Health Insurance, Medicaid and the Iowa Health and Wellness Plan

Authored By: Iowa Legal Aid LSC Funded
IowaCare, one of Iowa’s Medicaid programs, is ending December 31, 2013. Iowa plans to introduce a new plan on January 1, 2014. In addition, Iowans will have a chance to look for health insurance through the State Exchange.
What is Iowa’s new plan to take the place of IowaCare? 
  • Iowa has proposed a plan called the Iowa Health and Wellness Plan.  
  • This proposed plan is being reviewed by the federal agency, Health and Human Services, but has not been approved as of November 25, 2013.
  • If approved, the Iowa Health and Wellness Plan will be available to low-income Iowans, aged 19 to 64. Their income must not be more than 133% of the federal poverty level for their family size. They must also not be eligible for full benefits under Medicaid or Medicare, or eligible for affordable employer-sponsored health care coverage. They must also not be pregnant.
  • The proposed Iowa Health and Wellness Plan will not pay for any medical care received before an individual is approved for coverage.
  • You can enroll in the Iowa Health and Wellness Plan by using the State Exchange, or by applying at the Iowa Department of Human Services (DHS).
  • Enrollment in the Iowa Health and Wellness Plan will last for 12 months, just like with IowaCare.
  • Individuals whose income is at or below 100% of the federal poverty level will receive a member card and have a health benefits plan that is offered and generally available to State of Iowa employees, with the following coverage:
    • Essential health benefits;
    • Prescription drugs;
    • Dental services, and
    • Habilitation services for individuals with certain psychiatric needs.
  • Individuals whose income is between 101 and 133% of the federal poverty level will receive a marketplace choice plan, unless they are exempt. The premiums for the plan will be paid for by DHS.
    • Exempt individuals will be given a choice of receiving benefits through Iowa Wellness Plan or normal Medicaid.  
    • If an individual in this income range has access to cost-effective employer-sponsored health coverage, then that person can be enrolled in Iowa’s HIPP program (where DHS pays the premiums to the employer’s health insurance).  
Is Iowa’s Medicaid Plan changing in any other ways?
  • Yes. One change is that there is a new coverage group for former foster care children, up to age 26.  
  • Another change is that dependent relatives of a recipient of State Supplementary Assistance will no longer be eligible for Medicaid. DHS says this is because there are now other medical programs that are available for those people. 
  • Another change is that beginning January 1, 2014, financial eligibility for regular Medicaid will be determined using something called “Modified Adjusted Gross Income,” or MAGI.
    • MAGI is defined by the IRS. It is your adjusted gross income, with some other amounts added back to it.  
  • Beginning January 1, 2014, there will be no assets or resource limit for Medicaid or waiver program eligibility.
  • The new income limits for certain programs are in the chart below.
What about other options for health insurance?
  • Iowa will have an Exchange available for people to consult about options for health insurance.
    • The Exchange will take information from individuals about their household composition and income, and provide them with information about what plans are available, and whether the individuals qualify for a “premium tax credit.”
    • A premium tax credit is a potential way to help pay for your health insurance premiums.
    • The Exchange will also inform people about whether they or their family members would qualify for Medicaid, the Iowa Health and Wellness Plan, Hawk-i, or other medical assistance programs. 
  • The general enrollment period for the Exchange will last from October 1, 2013 to March 31, 2014. People who need insurance starting January 1, 2014, must enroll by December 15, 2013. People can enroll in Iowa’s Health and Wellness plan at any time during the year.
The Exchange is a new program and there have been startup problems. If you have questions, you may call Iowa Legal Aid for advice. For online resources, go to and enter marketplace in the search box for a list of resources with more information.
Helping low-income Iowans who face legal problems impacting a basic family need like eligibility for Medicaid or health insurance is a priority for Iowa Legal Aid. To find out if help is available for a legal problem you may have, call Iowa Legal Aid at 1-800-532-1275.
Last Review 12/6/13
Last Review and Update: Dec 06, 2013

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