Health Insurance Coverage - NAMI - Greater Des Moines
Health Insurance Coverage - NAMI - Greater Des Moines
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Health Insurance Coverage

HEALTH INSURANCE COVERAGE TOPICS

Medicaid - Iowa Health and Wellness program - Iowa Insurance Exchange   

Iowa Medicaid Enterprise (IME) - HCBS Waivers 

Advocates Guide to Accessibility in Medicaid Managed Care Grievances, Appeals, and State Fair Hearing

10 Things to Know About MedicaidKaiser Foundation

From Coverage to Care - A Behavioral Health Roadmap

Kaiser Family Foundation's

2017 Federal Poverty Level (FPL) Guidelines

Family Size

Medicaid

limited to 100% FPL
or determined to be medically exempt

(and under 138% FPL)

Iowa Health and Wellness Plan

limited 138% FPL
income guidelines

Iowa Insurance Exchange

limited to 400% FPL
income guidelines

1

$12,060

$16,643 

$48,240

2

$16,240

$22,411

$64,960

3

$20,420

$28,180

$81,680

4

$24,600

$33,948

$98,400

5

$28,780

$39,716

$115,120

6

$32,960

$45,485

$131,840

7

$37,140

$51,253

$148,560

8

$41,320

$57,022

$165,280

You can file for Medicaid benefits throughout the year at the local DHS office.

You can file for insurance throughout the year for the Iowa Health and Wellness Plan (up to 138% of the Federal Poverty level).  Once your eligibility has been determined for insurance coverage, you can request a determination whether you are medically exempt/medically frail.  If found medically exempt/medically frail, you can receive Medicaid benefits instead of Iowa Health and Wellness benefits.  

A comparison of benefits for Medicaid vs.Iowa Health and Wellness plan can be found here.

Definition of medically exempt:  An individual will be considered medically exempt if he or she has any one or any combination of the following:

  1. Disabling mental disorder
  2. A chronic substance abuse disorder
  3. Serious and complex medical condition
  4. Physical, intellectual, or developmental disability that significantly impairs the individual’s ability to perform one or more activities of daily living, or
  5. A determination of disability based on Social Security Administration
  6. Medically exempt individuals can choose to be part of an integrated health home

Medically exempt adults between 19 and 64 with income up to 138% FPL can receive Medicaid benefits.

Non-Medically exempt adults between 19 and 64 with income up to 138% FPL can receive Iowa Health and Wellness Plan benefits.  To find more information about the Health and Wellness Plan, click here

To file for health insurance coverage through the Iowa Health and Wellness Plan – go to the DHS Self Service Portal at www.dhsservices.iowa.gov/apspssp/ssp.portal or call the DHS Contact center at 1-855-889-7985.


For those who are purchasing private health insurance through the Iowa Insurance Exchange (139% to 400% of the Federal Poverty level) – coverage can be purchased Nov. 15 to Feb. 1.  Premium subsidies can also be obtained and the amount will depend on income level.  To sign up for health insurance, click here, or call 1-800-318-2596.


Which Door Could You Enter to Get Health Insurance?  click here

Mental Health Information - click here


IME (Iowa Medicaid Enterprise) website - click here
Iowa Health Link (Managed Care Organization information) - click here
DHS (Dept. of Human Services) website - click here


Home and Community Based Waivers (HCBS) - services provided in your home

The types of HCBS waivers are:  Elderly, HIV/Aids, Health & Disability, Intellectual Disability, Brain Injury, Children's Mental Health and Physical Disability.  Click here for a comparison chart of the HCBS waivers.

If you are receiving assistance through an HCBS waiver, the Managed Care Ombudsman's office is available for your assistance in case you have a complaint - ManagedCareOmbudsman@iowa.gov - Phone:  866-236-1430
The complaint form can be found here.

If you want more information on HCBS waivers, application packets, etc., - click here.


Managed Care Organization (MCO) Grievances and Appeals Guide  

States require managed care plans who serve Medicaid enrollees to establish and maintain an internal grievance and appeal and fair hearing system. As states begin to incorporate new federal regulations into their Medicaid rules, there’s opportunity for advocates to help shape those rules to ensure that older adults and people with disabilities have equal access to the grievance and appeal and state fair hearing systems, as mandated by Section 504 of the Rehabilitation Act (“Rehab Act”), the Americans with Disabilities Act (“ADA”), and Section 1557 of the Affordable Care Act (“ACA”). 

Disability Rights Education and Defense Fund (DREDF), Justice in Aging and National Health Law Program (NHeLP) collaborated on a new Advocates Guide to Accessibility in Medicaid Managed Care Grievances, Appeals, and State Fair Hearing. This new Advocates’ Guide, provides guidance on how the federal framework can be made fully accessible to Medicaid beneficiaries who are older and/or have disabilities. 

The Guide includes detailed suggestions for state regulatory language, best practices, and practice tips for ensuring accessibility that will be useful for all states as they conform their grievance, appeal, and state fair hearing processes to the federal rule. 

Links to three accessible versions of the guide can be found below.

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