Evaluation of the Iowa Wellness Plan (IWP): Member Experiences in 2016

Bentler, S.; McInroy, B.; Heeren, T.; Momany, E.; Damiano, P.


The findings in this report represent survey responses about the health care experiences of Iowa Wellness Plan (IWP) members two years post implementation. Since the last survey report, two events occurred that impacted the structure and administration of the IWP and subsequently could have had an effect on IWP members’ experiences:

  • The Marketplace Choice Plan (MPC) was no longer an option for the Medicaid expansion population because both of the qualified health plan choices within the MPC dropped out of the Health Insurance Marketplace. Thus, the two original Medicaid expansion populations – adults from 0-100% FPL in the Wellness Plan (the plan administered by the state Medicaid program) and adults from 101 – 133% FPL in the Marketplace Choice plan merged into one, the Iowa Wellness Plan (IWP). 
  • Almost all Medicaid members (including IWP members) were transitioned to a private Medicaid Managed Care Organization (MCO) which managed and administered their health care coverage.  

Key Characteristics of the IWP population

  • IWP members are older and more likely to be male than the traditional Medicaid population
  • IWP members are less physically healthy and report significantly more functional limitations that adults in traditional Medicaid
  • Around half of the IWP members surveyed were employed; 16% were unemployed and 17% reported being unable to work

Key Takeaways

  • The Medicaid expansion in Iowa, the IWP, resulted in more adults having health insurance – In the first year of IWP, 30% of those surveyed did not have health insurance at all in the previous year compared to 2% reporting the same now
  • IWP member experiences varied with regard to obtaining prior authorization from their MCO to get care, tests, or treatment; around 30% of IWP members reporting it ‘very easy’ to get prior authorization from their MCO. However, another 30% reported that it was ‘somewhat or very hard’ to get the needed authorization for care.
  • Continuity with a personal doctor after the transition to MCO management was variable –
    • Continuity - over half (58%) of IWP member reported having the same personal doctor before and after the MCO management transition
    • Discontinuity - around 20% reported that, after enrollment in an MCO, they had a different personal doctor than before enrollment
    • Others gained a personal doctor – around 20% reported not having a personal doctor at all before enrolling in an MCO 
  • Almost three-quarters (72%)of IWP members reported a need for prescription medicine, over one-third(38%) reported a need for specialist care, and around one-quarter (22%)reported a need for treatment for a mental or emotional health problem
  • Unmet need for prescription medicine was reported by 17% of IWP members; unmet need for other services was relatively low (6% preventive care, 7% specialist care, 7% mental health care)

Potential for Action

  • Smoking Cessation – 40% of IWP members reported using tobacco products (cigarette smoking or other tobacco use) at lease some days. There is an opportunity for treatment or intervention for IWP smokers as only 50% reported that their doctor advised them to quit and around 25% reported that their doctor offered treatment options (medication or other methods) to help them quit. 
  • Access to transportation – 11% of IWP members reported an unmet need for transportation to or from a health care visit but could not get it; Yet, relatively few Medicaid members (IWP or traditional Medicaid) reported having used transportation paid for by their MCO to get to health appointments.  
  • Promote ways to get information or help – Less than half (47%) of the IWP members surveyed were aware of the Medicaid helpline; Yet, of those who used it, over three-quarters (79%) reported ‘usually’ or ‘always’ getting the information or help they needed by using the helpline.