Iowa's Medicaid expansion model, which pays beneficiaries' premiums so they can obtain private coverage plans, is coming to an end. In response, the state is seeking a waiver to move beneficiaries to its traditional Medicaid program.
There are now two coverage options for Iowans with incomes below 138% of the federal poverty level. One is called the Iowa Wellness Plan, which is for adults at or below 100% of the federal poverty level. The other is the Iowa Marketplace Choice Plan, offered to adults with income from 101% to 133% of the federal poverty level. Under this option, beneficiaries get healthcare coverage through insurers with plans on the Health Insurance Marketplace and the state pays the premiums.
Iowa now seeks to make enrollees in the Marketplace Choice Plan option eligible for the Health Insurance Marketplace through a waiver. The language in the new waiver allows Iowa to retain its authority to provide premium cost coverage to individuals with incomes between 100% and 138% of the federal poverty level, should it decide to do so at a later date.
Historically, members could elect to receive coverage through one of two qualified health plans—CoOportunity Health and Coventry Health Care of Iowa. CoOportunity withdrew from the program in November 2014, and Coventry told the state it will not be accepting any new members in 2015, and intends to discontinue coverage for Medicaid expansion individuals by the end of the year.
Pennsylvania made a similar move earlier this year to rope its entire Medicaid population into one program. Arkansas is now the only state that continues to cover premiums for individuals between 100% and 138% of the federal poverty level, and New Hampshire will do so beginning Jan. 1, 2016.
Iowa's new waiver will still require beneficiaries to pay premiums as they previously did. The state currently charges $10 a month for enrollees with incomes above 100% of poverty. For Iowans with incomes between 50% and 100% of poverty, the state charges $5 a month after they've been in the program for one year. That obligation is reduced or eliminated for beneficiaries who complete a wellness exam and a health-risk assessment.
The new waiver will also seek to allow the Iowa Wellness Plan to become an exclusively managed-care program. Currently, Iowa administers the program through several delivery systems, including independent primary-care physicians, accountable care organizations and managed-care plans.
Earlier this year, the Iowa Department of Human Services released a request for proposals, announcing it will contract with two to four insurers to manage benefits and care for the state's Medicaid population.
Iowa is collecting comments on the proposed waiver until August 24. It will be formally submitted to the CMS later this year. The state aims to begin enrolling beneficiaries into managed-care plans on Jan. 1, 2016.