Medicaid changes are coming

As changes in health care for Americans are about to go into effect, representatives from local health care and community service organizations had the opportunity to get a look at what is in store for Iowa’s low-income and Medicaid patients.

Jennifer Vermeer, Iowa Medicaid director, spoke to the group Tuesday afternoon at Iowa Central Community College’s East Campus about the new Iowa Health and Wellness Plan which will take effect on Jan. 1, 2014.

Vermeer said the new program was designed to provide health care coverage to Iowans who may not have been eligible for Medicaid before. It will cover Iowans 19 to 64 years old with incomes up to 133 percent of the federal poverty level.

“Not all adults are eligible for Medicaid now,” Vermeer said. “They have to be low-income and fit into a category of being a child, elderly, a pregnant mother, have a disability or be parents with dependent children in the home.”

Vermeer said many Medicaid patients presently have a chronic illness or are recipients of long-term care such as nursing home or home and community based mental health services.

“Medicaid is the primary payor for the assistance of these individuals,” said Vermeer.

Of Iowa’s 450,000 Medicaid recipients, Vermeer said the top 5 percent of high-cost members accounted for 90 percent of hospital readmissions, 75 percent of total in-patient costs, averaged 4.2 medical conditions with five physicians and 5.6 prescribers and made up 50 percent of the prescription drug cost.

Because there are individuals who may not qualify for Medicaid, Vemeer said there is a need for change in Iowa’s system to make coverage available to them.

“The cost of health care is unaffordable and unsustainable,” she said. “Medicaid relies on the same health care system as all others. They are part of the same health care delivery system.”

To help bring a new plan to Iowa, the Department of Human Services submitted a plan for a six-month grant with the State Healthcare Innovation Plan.

“The vision is to transform Iowa’s health care economy,” said Vermeer.

Under the new plans, members would not pay premiums the first year, and would have an opportunity to engage in healthy behaviors, such as getting a physical, in the following years which would lower, or even eliminate, their premiums. The new plans would offer a full network of medical providers and provide care for eligible individuals up to 133 percent of the federal poverty level.

Eligible health care recipients will have access to the Iowa Wellness Plan for those living at 0 to100 percent of the federal poverty level or the Marketplace Choice Plan for those 101 to 133 percent of the poverty level. The Marketplace plan will allow members to select a health plan available on the Health Insurance Marketplace which will become active Oct. 1 at