Medicaid Programs

Click on program title for more information.

American Indians and Alaskan Natives may choose to enroll in the Managed Care program. If you are a member who identifies as American Indian or Alaskan Native, contact Iowa Medicaid Member Services at 1-800-338-8366 to learn about enrolling in the IA Health Link Managed Care program.
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- and 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 Health and Wellness Plan: The Iowa Health and Wellness Plan provides comprehensive health benefits at low or no cost to members. The Iowa Health and Wellness Plan refers to one plan that includes two separate coverage programs. All Iowa Health and Wellness Plan members are covered for the same types of health benefits but how members get medical care is different for each program. Eligibility is based on household income. If you are eligible for the Iowa Health and Wellness Plan, you will be automatically assigned to one of the following coverage programs when you enroll.

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.

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.

Medicaid for Kids with Special Needs (MKSN)
On April 1, 2016, most Iowa Medicaid programs were joined together into one managed care program called IA Health Link. Most existing Medicaid members were enrolled in IA Health Link on April 1, 2016, and most new members who became eligible after April 1, 2016, will also be enrolled in IA Health Link. MKSN members receive coverage from the IA Health Link program. This program gives you health coverage through a Managed Care Organization (MCO) that you get to choose. 

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".

Medicaid is a joint federal and state program that helps pay medical costs for individuals with limited income and resources. Individuals with Medicare Part A and/or Part B, who have limited income and resources, may get help paying for their out-of-pocket medical expenses from their State Medicaid Program. Iowa has programs that can help pay your Medicare expenses, like your premiums, deductible, and coinsurance.
Under the QMB program, Medicaid only pays Medicare premiums, deductibles, and coinsurance for persons who are qualified Medicare beneficiaries. If you have Medicare Part A and your resources and income are within QMB limits, you could be eligible as a qualified Medicare beneficiary.For additional information, pleaser read the QMB brochure.
SLMB will only pay your Medicare Part B premium. The income limit is over 100 percent but less than 135 percent of the federal poverty level. Ask your DHS worker about SLMB. 

Mental Health and Substance Abuse Treatment: Almost everyone who is eligible for Iowa Medicaid is automatically eligible for mental health and substance abuse treatment. Excluded are those who have a spenddown for eligibility and those persons who reside in one of the DHS resource centers. On April 1, 2016, most Iowa Medicaid programs were joined together into one managed care program called IA Health Link. This new managed care program brings together physical, behavioral and long term care under one program. Read more about the Iowa Plan by following the link above.

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 Medical Transportation (NEMT): The NEMT services are for members with full Medicaid benefits, who need travel reimbursement or a ride to get to their medical appointments. Eligible members will receive NEMT services from different NEMT brokers depending on their eligibility status and whether they receive coverage directly from Iowa Medicaid Fee-for-Service or are enrolled in the IA Health Link managed care program. An NEMT broker is a contracted provider with the Iowa Department of Human Services (DHS), the Iowa Medicaid Enterprise (IME), and the IA Health Link Managed Care Organizations (MCOs) The broker checks member and trip eligibility, handles claims, and follows up on trips and claims. 

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

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.