Iowa's Second Congressional District.  US Rep. Dave... Read More...
New Caucus Resources Available
09.30.19
We are in the process of developing our new 2020 Guide to the Iowa Caucuses. Because there are some decisions still being made on the Democratic side,... Read More...


Our Network

About the Iowa Wellness Plan

More articles »

WHO IS ELIGIBLE?
Iowans age 19-64 earning between 0-100% of the federal poverty level (FPL), who are not otherwise eligible for Medicaid.  If a person has access to insurance through an employer, the program will pay the premiums on their employer-sponsored plans. People who are considered “medically frail” and earn up to 138% of the federal poverty level are also eligible. 

WHAT DOES THE PLAN COVER?
The plan will include benefits similar to those in the state employees health plan, and all federally required “essential health benefits.”  These include primary care physician services, specialty care visits, home health services, chiropractic care, outpatient surgery as needed, allergy testing, chemotherapy, IV infusion services, radiation therapy, dialysis, dental services, emergency room services (non-emergency visits to the ER will require $10 copay after first year), emergency transportation, urgent care clinics, hospitalization, transplants, congenital abnormality corrections, hospice care & respite, skilled nursing (up to 120 days), prescription drugs, physical therapy (60 visit annual cap), durable medical equipment, prosthetics, lab tests, x-rays, medical imaging, sleep studies, diagnostic genetic tests, preventive care services, nutritional counseling (for patients with diabetes only), family planning, and vision care exams.  Mental health and substance use disorder inpatient and outpatient treatment is a covered service, but will be managed by the state’s mental health contractor (Magellan).  Dental services are covered, but will also be provided by contract.

WHAT ISN’T COVERED?
The plan does not cover infertility treatment or diagnosis, acupuncture, bariatric surgery, hearing aides, eye glasses, nursing facility services (except up to 120 days for rehabilitation), non-emergency transportation services, EPSDT (Early Periodic Screening, Diagnosis & Treatment), and Long Term Services and Supports (LTSS).  Individuals who need LTSS (including habilitation services) will be considered medically frail and will automatically be eligible for regular Medicaid services, which cover LTSS.  If a person chooses the Wellness Plan over regular Medicaid, they will not receive LTSS as a wrap-around service.  So if you want LTSS covered, you need to be enrolled in the state’s regular Medicaid plan.

HOW MANY PEOPLE WILL BE COVERED?
An estimated 116,000 people will qualify for this part of the plan, with an additional 19,000 qualifying for premium assistance for their employer-sponsored plans.

DO I GET TO PICK MY DOCTOR?
Yes, people will be given the chance to choose their primary care provider from a list of current Medicaid providers. However, if they do not choose, Medicaid will assign them one. The primary care provider will coordinate all care, and make referrals as needed.  Eventually the provider will be rewarded with better payments if they help a person become or stay healthy.

WILL I HAVE TO PAY FOR ANY SERVICES?
There is no cost to a person in the first year – no premiums and no copayments.  In the second year:

  • Copayments: There is a $10 fee for non-emergency use of the ER. There are no other copayments – not for prescriptions, office visits, hospitalizations, etc. 

  • Premiums: People earning 50% FPL or less are not charged a monthly premium.  People earning 51-100% FPL will be charged a monthly premium based on income ($10-16/month). However, premiums are waived annually if a person engages in certain “healthy behaviors.” Hardship waivers can be requested if they cannot do these healthy behaviors.

Again, there is no cost to anyone in the first year, and no cost in future years if a person engages in “healthy behaviors” annually and doesn’t misuse the ER.

WHAT ARE THESE “HEALTHY BEHAVIORS”?
In the first year, a person must visit their primary care provider for a wellness exam and health risk assessment.  If a person does this in 2014, the monthly premiums are waived in the second year.  Beginning in the second year (and annually after), a person will have to do two of the following annually: health risk assessment, wellness exam, dental exam, smoking cessation program or be a non-smoker, lower BMI, or participate in health education programs or preventive screenings (like a mammogram).

WHEN DOES THIS START?
Enrollment for the program begins October 1, 2013, and coverage begins January 1, 2014.