Iowa Health and Wellness Plan Rachel Johnson, MS, CHES Member Communications Iowa Medicaid Enterprise

2 Background Began January 1, 2014 Iowans age Income up to and including 133% of the Federal Poverty Level (FPL) New, comprehensive program replaced the IowaCare program, which ended December 31, 2013 The Iowa Health and Wellness Plan was enacted to provide comprehensive health coverage for low-income adults

3 One Plan, Two Options Iowa Wellness Plan For adults age Income up to and including 100% of the Federal Poverty Level Marketplace Choice Plan For adults age Income 101% to no more than 133% of the Federal Poverty Level

4 Goals and Objectives Health/improved outcomes Incentives for healthy behaviors Emphasis on care coordination Local access to care GOALS

5 Member Eligibility Member eligibility 12 months of covered benefits Income re-verified for eligibility after a 12-month period

6 Iowa Wellness Plan: 0-100% FPL Family of one $11,670 Family of two $15,730 Individuals up to 100% FPL

7 Iowa Wellness Plan: 0-100% FPL Administered by Iowa Medicaid Provides comprehensive health services Coverage is equal to the benefits provided to state employees Benefit Categories Covered Physician services, including primary care Outpatient services Emergency room services and transportation Hospitalization Mental health and substance use disorder Rehabilitative and habilitative services and devices Lab services, x-rays, imaging (MRI, CT, etc.) Preventive and wellness services Home & community-based services Prescription drugs Dental services

8 Iowa Wellness Plan: 0-100% FPL Access to the same providers currently available with Medicaid Ability to choose primary care physician Primary care physician coordinates care for member

LyonOsceolaDickinsonEmmet Winnebago Worth MitchellHoward WinneshiekAllamakee SiouxO’BrienClay Palo Alto HancockCerro Gordo Floyd Chickasaw Fayette Clayton PlymouthCherokee Buena Vista PocahontasHumboldt Wright Butler Bremer WoodburySac Calhoun Webster HamiltonHardin Grundy Black Hawk BuchananDelawareDubuque Monona Crawford Carroll Greene Dallas Story MarshallTama BentonLinn Jones Harrison ShelbyAudubon Guthrie Boone PolkJasperPoweshiek Kossuth Franklin Ida Jackson Clinton Iowa Johnson Cedar Scott Pottawattamie Cass AdairMadison WarrenMarion MahaskaKeokuk Washington Muscatine Louisa MillsMontgomery Union ClarkeLucasMonroeWapelloJefferson Des Moines Henry Adams FremontPageTaylorRinggoldDecaturWayneAppanooseDavisVan Buren Lee Iowa Wellness Plan Managed Care Map: As of June 2014 Counties in light blue are Iowa Wellness Plan Managed Care Counties in dark blue can have Iowa Wellness Plan Managed Care or HMO Counties in white are non-managed care (Fee-for-service)

10 Marketplace Choice Plan: % FPL Family of one $11,671- $15,521 Family of two $15,731- $20,920 Individuals 101% FPL up to 133% FPL

11 Marketplace Choice Plan: % FPL Members select a certain commercial health plan available on the Health Insurance Marketplace Medicaid pays the premiums to the commercial health plan on behalf of the member – often referred to as “premium assistance”

12 Marketplace Choice Plan: % FPL Commercial health plans available to members: CoOportunity Health Coventry Health Care of Iowa Uses the commercial plan’s statewide provider network – includes primary care, specialists, hospitals

13 Marketplace Choice Plan: % FPL Provides comprehensive health services Coverage includes the qualified health plan required essential health benefits Benefit Categories Covered Physician services, including primary care Outpatient services Emergency room services and transportation Hospitalization Mental health and substance use disorder Rehabilitative and habilitative services and devices Lab services, x-rays, imaging (MRI, CT, etc.) Preventive and wellness services Home & community based services Prescription drugs Dental services

14 Plan Summaries Wellness Plan 0-100% FPL Benefits equivalent to State Employee Benefit Plan Plan managed by Iowa Medicaid Uses Medicaid provider network Marketplace Choice % FPL Marketplace Plan benefits, at least equivalent to State Employee Benefit Plan Plan managed by commercial insurer Uses commercial insurer’s provider network

Dental Wellness Plan Began May 1, 2014 Operated by Delta Dental of Iowa Members use an earned benefits model, beginning with core set of benefits, earning additional benefits for preventive care maintenance Unique network of dental providers 15 Iowa Health and Wellness Plan

16 Medically Exempt Members who are considered ‘Medically Exempt’ must be given the option of enrolling in regular State Medicaid Plan or Wellness Plan ‘Medically Exempt’ includes individuals with disabling mental disorders (including adults with serious mental illness), individuals with chronic substance use disorders, individuals with serious and complex medical conditions, individuals with a physical, intellectual or developmental disability that significantly impairs their ability to perform 1 or more activities of daily living, or individuals with a disability determination based on Social Security criteria Medicaid has a process to screen for Medically Exempt members, both at enrollment, after enrollment, and through provider referral

Healthy Behaviors Program

New branding exclusively for the Iowa Health and Wellness Plan Healthy Behaviors Program Brand

19 Healthy Behaviors Program Goals Members take active role in their health care Engage providers and develop plan of care with primary care provider Meet federal requirement (CMS) for program

Healthy Behaviors Program Members take active role in their health care Helps waive any possible contribution (premium) for the next year of enrollment Physical Exam Health Risk Assessment No Premium in 2015

Healthy Behaviors Program Members have 12 months to complete Healthy Behaviors o Enrolled in January 2014, have until January 2015 o Enrolled in April 2014, have until April 2015 Contribution amount if activities not completed: o Wellness Plan (50-100% FPL): $5 per month o Marketplace Choice Plan ( % FPL): $10 per month

Identify the member’s primary care provider o Make sure member keeps appointment o Any wellness exam since the beginning of their eligibility qualifies, if billed correctly If unknown, member can: o Call Iowa Medicaid Member Services at (8-5, M-F) o Member Services can share provider and phone # 22 Wellness Exam

Health Risk Assessment Wellness Plan Members 1.Using tool called Assess My Health AssessMyHealth.com 2.Can be completed online or by phone By phone through IME Member Services 3.Member gets 5-digit code from their provider, enters code on assessment

Health Risk Assessment Marketplace Choice Plan Members CoOportunity Health members should use their assessment: Coventry members should use their assessment: Can also use Assess My Health if the member prefers

Outreach Support New website launched specific to Iowa Health and Wellness Plan and Healthy Behaviors: Provider Toolkit available: BehaviorsToolkit.pdf BehaviorsToolkit.pdf Stakeholder Toolkit available: Toolkit_ pdf Toolkit_ pdf

LyonOsceolaDickinsonEmmet Winnebago Worth MitchellHoward WinneshiekAllamakee SiouxO’BrienClay Palo Alto HancockCerro Gordo Floyd Chickasaw Fayette Clayton PlymouthCherokee Buena Vista PocahontasHumboldt Wright Butler Bremer WoodburySac Calhoun Webster HamiltonHardin Grundy Black Hawk BuchananDelawareDubuque Monona Crawford Carroll Greene Dallas Story MarshallTama BentonLinn Jones Harrison ShelbyAudubon Guthrie Boone PolkJasperPoweshiek Kossuth Franklin Ida Jackson Clinton Iowa Johnson Cedar Scott Pottawattamie Cass AdairMadison WarrenMarion MahaskaKeokuk Washington Muscatine Louisa MillsMontgomery Union ClarkeLucasMonroeWapelloJefferson Des Moines Henry Adams FremontPageTaylorRinggoldDecaturWayneAppanooseDavisVan Buren Lee ,561 6,499 2,633 1,956 8,437 3, , , ,579 1, , ,00321,842 1, , , , , ,612 Overall Iowa Health and Wellness Plan Enrollment: As of August 29, 2014 Map represents overall program enrollment, which include the Iowa Wellness Plan and the Iowa Marketplace Choice Plan. Total Enrollment as of August 29, 2014: 107,

27 APPLICATION PROCESS DHS Contact Center Federal Health Insurance Marketplace DHS website dhsservices.iowa.gov DHS Local Offices Application Process

28 Information Find up-to-date information on the Iowa Health and Wellness Plan at: wellness-plan Member Site: