Medicaid Programs

Click on program title for more information.

Breast and Cervical Cancer: Medicaid is available for women needing breast and cervical cancer treatment if they do not have health insurance coverage and are not eligible for Medicaid under one of the coverage groups. The woman must have been screened and diagnosed through the Breast and Cervical Cancer Early Detection Program or through use of Susan G. Komen Foundation funds and needs treatment for cancerous or precancerous conditions of the breast or cervix.
 

"Care for Kids" Early Periodic Screening, Diagnosis, and Treatment for Children (EPSDT): EPSDT is also known as "Care for Kids" Program and focuses on providing Medicaid eligible children age birth through 20 years with preventive health care services including physicals, immunizations, vision, hearing and dental exams.

Chronic Care Management: Medicaid has a special program for its members with chronic diseases like diabetes, asthma and heart disease. The program provides a health coach and help finding a primary care doctor. The health coach can explain tests and help you schedule appointments. You also have access to educational materials to help you better understand your health condition. The program is voluntary and no cost to the member.

Consumer Choice Option: Consumer Choices Option is an option available under the Home and Community-Based Services Waivers that gives you control over a targeted amount of Medicaid dollars so that you can develop a plan to meet your needs by directly hiring employees and/or purchasing other goods and services.

Consumer Directed Attendant Care (CDAC): Consumer-directed attendant care services are services designed to help people do things that they normally would for themselves if they were able. CDAC is a direct, hands-on service which takes place in the home or community.

hawk-i: Health and Well Kids in Iowa (hawk-i) provides health care coverage for children of working families. No family pays more than $40 per month and some families pay no premiums. Dental-only coverage is also available under hawk-I for children whose families have health insurance but not dental insurance.

Health Homes: A Health Home provides whole person, patient-centered, coordinated care for all stages of life and transitions of care. Iowa Medicaid is implementing a Health Home program for Medicaid members with specific chronic conditions. Members must have one chronic condition and be at-risk for a second condition such as hypertension, overweight, heart disease, diabetes, asthma, substances abuse and mental health. Health Homes will not cost extra for the Medicaid member. Health Homes will be a new option in the summer of 2012.

Health Insurance Premium Payment (HIPP): HIPP is for people who are working in lower paying jobs and can't afford to pay the premium for their company's insurance plan. HIPP helps to pay the premium on your employer's insurance plan and keep you covered.

Home and Community Based Services: Home & Community Based Services (HCBS) are Medicaid programs that give you more choices about how and where you receive services. Home and Community Based Services are for people with disabilities and older Iowans who need services to allow them to stay in their home and community instead of going to an institution. There are several programs that provide home and community based services. The program names are HCBS Waivers (there are seven), Habilitation, PACE, Home Health, Hospice, and Targeted Case management.

Iowa Family Planning Network (IFPN): IFPN is for men and women who are 12-54 years of age, Iowa's family planning waiver may be able to help you with the cost of your family planning related services. Women cannot be pregnant and participate in this program. 

Iowa Marketplace Choice Plan: The Iowa Marketplace Choice Plan covers adults age 19 to 64 with income from 101 percent through 133 percent of the Federal Poverty Level (between $11,491 and $15,282 for individuals or $15,511-$20,628 for a family of two). The Marketplace Choice Plan allows members to get health care coverage through select insurers with plans on the Health Insurance Marketplace. Medicaid pays the premiums of the health plan for the member. Members get care from providers approved by the health plan. Non-emergency transportation is not available to Iowa Marketplace Choice Plan members.

Iowa Wellness Plan: The Iowa Wellness Plan is an Iowa Medicaid program that covers adults ages 19 to 64. Eligible member income is at or below 100 percent of the Federal Poverty Level ($11,490 for individuals or $15,510 for a family of two). Members can choose a provider from the statewide Medicaid provider network and are able to get care from local providers. Non-emergency transportation is not available to Iowa Wellness Plan members.

Long Term Care: Long term care services are available for Medicaid members to help them maintain a good quality of life in settings such as nursing homes, hospice, intermediate care facilities, and in their communities with help through HCBS Waiver services. Services are intended to help people reach the highest degree of independence possible.

Managed Health Care (MediPASS and HMO): Managed Health Care (MHC) is a program designed to help members stay healthy. MHC works by making sure members have a medical provider with whom they can build a strong relationship. There are two managed health care options; MediPASS and Meridian HMO (only for Muscatine County.) Managed health care doesn't change benefits. It changes how the member gets medical care.

Maternity Management: Medicaid has a special program for its pregnant members. It gives pregnant members support, education and counseling by telephone. The goal of the program is to have a healthy mom and baby. The program is voluntary and no cost to the member.

Medicaid for Employed People with Disabilities (MEPD): is a Medicaid coverage group that allows people to work (and earn income) and still remain eligible for Medicaid because the earnings do not count against income eligibility rules. MEPD individuals must be disabled, under age 65, earning income with a net family income of less than 250% of the federal poverty level. If family income reaches a certain level, MEPD members will pay a sliding scale premium for Medicaid coverage.

Medically Needy: The Medically Needy Medicaid program is for members whose income is too high for Medicaid. However, if your medical costs are so high that they use up most of you income, you may qualify for some payment help through the Medically Needy program. If you qualify, you will be responsible for paying some of the costs of your medical expenses; this is called a "spend down".

Medicare Savings Programs: Medicare may be able to help member if they receive benefits through Medicare. If the member's income is low and they need help paying your Medicare premiums, Medicaid may be able to help pay the premiums.

Mental Health and Substance Abuse Treatment (The Iowa Plan): Mental Health and Substance Abuse Services may be provided for many Medicaid members under The Iowa Plan. This plan is operated for Medicaid by Magellan Behavioral Health Services, called "Magellan", and offers a range of services provided by community mental health centers, hospitals, psychiatrists, substance abuse programs and elsewhere.

Money Follows the Person: Money Follows the Person Partnership for Community Integration Project to provide opportunities for individuals in Iowa to move out of Intermediate Care Facility for Intellectually Disabled and into their own homes in the community of their choice. Grant funds provide funding for the transition services and enhanced supports needed for the first year after they transition into the community. 

Non-Emergency Transportation Reimbursement: Medicaid members can have their non-emergency transportation costs reimbursed by Medicaid. Transportation reimbursement helps when you need transportation to a doctor appointment or therapy treatment. A Transportation Broker now helps Iowa Medicaid provide this service. Transportation may be provided by a public transit system, a private company, a non-profit organization, a volunteer, or some other person. You must schedule all your non-emergency transportation needs with the broker before your trip to be eligible for reimbursement. The toll-free number is 1-866-572-7662. Always have your Medicaid member number available. Non-emergency transportation is not available to Iowa Health and Wellness Plan members.

Pre-Admission Screening and Resident Review (PASRR): The goal of the PASRR process is to reduce inappropriate institutionalization for individuals with serious mental illness, intellectual disability and related conditions and improve the quality of life for those individuals who are placed in Medicaid certified facilities. PASRR process identifies people with mental illness and/or intellectual disability and ensures they are served appropriately. 

Program of All-Inclusive Care for the Elderly (PACE): This program helps you and health providers come together for preventive care, primary care, social services, therapeutic recreation, acute and long-term care services. This program aims to protect and improve your health; and your quality of life. The goal of PACE is to keep you in your home. PACE is only available in a limited area.

Supports Intensity Scale (SIS): Iowa is piloting a new standardized assessment tool for individuals with intellectual disabilities and/or other developmental disabilities called the Supports Intensity Scale (SIS). Developed by the American Association on Intellectual and Developmental Disabilities (AAIDD), the SIS is designed to measure the intensity of supports that each person with an intellectual or developmental disability needs in order to fully participate successfully in community life. This pilot project will take place in Boone, Franklin, Hamilton, Humboldt, Madison and Wright counties. It will also be piloted with Money Follows the Person participants and residents of Woodward and Glenwood Resource Centers. More information on the SIS assessment tool may be found at http://www.aaidd.org/sis.

Smoking Cessation: Iowa Medicaid Smoking Cessation program is comprised of two components; Quitline Iowa and pharmacy services. Quitline Iowa provides counseling services for tobaccos users who want to quit. Toll-free helpline is 1-800-784-8669. Pharmacy services include various nicotine replacement products such as the patch, gum or other products. Medicaid members need to work with their physicians to receive a diagnosis and prior authorization for access to the products.

State Supplementary Assistance: State Supplementary Assistance (SSA) is a program to meet the additional special needs of aged, blind and disabled people not met by the standard benefit rate paid by Supplemental Security Income (SSI). Iowa's SSA program covers six categories of special needs; blind allowance, dependent person allowance, family life home assistance, in-home health-related care assistance, residential care facility assistance, and supplement for Medicare and Medicaid eligibles.