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Iowa Medicaid Ultimate Guide

The Iowa Medicaid program covers about one out of every seven adults, three out of every eight children, and one out of every two disabled people in Iowa. Use our ultimate guide to find out what’s covered and use our eligibility chart to find out if you can be one of the thousands of people in your area saving big on healthcare costs.

Click below to learn more about IA Medicaid:

About Iowa Medicaid

In 2016, Iowa developed a managed care program called IA Health Link. Most Medicaid members will be enrolled in one of the MCOs, or Managed Care Organizations, under IA Health Link. Having a MCO is great! It means that you have a network of doctors and providers that work well together to provide the highest quality care.

You may also hear about Hawki and the Iowa Health and Wellness plan. Hawki is the Iowa Medicaid program for kids, and the Iowa Health and Wellness plan is for people who don’t quite qualify for full Medicaid but still qualify for medical assistance.

Is Iowa Health and Wellness the Same as Medicaid?

The Iowa Health and Wellness program is a part of IA Medicaid. The Health and Wellness plan provides slightly fewer benefits than the regular state Medicaid program and is only for people between the ages of 19 and 64 who are not pregnant and do not earn more than 133% of the Federal Poverty Level. This amounts to about $15,521 for an individual or $20,921 for a couple. You also cannot be eligible for employer healthcare coverage, Medicare, or full Medicaid (which can happen based on your resources or other factors).

Hawk-I

Hawk-I, or Hawki, is the Children’s Health Insurance Program in Iowa. No family will ever have to pay more than $40 per month for Hawki, and some will pay nothing at all. Like Iowa Medicaid for adults, kids will be placed into a Managed Care Organization (one of three: Amerigroup Iowa, Iowa Total Care, UnitedHealthcare Plan of the River Valley). Kids will receive Hawki dental coverage through Delta Dental of Iowa. Kids can also get additional benefits like Boys & Girls Club memberships, fitness programs, and more.

Your child may qualify for Hawki even if you do not qualify for Medicaid, as the family income requirements are slightly higher.

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Most IA Medicaid members enroll through a IA Health Link Managed Care Organization (MCO). An MCO takes your benefits and rolls it all into one organized plan and network. Once you enroll, you’ll have three options: Amerigroup Iowa, Inc., Iowa Total Care, and UnitedHealthcare Plan of the River Valley, Inc. You may be automatically enrolled in one of the three but will have the opportunity to switch. The three plans have very similar benefits, but each one has unique value-adds.

Amerigroup Iowa, Inc.

The Amerigroup Iowa IA Health Link MCO includes excellent incentives on top of their medical benefits, like:

  • Free dental supplies
  • LiveHealth Online - video chat with doctors!
  • Free mobile phones with bonus minutes for qualifying members
  • Free post-discharge kits and home-delivered meals post hospital stay
  • Free weight management and exercise kits
  • Iowa Healthy Rewards - get $10-$30 for completing wellness activities like flu shots, wellness exams, vaccines, screenings, and prenatal/postpartum visits.

Iowa Total Care

On top of their comprehensive benefits program, the Iowa Total Care MCO includes:

  • My Health Pays - receive rewards via reloadable Visa card for performing healthy behaviors. You can use the card at participating retailers (like Walmart) for necessary goods, or you can use it for transportation, utilities, education costs, child care, and rent.
  • Start Smart For Your Baby - presents baby health education to expecting mothers.
  • MemberConnections Community Health Worker (CHW) Program - provides home visits to high-risk members.
  • ConnectionsPlus - Provides pre-programmed cell phones to high-risk members who otherwise lack cell phone access and require it for medical communication.

UnitedHealthcare Plan of the River Valley, Inc.

UnitedHealthcare has three plans for Iowa Medicaid recipients. The UnitedHealthcare Dual Complete HMO SNP is for people who have both Medicare and Medicaid, the UnitedHealthcare Community Plan Hawki is for those under 19, and the UnitedHealthcare Community Plan IA Health Link is for adults and families. Aside from the great health benefits these plans provide, the IA Health Link plan includes:

  • Adult day care
  • Asthma and COPD treatment plans
  • BabyBlocks rewards for expecting mothers and newborns
  • Equipment like oxygen tanks, hospital beds, and wheelchairs
  • Foot care
  • Healthy First Steps support and supplies for pregnant members and nursing moms
  • Interpreters and language help
  • Text4baby health and safety tips for expecting new mothers

Iowa Medicaid Coverage and Costs

The Iowa Medicaid program provides benefits like doctor visits, dental care, prescription drugs, hospitalizations, emergencies, preventive health, mental health, and more. There are no costs during your first year, and costs are extremely low after that. There are no charges for doctor visits, prescriptions, mental health, hospitalization, or preventive services, like annual wellness visits. Some members will be asked to pay a small premium based on income.

To encourage Iowa residents to not prevent people with real emergencies from not receiving timely care, Iowa Medicaid charges $8 whenever you use the emergency room for non-emergencies.

Prescription Coverage and the PDL

The IA Medicaid program covers most prescription drugs (and even some over-the-counter medicines). Your doctor is expected to always select generic prescriptions from the prescription drug list. If for some reason a generic version is not available, or if your doctor prefers another drug, he or she will need to get prior approval from the Medicaid program before issuing the prescription.

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Dental Wellness Plan

Adult (19 and older) IA Medicaid members will get dental coverage through the Dental Wellness Plan (DWP), which includes Delta Dental and MCNA Dental. In your first year of Dental Wellness Plan enrollment, you’ll get full benefits, including:

  • Cleanings
  • Crowns
  • Dentures
  • Exams
  • Extractions
  • Flouride
  • Fillings
  • Gum treatment
  • Root canals
  • X-rays

There is a yearly maximum dental benefit of $1,000 per year (July 1-June 30), but this does not include preventive, diagnostic, or emergency services and anesthesia.

To keep your full dental benefits, you will need to successfully complete “Healthy Behaviors.” That means that every year, you must complete an oral health self-assessment and attend a preventive appointment (annual checkup). If you do not complete your Healthy Behaviors, you may have to pay a monthly premium ($3/month) to keep your benefits.

Consumer Choices Option

Iowans with disabilities (with the Home and Community Based Services waiver) can use the Consumer Choices Option Program to get the best possible care. Eligible Iowans will have more control over their Medicaid waiver dollars and can work with a case manager to hire their own services and keep their health goals aligned.

Iowa Medicaid Eligibility

Medicaid qualifications are based on your household income compared to your family size. To qualify for the Health and Wellness plan, you must be between the ages of 19 and 64 and have an income below 133% of the Federal Poverty Level (about $15,521 for one person or $20,921 for a family of two in 2019). To qualify for full Iowa Medicaid, check the chart below.

What is the Income Limit for Iowa Medicaid?

Income limits are subject to change each year. Below are the income limits for 2019:

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Iowa Medicaid Application

You can apply online through the Department of Human Services benefits portal or by downloading the paper application and mailing it in. We recommend applying online for the fastest and easiest results.

Can You Have Both Medicare and Medicaid in Iowa?

If you qualify for both programs, you can benefit from both Medicare and Medicaid through a Medicare Special Needs Plan. Dual-eligible Special Needs Plans are usually available at no or very little cost and cover most of your healthcare costs. Plus, qualifying for a DSNP means you do not have to wait for the annual enrollment period in the fall to enroll in Medicare! We specialize in Medicare plans and would love to help you work through your options. Just send us a message or give us a call at 833-438-3676 to get started.

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