Medicaid Fee-for-Service (FFS) Programs


Most Iowa Medicaid members are enrolled in the IA Health Link managed care program, with coverage provided by a Managed Care Organization (MCO). Some Medicaid members, however, will continue to receive Medicaid coverage through the Medicaid Fee-for-Service (FFS) programsThis includes members who qualify for or receive services from a variety of FFS programs listed below. 

In addition to the Medicaid FFS programs and the IA Health Link managed care program, the Children’s Health Insurance Program (CHIP) is offered through the Healthy and Well Kids in Iowa program, also known as hawk-i.  Simply put, Iowa Medicaid has three main coverage groups:

  1. IA Health Link
  2. Medicaid Fee-for-Service (FFS)
  3. hawk-i

The Frequently Asked Questions webpage is regularly updated to offer the latest information. You can also learn more by viewing Your Guide to Medicaid Fee-for-Service (FFS).

MEDICAID FEE-FOR-SERVICE (FFS) PROGRAMS
The HIPP program helps people get or keep health insurance through their employer by reimbursing the cost of the health insurance premium. HIPP helps by paying for the insurance premium. Please visit the HIPP web page for additional information. To qualify for HIPP:
  • You or someone in your home must have Medicaid.
  • You must have health insurance or be able to get it through your employer.
  • The health insurance must be cost-effective.
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. 
 
3. 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.
 
4. MEDICALLY NEEDY (also known as the spenddown program)
If your income is too high for Medicaid but your medical costs are so high that is uses up most of your income, you may qualify for some payment help through the Medically Needy plan. If you qualify, you are responsible for paying some of the costs of your medical expenses. For more information regarding the Medically Needy program, please visit the Medically Needy web page.
 
5. PRESUMPTIVE ELIGIBLES (subject to change once ongoing eligibility is determined)
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). The goal of the presumptive eligibility process is to offer immediate health care coverage to people likely to be Medicaid eligible, before there has been a full Medicaid determination. Please visit the Presumptive Eligibility web page for more information on this program.
 
6. RETROACTIVE ELIGIBILITY FOR PREVIOUS MONTHS
You may qualify for Medicaid for up to three months before the month you applied. These months are called the “retroactive period.” For more information regarding retroactive eligibility program, please read pages 5 and 6 of the document, "Your Guide to Medicaid Fee-for-Service (FFS)".
 
PACE is a program that blends Medicaid and Medicare funding. The PACE program must provide all Medicare and Iowa Medicaid covered services as well as other services that will improve and maintain the member’s overall health status. The focus of the PACE program is to provide needed services that will allow persons to stay in their homes and communities. Please visit the PACE web page for more information regarding this 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.
 
 
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.
 
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.