1. Iowa Health and Wellness Plan
Maddisen Kies,
Communications Analyst
Iowa Medicaid Enterprise

2. One Plan, Two Options Iowa Wellness Plan • For adults age 19 - 64
• Income up to and including 100% of the Federal
Poverty Level
Marketplace Choice Plan
• Income 101% to no more than 133% of the Federal

3. Iowa Wellness Plan: 0-100% FPL
Quick Facts
Administered by Iowa Medicaid
Uses Iowa Medicaid provider network
Offers comprehensive set of benefits
Uses a primary care case management (PCCM) program, referred to as managed care
Primary Care Patient Manager, or primary care provider (PCP) coordinates care and referrals for the member

4. Iowa Wellness Plan: 0-100% FPL
Member Enrollment
Iowa Wellness Plan members have 1,500 primary care providers available, in addition to other contracted Medicaid providers
All members have access to local providers (doctors, hospitals, pharmacies, etc.)
In 87 counties, members will be assigned to a primary care physician of their choice in their county (where approx. 94% of members live)

5. Iowa Wellness Plan: 0-100% FPL
Provider Incentives: Physician is contracted similar to MediPASS (current managed care program)
Primary Care Physician (PCP) is eligible to earn four additional types of payments above the regular fee-for-service payment
Primary Care Case Manager Monthly Payment
Wellness Exam Incentive
Wellness Plan Medical Home Value Index Score Bonus
HRA Incentive for Incorporation Into Care Plan
$4 Per Member Per Month (PMPM)
$10 Per Member Annually
Up to $4 Per Member Per Month (PMPM)
$25 Per Member Annually

6. Marketplace Choice Plan: 101-133% FPL
Quick Facts
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
Offers comprehensive set of benefits
Commercial health plans available to members are CoOportunity Health and Coventry Health Care of Iowa
Uses the commercial plan’s statewide provider network

7. 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

8. Healthy Behaviors Program

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

10. 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

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

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

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

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

15. Assess My Health 8th grade reading level
Available in English or Spanish
Takes minutes
Asks questions about health
Additional questions based on health conditions

16. Assess My Health

17. Assess My Health

18. 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

19. Healthy Behaviors Outreach Campaign Strategy
Comm. Action Agencies
Community Social Service Agencies
Public Health Depts / WIC
Counties / Local Health Organizations
Food Banks / Homeless Shelters
Agencies Serving Low Income Adults
Churches
Faith-Based Organizations
CAC’s & Navigators
IME Provides Training and Materials
Community Based Organizations as Intermediaries
Health and Wellness Plan Members
Accountable Care Organizations &
Medical Homes

20. Member Campaign All members received a letter and flyer end of May
Ongoing communications beginning in September, continuing throughout the year
Active community outreach, events, educational forums

21. Outreach Support
Provider Toolkit Available:
Stakeholder toolkit and other resources coming
Event ideas, support or collaboration opportunities, contact:

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

23. Information Find up-to-date information on
the Iowa Health and Wellness Plan at:
Member Site: