Iowa Medicaid

Iowa Medicaid is funded by the federal and state government and is managed by the Iowa Department of Human Services. A wide range of medical and health care services is available through the Medicaid program. These services are covered only if they are medically necessary.

Most Medicaid members are covered under one of the managed care plans. Medicaid members must receive services through the provider network of the Managed Care Organizations (MCO) that they are enrolled in. Some services covered by Medicaid do require a small copayment that the member must pay.

Eligibility Requirements

To be eligible for Iowa Medicaid, you must be a resident of the state of Iowa, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income.

You must also be one of the following:*

• Pregnant
• Be responsible for a child 17 years of age or younger
• Have a disability or a family member in your household with a disability

* ACA Medicaid expansion covers eligible low-income adults.

Annual Household Income Limits (before taxes)

*For households with more than eight people, add $6,038 per additional person.

Available Services Include:

Services not covered include the following:

• Services or items used for cosmetic purposes only
• Acupuncture
• Infertility Services
• Dental Services

Copayments

Some Iowa Total Care Members are subject to a copay for certain services. Member copayments are capped at 5% of household income.

These types of members are always exempt from paying copays:

• Children under the age of 21
• Pregnant women
• Individuals receiving hospice care
• Federally-recognized American Indians/Alaska Natives
• Children in Foster Care
• Breast and Cervical Cancer Care Program (BCCCP)
• Disabled children under Family Opportunity Act

An $8 copayment for Iowa Total Care Plan members and a $25 copayment for Hawki members will be applied for use of a hospital emergency department (ED) to treat non-emergent conditions. A copayment shall not be imposed on Hawki members whose family income is less than 182% of the federal poverty level.