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

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Presentation on theme: "Iowa Health and Wellness Plan Maddisen Kies, Communications Analyst Iowa Medicaid Enterprise."— Presentation transcript:

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

2 2 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

3 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 3 Iowa Wellness Plan: 0-100% FPL

4 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) 4 Iowa Wellness Plan: 0-100% FPL

5 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 5 Iowa Wellness Plan: 0-100% FPL 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 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 6 Marketplace Choice Plan: % FPL

7 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 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 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

12 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

13 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 # 13 Wellness Exam

14 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

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

16 Assess My Health

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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 19 CAC’s & Navigators IME Provides Training and Materials Community Based Organizations as Intermediaries Health and Wellness Plan Members Accountable Care Organizations & Medical Homes Healthy Behaviors Outreach Campaign Strategy

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: 0Healthy%20Behaviors%20Toolkit_ _0.pdf 0Healthy%20Behaviors%20Toolkit_ _0.pdf Stakeholder toolkit and other resources coming Event ideas, support or collaboration opportunities, contact:

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

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


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