Who Receives Medicaid?


Medicaid is a health insurance program based on income. In addition to meeting certain income levels, you need to meet specific eligibility requirements to receive Medicaid coverage. The following are some of these general requirements:

  • A child under the age of 21
  • A parent living with a child under the age of 18
  • A woman who is pregnant
  • A woman in need of treatment for breast or cervical cancer
  • A person who is elderly (age 65 or older)
  • A person who is disabled according to Social Security standards
  • An adult between the ages of 19 and 64 and whose income is at or below 133 percent of the Federal Poverty Level (FPL)
  • A person who is a resident of Iowa and a U.S. citizen
  • Others may qualify (see list below)
HOW TO APPLY FOR MEDICAID:
Iowa Medicaid has three main coverage groups:
  1. IA Health Link 
  2. Medicaid Fee-for-Service 
  3. hawk-i 
1. IA Health Link
Most Iowa Medicaid members are enrolled in the IA Health Link managed care program, These members will get health coverage from a Managed Care Organization (MCO) they get to choose. Find more information on the IA Health Link webpageSome members will continue to receive Medicaid Fee-for-Service and will not transition to the IA Health Link program (see Fee-for-Service below). IA Health Link includes:

a. Iowa Health and Wellness Plan
On January 1, 2014, Medicaid began to offer a health care coverage option to adults age 19-64 with income up to and including 133 percent of the Federal Poverty Level. (The majority of Iowa Health and Wellness Plan members will be in the IA Health Link Program. A very limited number of members in this program will be in the Medicaid Fee-for-Service coverage program.)

b. Long Term Care

c. Home- and Community-Based Services (HCBS) Waivers

d. Medicaid for Employed People with Disabilities (MEPD)

e. Medicare Assistance (Dual-Eligibility)
If your income is low and you have a hard time paying Medicare premiums, Medicaid may be able to help pay the premiums.

f. Iowa Family Planning Network (IFPN)
If you are between the ages of 12-54, Iowa's family planning waiver program may be able to help you with the cost of your family planning related services.

2. Medicaid Fee-for-Service
Members who are not transitioning to the IA Health Link managed care program will remain in Medicaid Fee-for-Service. This includes members who qualify for or receive services from the following Fee-for-Service programs:

b. Medicare Savings Program (MSP) 

Qualified Medicare Beneficiary (QMB) 

Specified Low-Income Medicare Beneficiary (SLMB) 

c. Three Day Emergency
Up to 3 days of Medicaid is available to pay for the cost of emergency services for aliens who do not meet citizenship, alien status, or social security number requirements. The emergency services must be provided in a facility such as a hospital, clinic, or office that can provide the required care after the emergency medical condition has occurred.

d. Medically Needy (also known as the spenddown program)

e. Presumptive Eligibility (subject to change once ongoing eligibility is determined)

f. Retroactive Eligibility for Previous Months

g. Program of All-Inclusive Care for the Elderly (PACE) program

h. American Indian or Alaskan Native program
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.

3. Healthy and Well Kids in Iowa (hawk-i)
The Children’s Health Insurance Program (CHIP) services will continue to be available through the Healthy and Well Kids in Iowa program, also known as hawk-i. For more information go to the Find more information on the hawk-i webpage.

 


Iowa Medicaid Member Services (Monday to Friday from 8 a.m. to 5 p.m.)
1-800-338-8366 (Toll Free) 
515-256-4606 (Des Moines Area)
515-725-1351 (Fax)
 
For telephone accessibility assistance if you are deaf, hard-of-hearing, deaf-blind, or have difficulty speaking, call Relay Iowa TTY at 1-800-735-2942.
 
Llame al 1-800-735-2942, a Relay Iowa TTY (teléfono de texto para personas con problemas de audición, del habla y ceguera) si necesita asistencia telefónicamente.