Iowa: Substantial Health Reforms

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In May, Iowa enacted health reform legislation (House File 2539) based on recommendations developed by the governor and the Legislative Commission on Affordable Health Care Plans for Small Businesses and Families. The commission consisted of 10 members of the General Assembly and 19 members of stakeholder groups, including consumers.[i] The reform law includes a broad variety of provisions regarding the affordability of health care for Iowans, including the following:

  • Children’s Coverage—The law aims to extend health coverage to all children. The state will cover children in families with incomes up to 300 percent FPL beginning in FY 2010, pending CMS authorization and sufficient federal funding. The law requires families earning above 200 percent FPL to pay a premium. The expansion could extend coverage to approximately 9,000 uninsured Iowa children. The Department of Human Services will receive more than $40 million in General Fund appropriations from 2009 to 2011 to implement the expansion programs. The state intends to launch the program on July 1, 2009, for fiscal year 2010. One significant provision of the law requires Iowans to indicate on their income tax forms if their dependent child has health care coverage.
  • Iowa Choice Health Care Coverage Advisory Council—The council is charged with assisting the Iowa Comprehensive Health Insurance Association (Iowa’s high-risk pool) with development of a comprehensive plan to provide health care coverage to all state residents within five years.
  • Continuous Eligibility—The Medicaid program will provide continuous eligibility for 12 months for children who might otherwise become ineligible because of changes in family income.
  • Annual Report—The Department of Revenue and the Department of Human Services (DHS) must submit an annual report to the governor and General Assembly, providing: 1) the number of families claiming state income tax exemptions for dependent children; 2) the number of families claiming state income tax exemptions for dependent children showing the presence or absence of health care coverage for those children; and 3) the effect of the tax form reporting requirements and subsequent outreach and education activities on the number of uninsured children.
  • Enrollment—The DHS must develop a plan to maximize enrollment and retention of eligible children in all public coverage programs.
  • Bureau of Health Insurance Oversight—Located within the Insurance Division of the Department of Commerce, this agency will assume responsibility for ensuring uniformity and transparency of health insurance operations.
  • Long-Term Living Planning and End-of-Life Care Education Campaign—The Department of Elder Affairs must implement a public education campaign to inform state residents about long-term care options and end-of-life care.
  • Medical Home System—The Department of Public Health (DPH) must create and implement a system of medical homes focused on reducing health disparities, improving quality, reducing costs, and promoting sustainability. The state’s Medical Home System Advisory Council will make recommendations to the DPH on the plan for implementing this statewide system, which will coordinate health care services, monitor data collection on patient-centered medical homes, and provide training and education to health care professionals and families. The first phase of system development will create a medical home for children eligible for Medicaid.
  • Family Opportunity Act—The act provides a Medicaid buy-in option for individuals under the age of 19 with disabilities whose family income is at or below 300 percent FPL. The act takes effect on January 1, 2009, and calls for a premium to be charged for those between 100 and 300 percent FPL.
  • Healthy Communities Initiatives—A grant program will promote healthy lifestyles, and the Governor’s Council on Physical Fitness will develop a strategy for the implementation of a statewide comprehensive plan to increase physical activity, improve nutrition, and promote healthy behaviors.
  • Medicaid Quality Improvement—A Medicaid Quality Improvement Council will be established to evaluate clinical outcomes and consumer and provider satisfaction.
  • Transparency—A quality and transparency workgroup will develop recommendations on cost and quality measures in order to provide information to consumers.
  • Reimbursement Accounts—The Commissioner of Insurance will assist employers with 25 or fewer employees with the implementation and administration of Section 125 plans, including Medical Expense Reimbursement Accounts and Dependent Care Accounts.
  • Pre-Existing Conditions—Pre-existing condition exclusions are prohibited for consumers moving between plans, including to and from non-group policies.
  • Dependent Coverage—Dependents under age 25 or still full-time students may remain on their parents’ or guardians’ health plans until they marry or leave the state.
  • Iowa Electronic Health Information Commission—The commission is charged with developing a statewide health information technology plan by January 1, 2009. The system will expand the use of electronic health records and improve health care quality to decrease costs.
  • Health Care Coverage to Caregivers—A two-year pilot program will offer premium assistance for health care coverage to direct care workers. The program will help determine if such assistance should be offered across the state.[ii]


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[i] “Updated Health Care Bill HF 2539,” Iowa House Democratic Research Staff, 82nd General Assembly, ,Bill Summary, April 22, 2008.
[ii] Iowa House File 2539, available at; “Iowa Enacts Health Reform Legislation,” St@teside, State Coverage Initiatives, June 2008, available at