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Iowa Health and Wellness Plan

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Presentation on theme: "Iowa Health and Wellness Plan"— Presentation transcript:

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 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 DHS website DHS Local Offices

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

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