Iowa Medicaid History and Facts

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Initial Medicaid Implementation: Iowa began their Medicaid program in July of 1967, two years after the passage of the Medicaid program. The state did not participate in the Kerr-Mills program but began drafting a plan to participate in 1963. By then it was clear that Congress was looking to a new direction in providing health care services to states. Iowa would have become the 30th state to participate in the program.

Key Medicaid Political Issues: In recent years the focus of Iowa’s Medicaid program has been on transferring nearly all of the beneficiaries on Medicaid to managed care organizations. The transition plan was introduced in 2014 and implemented in 2016. The plan has been met with considerable political pressure and the Senate voted in 2016 to overturn the direction. It has continued to be a topic for a great deal of scrutiny as the transition to managed care has displaced and disrupted the care for many individuals.

 Medicaid Expansion Implementation: Iowa expanded Medicaid in 2014 due in part to the state receiving a waiver similar to the waivers received by Arkansas and Michigan who also expanded Medicaid at this time with a premium assistance waiver for individuals over 100% of the federal poverty level to purchase qualified health plans on the exchange. Uniquely to Iowa, the state decided to no longer participate in their waiver program in July of 2015. Instead the state would only implement the second waiver that they received when they decided to apply for Medicaid expansion funding and move beneficiaries into managed care organizations.

General facts about Iowa Medicaid:

Medicaid program name: Medicaid

CHIP Program name: Healthy and Well Kids in Iowa

Separate or combined CHIP: Combination

Medicaid Enrollment: 632,600 (2017)

Total Medicaid Spending: $4.8 billion

Share of total population covered by Medicaid: 17% (2015)

Share of Children covered by Medicaid: 40% (estimate)

Share of Medicaid that is Children and Adults: 80%

Share of Spending on Elderly and people with disabilities: 65%

Share of Nursing Facility Residents covered by Medicaid: 50% (estimate)

FMAP: 56.7%

Expansion state: Yes

Number of people in expansion: 149,300

Work Requirement: No


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