Extension approved November 2016
Waiver Approval Period:
Jan. 1, 2017 through Dec. 31, 2019
Key Themes from Waiver:
- Dental benefits
- Healthy behavior incentive
- Non-emergency medical transportation
In November 2016, the “Iowa Marketplace Choice” Section 1115 waiver, which provided coverage to adults between the ages of 19-65 with income between 100 and 133 percent of the federal poverty level (FPL), was terminated. Coverage for this population was transitioned to the Iowa Wellness Plan 1115 waiver. This transition allows all individuals eligible under the adult Medicaid expansion to be covered under one waiver.
- The waiver seeks to influence enrollee decisions related to healthy behaviors through the assessment and potential waiver of monthly premiums. Premiums may be imposed on enrollees with incomes between 50 and 133 percent of the federal poverty level in year two of the demonstration. Enrollees who complete required healthy behaviors in a year will have their monthly premiums waived for the following year.
- Healthy behaviors for year one of the demonstration include a wellness exam and a health risk assessment.
- Premiums may not exceed $5/month for households from 50 up to 100 percent FPL and $10/month for households between 100 and 133 percent FPL There is a 90 day premium grace period. Nonpayment of imposed premiums could result in a collectible debt, but enrollees under 100 percent FPL will not lose coverage for failure to pay the assessed premium.
- With the exception of a copayment for non-emergency use of the emergency room, premiums will be used in lieu of other forms of cost-sharing. The waiver maintains existing population exemptions from premiums that are outlined by the Medicaid program and does not assess premiums on enrollees who are medically frail or receiving premium assistance.
- Enrollees receive core dental benefits through the Wellness alternative benefit plan. Individuals will qualify for “Enhanced” or “Enhanced Plus” dental benefits based on completion of periodic exams. Dental services will be provided through a Prepaid Ambulatory Health Plan (PAHP). The PAHP must allow access to non-network providers when services cannot be provided within state timeliness standards.
- Non-emergency medical transportation will not be provided to the Medicaid expansion population.
Association Principles: The waiver is consistent with CHA’s principles.
Association Contact: Shannon Lovejoy, (202) 753-5385