Iowa Health and Wellness Plan

1. Iowa Health and Wellness Plan Rachel Johnson, MS, CHES Member Communications Iowa Medicaid Enterprise

2. Background • The Iowa Health and Wellness Plan was enacted to provide comprehensive health coverage for low-income adults • • Began January 1, 2014• Iowans age 19 - 64• Income up to and including 133% of the Federal Poverty Level (FPL)• New, comprehensive program replaced the IowaCare program, which ended December 31, 2013

3. 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 • For adults age 19 - 64 • Income 101% to no more than 133% of the Federal Poverty Level

4. Goals and Objectives

5. Member eligibility • 12 months of covered benefits • Income re-verified for eligibility after a 12-month period Member Eligibility

6. Family of one $11,670 • Individuals up to • 100% FPL Iowa Wellness Plan: 0-100% FPL • Family of two • $15,730

7. Iowa Wellness Plan: 0-100% FPL Administered by Iowa Medicaid Provides comprehensive health services Coverage is equal to the benefits provided to state employees

8. Access to the same providers currently available with Medicaid • Ability to choose primary care physician Iowa Wellness Plan: 0-100% FPL • Primary care physician coordinates care for member

9. Iowa Wellness Plan Managed Care Map: As of June 2014 Worth Lyon Osceola Dickinson Emmet Mitchell Howard Winnebago Winneshiek Allamakee Kossuth Sioux O’Brien Clay Hancock Cerro Gordo Palo Alto Chickasaw Floyd Fayette Clayton Wright Franklin Bremer Buena Vista Pocahontas Humboldt Butler Plymouth Cherokee Black Hawk Webster Buchanan Delaware Dubuque Woodbury Sac Hamilton Hardin Ida Calhoun Grundy Jackson Jones Carroll Boone Marshall Tama Crawford Greene Story Benton Linn Monona Clinton Shelby Audubon Polk Jasper Poweshiek Iowa Cedar Harrison Guthrie Dallas Johnson Scott Muscatine Adair Madison Mahaska Keokuk Cass Warren Marion Washington Pottawattamie Louisa Mills Montgomery Clarke Lucas Monroe Wapello Jefferson Henry Adams Union DesMoines Fremont Page Taylor Ringgold Decatur Wayne Appanoose Davis Van Buren Lee • Counties in lightblueare 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)

10. Family of one $11,671-$15,521 • Individuals 101% FPL • up to • 133% FPL Marketplace Choice Plan: 101-133% FPL • Family of two • $15,731- • $20,920

11. Marketplace Choice Plan: 101-133% FPL 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 – often referred to as “premium assistance”

12. Marketplace Choice Plan: 101-133% FPL Commercial health plans available to members: • CoOportunity Health • Coventry Health Care of Iowa Uses the commercial plan’s statewide provider network – includes primary care, specialists, hospitals

13. Marketplace Choice Plan: 101-133% FPL Provides comprehensive health services Coverage includes the qualified health plan required essential health benefits

14. Plan Summaries

15. Iowa Health and Wellness Plan • Dental Wellness Plan • Began May 1, 2014 • Operated by Delta Dental of Iowa • Members use an earned benefits model, beginning with core set of benefits, earning additional benefits for preventive care maintenance • Unique network of dental providers

16. 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

17. Healthy Behaviors Program

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

19. Healthy Behaviors Program Goals

20. Healthy Behaviors Program • Members take active role in their health care • Helps waive any possible contribution (premium) for the next year of enrollment

21. 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 (101-133% FPL): $10 per month

22. 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 1-800-338-8366 (8-5, M-F) • Member Services can share provider and phone #

23. 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

24. Health Risk Assessment Marketplace Choice Plan Members • CoOportunity Health members should use their assessment: www.cooportunityhealth.com • Coventry members should use their assessment: www.coventryhealthcare.com • Can also use Assess My Health if the member prefers

25. Outreach Support • New website launched specific to Iowa Health and Wellness Plan and Healthy Behaviors:www.iahealthlink.gov • Provider Toolkit available: http://www.iahealthlink.gov/sites/default/files/ProviderHealthyBehaviorsToolkit.pdf • Stakeholder Toolkit available: http://www.iahealthlink.gov/sites/default/files/Stakeholder%20Toolkit_07012014.pdf

26. Overall Iowa Health and Wellness Plan Enrollment: As of August 29, 2014 Worth Lyon Osceola Dickinson Emmet Mitchell Howard Winnebago Winneshiek Allamakee 115 104 360 257 195 156 193 190 Kossuth 309 357 Sioux O’Brien Clay Hancock Cerro Gordo Palo Alto 284 Chickasaw Floyd 230 1,561 213 191 415 561 241 278 Fayette Clayton 359 651 Wright Franklin Bremer Buena Vista Pocahontas Humboldt Butler Plymouth Cherokee 358 242 346 300 193 391 221 172 395 Black Hawk Webster Buchanan Delaware Dubuque Woodbury Sac Hamilton Hardin Ida Calhoun Grundy 3,800 132 176 276 314 1,807 2,633 436 192 464 6,499 550 Jackson Jones Carroll Boone Marshall Tama Crawford Greene Story Benton Linn Monona 633 558 9,474 309 329 442 252 1,579 561 688 624 1,426 Clinton 1,956 Shelby Audubon Polk Jasper Poweshiek Iowa Cedar Harrison Guthrie Dallas Johnson 404 Scott 1,121 452 969 207 1,003 21,842 3,406 391 198 135 8,437 Muscatine Adair Madison Mahaska Keokuk Cass Warren Marion Washington Pottawattamie 1,736 5,291 327 360 362 141 905 715 764 642 Louisa 351 Mills Montgomery Clarke Lucas Monroe Wapello Jefferson Henry Adams Union DesMoines 86 411 204 274 383 326 265 980 1,767 695 1,806 Fremont Page Taylor Ringgold Decatur Wayne Appanoose Davis Van Buren 161 364 142 134 292 176 521 223 225 Lee 1,612 • Map represents overall program enrollment, which include the Iowa Wellness Plan and the Iowa Marketplace Choice Plan. • Total Enrollment as of August 29, 2014: 107,425

27. Application Process

28. Information Find up-to-date information on the Iowa Health and Wellness Plan at: http://dhs.iowa.gov/ime/about/iowa-health-and-wellness-plan Member Site: www.iahealthlink.gov