IowaCare Fact Sheet - Iowa Primary Care Association

The IowaCare Program Is:
A CMS 1115 demonstration waiver, first approved in 2005
o A patient-centered medical home model was included as part of the most recent waiver approved by
A Medicaid expansion program that covers adults:
o Age 19-64
o Up to 200% of FPL
o Not otherwise eligible for Medicaid
A limited benefit package and limited provider network
o Providers are limited to:
 Broadlawns Medical Center
 The University of Iowa Hospitals and Clinics
 Federally Qualified Health Centers in Iowa
o Services include:
 Inpatient and outpatient hospital services
 Physician and midlevel (advanced registered nurse practitioner and PA) services, including
annual preventive physicals
 Limited dental services
 Tobacco cessation
o Services not included:
 Comprehensive prescription drug benefit
 Only a 10-day supply of prescriptions associated with an inpatient or outpatient DRG
are covered
 Services not typically provided directly by primary care clinics
 Non-CLIA waived laboratory services
 High-cost diagnostic testing
 Only services provided by the clinic can be billed
 IowaCare providers donate prescription drugs and many other services to IowaCare members
with their own funds
A safety net for hospitals that have high amounts of uncompensated care
o In SFY11, a capped $2M reimbursement for emergency services at non-IowaCare hospitals (associated
with inpatient stay) was implemented
The IowaCare Program Is Not:
A comprehensive insurance package
A long term solution
o The program will transition to Medicaid Expansion under the Affordable Care Act January 1, 2014
when Medicaid will cover all persons 133% FPL and below
A free program
o Members are required to pay a monthly sliding scale premium if above 150% FPL (up to $60 per
month for individuals or $80 per month for two or more members in a household at 200% FPL)
What We Know About IowaCare Members:
More than 80% of IowaCare members have an income below 100% FPL
The average monthly income for an IowaCare member is $850
25% have never had health insurance; 66% have not had insurance for more than 2 years
80% of patients have one or more chronic conditions (diabetes, chest pain, coronary artery disease, cancer,
high blood pressure, pain)
IowaCare members self report poorer health status than the general Medicaid population