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

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 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.

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.

 

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