Iowa

IA Health Link

In 2016, Iowa transitioned to a new Medicaid managed care program known as IA Health Link. The program, which operates under authority of Sections 1902(a) and 1915(b) of the Social Security Act, was approved by CMS in February 2016. Managed home and community-based services are provided through 1915(c) Waivers operating concurrently. The statewide program is mandatory for people in all Medicaid eligibility categories, with very limited exceptions, and includes participants in all 1915(c) Waivers.

Capitation rates for IA Health Link are based on Medicaid eligibility category, age, and gender; in addition, there are separate rate cells for people receiving LTSS. For LTSS users, there are four blended capitation rates that include people receiving either institutional services or HCBS:

LTSS—Elderly, for people 65 or over in custodial care nursing homes or getting hospice care or Elderly Waiver services.
LTSS—Non-Dual or Pre-65, for those under 65 in custodial care nursing homes, non-duals of any age in skilled nursing facilities, people under 65 getting hospice services, and people on the Physical Disability Waiver, the Health and Disability Waiver, the AIDS Waiver, or the Brain Injury Waiver.
LTSS—Intellectual Disability, for people in institutions for people with intellectual disabilities or getting services through the Intellectual Disability Waiver.
LTSS—Children's Mental Health, for children institutionalized for mental health conditions or receiving services through the Children's Mental Health Waiver.

The blended rates are calculated according to the mix of institutional and community residents and then adjusted downward to reflect a target for rebalancing the system in favor of HCBS. Although nominally intended to provide an incentive for MCOs to divert members from nursing home placement and transition them out, plans that are unable to meet those targets will find themselves shortchanged and perhaps unable to meet member LTSS needs.