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Medicaid, SCHIP, & Federal Authority

  • Section 1115 Waiver The IowaCare program extends a limited set of Medicaid benefits to uninsured adults ages 19 through 64 with incomes at or below 200 percent of the federal poverty level (FPL), including parents of Medicaid or State Children’s Health Insurance Program (SCHIP)-eligible children. The program is a capped, non-entitlement program that converts uncompensated care funds into insurance coverage for adults. Benefits includehospital, physician, limited pharmacy, and limited dental services that are provided through a limited provider network. Under this 1115 waiver program, Iowa also provides additional home and community-based benefits to children with serious emotional disturbance (Children’s Mental Health Waiver) with net family income at or below 250 percent of FPL. 

    In 2007, the Iowa legislature granted funding that would allow the State to serve an additional 300 children with serious emotional disturbance through the Children’s Mental Health Waiver and to eliminate premiums for enrollees with incomes at or below 100 percent of the FPL.


High-Risk Pools

  • The Health Insurance Plan of Iowa (HIPIOWA) is the high-risk pool that serves residents that cannot purchase coverage in the private market for reasons including: pre-existing medical condition or disease diagnosis that results in a premium higher than HIPIOWA rates, reduced benefits or benefit limitation, or an outright denial. Residents of Iowa are also eligible if they qualify under federal HIPAA or COBRA protections. At the end of 2005, just over 1,300 persons were enrolled.

    The Iowa Individual Health Benefit Reinsurance Association (IHBRA), a previously existing pool of reinsured individuals, was merged into HIPIOWA effective January, 2005.


Dependent Coverage

  • H.F. 2539 requires health insurance carriers to allow dependents to maintain their parent's coverage if the child is under age 25, a full-time student, or has a disability.