Iowa still awaiting full federal waiver on new Medicaid option

Implementation of part of Iowa Health and Wellness Plan may be delayed

DES MOINES – Iowa may have to delay implementing part of its bipartisan Iowa Health and Wellness Plan if federal officials do not grant a full waiver on the program by next week, Gov. Terry Branstad said Thursday.

Branstad said he had a “very frank” meeting with officials in the U.S. Department of Health & Human Services when he was in Washington earlier this week, but federal officials still have not signed off on a piece of Iowa’s program that sets “very modest” insurance premiums for low-income participants that is paid for with Medicaid money providing they engage in a health-risk assessment designed to contain costs.

“It’s not resolved yet,” the governor said.

“We feel that to be successful in our goal to be the healthiest state that we’ve got to have people take ownership of their own health. HHS seems to have a problem with the premiums,” Branstad said.

“We’re saying the premiums are waived if they do a health-risk assessment and they have a whole year to do that,” he added. “We don’t think that that’s an onerous requirement at all, plus the premiums are very modest. So far they’ve not been willing to do that and we’re saying that this is really an essential part of the program.”

Branstad said his administration feels an obligation to follow through with innovative legislation designed to increase access, drive personal health ownership, and reform the health-care delivery system in a way that pays for quality, not the quantity of health-care services.

The pact hammered out last May by Iowa’s split-control Legislature seeks to use federal money to expand health-care coverage to needy Iowans by financing insurance premiums for participants who help manage their costs with healthy choices. Backers say at least 150,000 more Iowans will be eligible for health care at a reasonable cost via the legislation, which can’t take effect without a waiver from the federal government.

Branstad said he had a “very constructive” meeting with David Agnew, deputy assistant to President Obama and director of intergovernmental affairs, regarding Iowa’s unique approach to government-subsidized expansion for Medicaid-eligible recipients. “I think he really gets it,” the governor said.

However, he said there is “a little more of a challenge” convincing HHS officials and he remains hopeful they will sign off on the full waiver in time for state officials to begin enrolling eligible participants Oct. 1 for Iowans aged 19-64 with incomes up to and including 133 percent of the federal poverty level.

“We’ve got pretty much everything else resolved except this one last point,” Branstad said.

Under the compromise legislation, Iowans with income up to 100 percent of the federal poverty guideline ($11,490 for a family of one and $15,510 for a family of two) would receive the same benefits as state employees with their insurance premiums being paid for entirely by federal Medicaid money.

Iowans who have yearly income between 101 percent and 133 percent of the federal poverty standards (up to $15,281 for a family of one and up to $20,268 for a family of two) will seek private coverage via the state-federal insurance exchange being established under provisions of the federal Affordable Care Act. The premium for the commercial insurance is paid by Medicaid providing the recipients participate in the health-risk assessment.

Enrollment of the eligible population is expected to occur over several years with 60 percent signing up in the first year and 30 percent in the second year, according to the state Department of Human Services. The Iowa Council on Human Services finalized the program’s rules on Thursday.

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