Medicaid Initiatives

Managed Health Care
The Iowa Department of Human Services (DHS), with support from the Iowa Medical Society and the Iowa Osteopathic Medical Association, developed and Implemented the Managed Health Care program in Iowa as mandated by the Iowa Legislature via House File 2447 in 1988 and Senate File 541 in 1989. Learn more about the various managed health care options available.

Presumptive Eligibility (PE)
Medicaid presumptive eligibility (PE) provides Medicaid for a limited time while a formal Medicaid eligibility determination is being made by the Iowa Department of Human Services (DHS). 

International Classification of Diseases, 10th Edition (ICD-10): 
ICD-10-CM and PCS (International Classification of Diseases, 10th Edition, Clinical Modification and Procedure Coding System) is an update to the ICD-9 and provides an expanded set of diagnosis and procedure codes to keep pace with advances in medicine over the last three decades. As announced in Informational Letter 1440, the Iowa Medicaid Enterprise (IME) can no longer accept claims with ICD-9 codes for services delivered on or after October 1, 2015, and inpatient discharges occurring October 1, 2015 or after. The registration for Iowa Medicaid Enterprise (IME) ICD-10 Volunteer Testing is now open. To register for testing, please contact the IME Provider Services Unit at 1-800-338-7909, or locally in Des Moines at 515-256-4609 or by email at ICD-10project@dhs.state.ia.us.

Iowa's Medicaid Electronics Health Records (EHR) Incentive Program is playing an important role in establishing critical health information technology designed to reduce costs, improve care, and advance coordination across the healthcare platform. This focused effort is leading to better coordination, quality of care, and fostering healthier lives in Iowa. Eligible professionals and hospitals can apply for the EHR via the Provider Incentive Payment Program (PIPP) system at http://www.imeincentives.com/.

Iowa Medicaid Care Management Programs:
The Iowa Medicaid Care Management consists of Care Management, Disease Management, Maternity, and Lock-In. The common themes across these programs are to provider a high level of care coordination to high utilization high risk Medicaid members. The goals of the programs are to support the provider's plan of care and to coordinate services deemed necessary. Medicaid members receiving the best possible health outcomes from high quality health care.

Iowa Medicaid Pharmaceutical Care Management:
Iowa Medicaid Pharmaceutical Care Management (PCM) is an Iowa Medicaid service provided by physicians and pharmacists working together to closely manage the total medication regimens of their most complex patients. The services are provided to Medicaid members who are identified as being at high risk for medication-related problems. The innovative care delivered through this program is based on a model of care known to improve medication safety in hospital and clinic settings where pharmacists and physicians practice under the same roof and have access to patient care records.