Evaluation of Provider Adequacy in the Iowa Health and Wellness Plan During the Second Year

McKernan, S.C.; Pooley, M.; Momany, E.T.; Ingleshwar, A.; Damiano, P.C.


This report, focusing on CY 2015, is one of a series that evaluates provider network adequacy for the Iowa Health and Wellness Plan (IHAWP). “Adequacy”, for this report, is evaluated from a geographic perspective and includes assessments of total number of Medicaid contracted medical providers and travel distance with travel time where appropriate.

Selected outcomes for the Wellness Plan (WP) portion of the IHAWP are compared with the traditional Medicaid State Plan (MSP). IHAWP members who were in health plans through the Marketplace Choice program (those from 100-133% FPL) are excluded from this evaluation due to withdrawal of the two private health plans (CoOportunity left the market in 2014 and Coventry phased out its participation beginning in July 2015). 

Provider networks were identified by 2 methods: 1) the list of providers with a signed Medicaid contract (“contracted providers”), and 2) contracted providers who submitted at least 1 claim in 2015 (“active providers”).