Iowa Health and Wellness Plan
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1 Iowa Health and Wellness Plan Bryan Dempsey Provider Services Outreach Supervisor Iowa Medicaid Enterprise 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 2 Marketplace Choice Plan: % 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 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 Coverage limitations available at: s%20plan%20benefits%20coverage%20list_0.pdf Iowa Wellness Plan: 0-100% FPL Lyon Member Enrollment Iowa Wellness Plan members have 1,501 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) Osceola Dickinson Emmet Winnebago Worth Mitchell Howard Winneshiek Allamakee Sioux O Brien Clay Palo Alto Hancock Cerro Gordo Floyd Chickasaw Plymouth Cherokee Buena Vista Pocahontas Humboldt Wright Franklin Butler Bremer Woodbury Ida Sac Calhoun Monona Crawford Carroll Greene Harrison Shelby Audubon Guthrie Pottawattamie Kossuth Webster Dallas Boone Iowa Wellness Plan Managed Care Map: As of September 2014 Hamilton Hardin Grundy Black Hawk Fayette Clayton Buchanan Delaware Dubuque Story Marshall Tama Benton Linn Jones Polk Jasper Poweshiek Iowa Johnson Cedar Cass Adair Madison Warren Marion Mahaska Keokuk Washington Mills Montgomery Adams Union Clarke Lucas Monroe Wapello Jefferson Fremont Page Taylor Ringgold Decatur Wayne Appanoose Davis Van Buren Muscatine Louisa Henry Des Moines Lee Jackson Clinton Scott 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) 1
2 Iowa Health and Wellness Plan Member Assignments All members start as Iowa Wellness Plan Fee-for- Service for the first 4-6 weeks, depending on application date Selection is always effective the first of a month Selections made prior to the Cut off date are effective the next month Selections made after the Cut off date are effective the month after Brand New branding exclusively for the Iowa Health and Wellness Plan Goals Empower members to make healthy behavior changes Establish future member healthy behaviors and rewards Begin to integrate HRA data with providers for clinical decisions at or near the point of care Encourage members to take specific proactive steps in managing their own health and provide educational support Encourage providers to engage member in completion of the healthy behaviors by offering incentive payments Comply with CMS requirements for Members take active role in their health care Helps waive any possible contribution (premium) for the next year of enrollment Complete Healthy Behaviors = No Contributions Don t Complete Health Behaviors = May Have Contribution 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 2
3 Healthy Behaviors Contributions Individuals with Income 0-49 Percent of the FPL: No premiums are required, per state legislation Individuals with Income Percent of the FPL*: Nonpayment of premiums will result in debt subject to collection by Iowa, no loss of coverage will occur Individuals with Income Percent of the FPL*: Nonpayment of premiums will result in disenrollment from the Iowa Health and Wellness Plan *Members can claim hardship if one exists in the month 2014 Healthy Behaviors 1. Health risk assessment 2. Wellness exam (annual physical) Wellness Exam 1. Members should call their primary care provider and set up a check-up o Any wellness exam since the beginning of their eligibility qualifies, if billed correctly 2. Make sure to keep the appointment 3. First Healthy Behavior is complete Wellness Plan Members 1. Using tool called AssessMyHealth.com 2. Can be completed online or by phone 3. Member gets 5-digit code from their provider, enters code on assessment Wellness Plan Members Cont. 1. Must enter state ID once done, and select Yes to share results with their provider o Sharing results is optional, but encouraged 2. Should review results at their wellness exam Provider Access Providers register to receive 5-digit access code (Informational Letter 1388) o Code provides access to summary results for patients o Incorporating results into patient s care plan can be billed for $25 3
4 8 th grade reading level Available in English or Spanish Takes minutes Asks questions about health o Additional questions based on health conditions Marketplace Choice Plan Members CoOportunity Health members should use their assessment: Coventry members should use their assessment: Can also use if the member prefers Member Campaign All members received a letter and flyer end of May Ongoing communications beginning in July, continuing throughout the year Active community outreach, events, educational forums Outreach Support Provider Toolkit Available: 0Healthy%20Behaviors%20Toolkit_ _0.pdf Stakeholder toolkit and other resources coming Event ideas, support or collaboration opportunities, contact: lbueche@dhs.state.ia.us 4
5 Application Process Information Federal Health Insurance Marketplace DHS website dhsservices.iowa.gov Find up-to-date information on the Iowa Health and Wellness Plan at: DHS Contact Center APPLICATION PROCESS DHS Local Offices
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