On April 1, 2016, most Iowa Medicaid programs were joined together into one managed care program called Iowa Health Link. Most existing Medicaid members were enrolled in Iowa Health Link on April 1, 2016. Most new members who become eligible after April 1, 2016 will also be enrolled in Iowa Health Link. MEPD members receive coverage from the Iowa Health Link program. This program gives you health coverage through a Managed Care Organization (MCO) that you get to choose.
What is MEPD?
Medicaid for Employed People with Disabilities (MEPD) is a Medicaid coverage group to allow persons with disabilities to work and continue to have access to medical assistance.
What are the eligibility requirements for MEPD?
People who are disabled and have earned income can get Medicaid when the person:
- Is under age 65.
- Is still considered to be disabled based on SSI medical criteria for disability.
- Has earned income from employment or self-employment.
- Meets general SSI-related Medicaid eligibility requirements.
- Is not eligible for any other Medicaid coverage group other than QMB, SLMB, or Medically Needy.
- Have resources less than $12,000 for an individual and $13,000 for a couple.
- Has net family income less than 250% of the federal poverty level.
- Pays any premium due for the monthly eligibility.
| 2023 MEPD Monthly Income Limits | |
|---|---|
| Household/ Family Size | Limit (Net countable income less than 250%) |
| 1 | $3,038 |
| 2 | $4,109 |
| 3 | $5,180 |
| 4 | $6,250 |
| 5 | $7,321 |
| 6 | $8,392 |
| 7 | $9,463 |
| 8 | $10,534 |
| 9 | $11,605 |
| 10 | $12,675 |
| 11 | $13,746 |
| 12 | $14,817 |
| 13 | $15,888 |
| 14 | $16,959 |
What services are covered by MEPD?
- MEPD members receive all Iowa Medicaid benefits.
- Prescription services are included for members who do not have Medicare. For those members enrolled with Medicare as well as MEPD, prescription coverage will go through a Medicare Part D plan.
- MEPD will pay for your Medicare Premiums.
Do I have to pay a monthly premium for MEPD?
If your monthly gross income is over 150% of the federal poverty level, you will have to pay a premium. You will get a Notice of Decision telling you the amount of your monthly premium.
HHS waives all co-pays, premiums, and contributions during emergency declaration
To find your monthly gross income, add your gross earned income and your gross unearned income together. The premium you will have to pay will be on the same line. (Updated 2022)
| MEPD Premimum Amounts Effective August 1, 2020* | ||
|---|---|---|
| If the monthly gross income of the disabled person is: | Federal Poverty Level (FPL): | The monthly premium payment is: |
| $1,699 or less | At or below 150% | $0 |
| More than: | More than: | |
| $1,699 | 150% | $34 |
| $1,869 | 165% | $47 |
| $2,039 | 180% | $56 |
| $2,265 | 200% | $66 |
| $2,549 | 225% | $77 |
| $2,832 | 250% | $89 |
| $3,398 | 300% | $112 |
| $3,964 | 350% | $137 |
| $4,530 | 400% | $161 |
| $5,097 | 450% | $186 |
| $6,229 | 550% | $232 |
| $7,362 | 650% | $280 |
| $8,494 | 750% | $329 |
| $9,627 | 850% | $389 |
| $11,325 | 1000% | $467 |
| $13,024 | 1150% | $547 |
| $14,723 | 1300% | $631 |
| $16,761 and above | 1480% | $729 |
Note: Your monthly premium will not go up during the 12-month enrollment period. The premium may go down if you report that your income has decreased.
When are premiums due?
A billing statement will be sent to you that shows the month a premium is due.
What happens if I am late paying my premium?
If you do not pay the premium by the due date, your MEPD will be cancelled. If you make a premium payment late:
- MEPD can be reinstated if your ongoing month’s payment is received by the last day of the month it is due.
- MEPD coverage can be reopened if the payment is late but is received in the month after the month which it was due
- If your payment is more than three months late, it will not be accepted and you will not be able to get Medicaid for that month. It is very important that you make your premium payment on time or early if possible.
Where can I get medical care?
The Managed Care Organizations (MCOs) have an extensive network of providers across the state for members to choose from. Providers have contracted with MCOs in order for them to continue providing care to Iowa Medicaid members.
Each MCO has a list of providers in their network and are adding more providers each day. You will want to make sure that your provider is within your MCO’s network once you are enrolled in the managed care program. If your provider is out of your MCO’s provider network, they may still continue to see you however, they may also choose not to see you.
Before receiving services from your providers, please show them your MCO card to let them know your chosen MCO and ask them which MCO networks they are signed with. If your provider is not in your MCO’s provider network, this is a “Good Cause” reason to change your MCO. If you do not wish to change your MCO, you may choose another provider within your MCO’s provider network.
Will I have a co-payment?
Yes, the following is a breakdown of your co-payment amounts:
| Co-Payment Amount | Service |
|---|---|
| $1.00 per visit | Services from a podiatrist, chiropractor and physical therapy. |
| $2.00 per visit | Ambulance services, audiology services, hearing aid dealer services, medical equipment, optical services, prosthetic devices, psychology services and rehabilitation services. |
| $3.00 per visit | Dental services, hearing aides, physician office visits and lab services |
How do I find out if I qualify for MEPD?
To find out if you can get MEPD, you must fill out a Medicaid application and send it to your local Department of Health and Human Services (HHS) office. The application may be mailed, faxed or delivered to the HHS office. For further information on how to apply, please go to the "Apply for Services" web page.