Overview of Medicaid :: Iowa People's Law Library

Overview of Medicaid

Medicaid is a state and federal program that provides health coverage to eligible low-income adults, children, pregnant women, older adults, and people with disabilities. A person must be determined to be eligible in order to receive Medicaid. Generally, to be eligible for Medicaid, you must be a resident of Iowa, a citizen of the U.S., meet certain income requirements, and be one of the following:

A child under the age of 21
A parent living with a child under the age of 18
A woman who is pregnant
A person in need of treatment for breast or cervical cancer
A person who is 65 or older
A person who is disabled according to Social Security standards
An adult between the ages of 19 and 64 and whose income is at or below 133 percent of the Federal Poverty Level (FPL)

There are many programs and services available and not all are covered here. For more information about eligibility, member responsibilities, providers, programs, benefits, and services, visit the the Iowa Department of Health and Human Services (HHS) website here. Understanding if you are eligible for Medicaid and which programs you are eligible for can be confusing and complicated. It is important that you talk with someone who is an expert in Medicaid and the application process if you have questions.

How do I apply for Medicaid?

You can apply for Medicaid with the Iowa Department of Health and Human Services (HHS) online or by phone at 800-338-8366. To check your eligibility or to apply, you can go directly to the HHS Services Portal here.

What are the options under Medicaid?

Iowa Medicaid has three main options for coverage: Iowa Health Link, Medicaid Fee-for-Service (FFS), and Healthy and Well Kids in Iowa (Hawki).

Iowa Health Link

Health coverage under this program is provided by a managed care organization, also called an MCO. Most Iowans who qualify for Medicaid are members of Iowa Health Link. You can find resources and information for members of the Iowa Health Link program on the Department of Health and Human Services (HHS) website here.

Medicaid Fee-for-Service (FFS)

Under FFS, an Iowa Medicaid member's health care providers are paid separately for each service the member receives, like an office visit or a test. There are many programs under FFS:

Health Insurance Premium Payment Program (HIPP) helps cover the costs of health insurance premiums.
Medicare Savings Program (MSP) helps pay for the out-of-pocket expenses of Medicare. This includes the Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) programs.
Emergency Medical Services helps pay the costs of emergency medical services for undocumented noncitizens.
Medically Needy (spend down program) provides payment assistance to people whose income is too high for Medicaid but whose medical expenses take up most of their income.
Presumptive Eligibility provides temporary assistance to people who are likely to be eligible for Medicaid before they have been determined to be eligible for Medicaid.
Program of All-Inclusive Care for the Elderly (PACE) provides services that will allow persons to stay in their homes and communities and combines Medicaid and Medicare funding.
Family Planning Program (FPP) helps men and women between the ages of 12 and 54 with the cost of family planning services like birth control, pelvic exams, and voluntary sterilization.

You can find resources and information for members of the FFS program on the Department of Health and Human Services (HHS) website here.

Health and Well Kids in Iowa (Hawki)

Health care coverage under this program is for uninsured children of working families. The amount members pay for the coverage is based on the family’s income, and some families will pay nothing. You can find resources and information for members of Hawki on the Department of Health and Human Services (HHS) website here.

What is managed care?

Medicaid managed care provides for the delivery of Medicaid health benefits and other services through contracts between state Medicaid agencies and managed care organizations (MCOs) that accept a set payment for these services. You can find contact information for the Iowa Medicaid MCOs on the Iowa Department of Health and Human Services (HHS) website here.

What is an HCBS Medicaid waiver?

The Iowa Home & Community Based Services (HCBS) waivers are Medicaid programs that allow a person to have more choice about how and where they receive services than they might have under Medicaid. HCBS waiver programs are for individuals with disabilities and older Iowans who with supports and services are able to stay in their home or community rather than live in an institution. Individuals must be eligible for Medicaid and meet the level of care requirements for the waiver. You can find information about the waivers on the Iowa Department of Health and Human Services (HHS) website here.

Can Medicaid help with nursing home costs?

Medicaid pays most nursing home costs for people who may not have enough income or assets to pay and can also help with costs so that a person can stay in their home. Not all nursing homes accept Medicaid and Medicaid will only pay for nursing home care provided in a facility certified by the government to provide service to those who receive Medicaid. If a person is eligible for Medicaid and is accepted as a resident by a facility, the Medicaid payment must be accepted by the facility as full payment for care. The facility cannot charge the Medicaid recipient more than Medicaid pays.

Understanding the Medicaid resource limits and whether the assets you have count as resources can be confusing and complicated. There are also legal options available that may help you become eligible for Medicaid assistance to cover long-term care costs. It is important that you speak with someone who is an expert in Medicaid and the legal options available to you if you have questions.

Where can I get help or more information?

Iowa Medicaid Member Services of the Iowa Department of Health and Human Services (HHS) is available by phone Monday to Friday from 8 a.m. to 5 p.m. at 1-800-338-8366, 515-256-4606, or 1-800-735-2942 (Relay Iowa TTY). Visit Iowa Medicaid Member Services online here.
The Managed Care Ombudsman can be reached Monday-Friday from 8-4:30 at (866) 236-1430 or through email at ManagedCareOmbudsman@iowa.gov. The managed care ombudsman assists and advocates for Iowa Health Link members who live in or receive long-term care or are enrolled in one of the Medicaid waivers.
Iowa Legal Aid is a non-profit agency that provides legal assistance to low-income and vulnerable Iowans. Information can be found on the Iowa Legal Aid website and they can be reached by phone at 800-532-1503 or, for Iowans 60 or older, 800-992-8161. Find information about Medicaid on their website here.
Your local area agency on aging can assist older Iowans and those with disabilities with Medicaid questions and understanding which programs might be of help to you. You can find contact information for your local area agency on aging here.
Iowa Find-A-Lawyer is an online directory of attorneys provided by the Iowa State Bar Association. Find general information about Medicaid on the Iowa State Bar Association's website here. Information about Medicaid programs and services available to older persons can be found in its Older Iowans Handbook.