Medicaid, a joint federal and state program, provides healthcare coverage to individuals with limited income and resources. In Iowa, most Medicaid members are enrolled in managed care plans like Iowa Health Link. However, some individuals receive coverage through fee-for-service (FFS) programs. This article explains what Medicaid FFS is and which programs are included.
What is Fee-for-Service (FFS)?
Fee-for-service is a payment model where healthcare providers are reimbursed for each individual service they provide. This contrasts with managed care, where providers receive a fixed payment per member regardless of the services used. Iowa’s Medicaid FFS programs cover specific populations and services not included in managed care.
Iowa Medicaid FFS Programs
Several programs fall under Iowa’s Medicaid FFS umbrella:
Health Insurance Premium Payment (HIPP)
HIPP helps eligible individuals maintain employer-sponsored health insurance by covering premium costs. To qualify:
- You or a household member must be enrolled in Medicaid.
- You must have or be eligible for employer-sponsored health insurance.
- The health insurance must be cost-effective.
Qualified Medicare Beneficiary (QMB)
QMB assists individuals who are eligible for both Medicare and Medicaid with Medicare cost-sharing, including premiums, deductibles, and coinsurance. Eligibility is based on income and resource limits.
Specified Low-Income Medicare Beneficiary (SLMB)
SLMB helps pay Medicare Part B premiums for individuals with incomes slightly above the QMB threshold (between 100% and 135% of the federal poverty level).
Emergency Services for Non-Citizens
This program provides up to three days of Medicaid coverage for emergency services for undocumented immigrants who do not meet citizenship or social security requirements. Services must be provided in a qualified medical facility.
Medically Needy Program
This program offers financial assistance to individuals with incomes too high for traditional Medicaid but whose medical expenses consume a significant portion of their income. Participants share in the cost of their care.
Presumptive Eligibility (PE)
PE provides temporary Medicaid coverage while a formal eligibility determination is pending. This ensures access to immediate healthcare for those likely to qualify.
Program of All-Inclusive Care for the Elderly (PACE)
PACE integrates Medicaid and Medicare benefits to provide comprehensive care and services that allow seniors to remain in their homes and communities.
American Indians and Alaskan Natives
Members identifying as American Indian or Alaskan Native can choose between managed care and fee-for-service options.
Iowa Medicaid Coverage Options: A Summary
Iowa Medicaid offers three primary coverage pathways:
- Iowa Health Link (Managed Care)
- Medicaid Fee-for-Service (FFS)
- Hawki (Children’s Health Insurance Program)
Finding More Information
For detailed information about fee-for-service programs and eligibility requirements, contact your local Iowa Department of Human Services (HHS) office or Iowa Medicaid Member Services:
1-800-338-8366
515-256-4606
515-725-1351
Relay Iowa TTY: 1-800-735-2942
Conclusion
Understanding the different coverage options available through Iowa Medicaid is crucial for accessing necessary healthcare services. While managed care serves the majority of members, fee-for-service programs provide critical coverage for specific populations and needs. Contact Iowa Medicaid Member Services or your local HHS office to determine the best coverage option for you.
