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Healthy Behaviors Incentive Program Evaluation

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Health Care Reform

As a part of both the Wellness Plan and the Marketplace Choice Plan, enrollees are encouraged to participate in an HBI program involving three components: 1) a wellness exam and health risk assessment (HRA), 2) provider incentives, and 3) healthy behaviors. This program is designed to:

* Empower members to make healthy behavior changes.
* Establish future members’ healthy behaviors and rewards.
* Begin to integrate HRA data with providers for clinical decisions at or near the point of care.
* Encourage members to take specific proactive steps in managing their own health and provide educational support.
* Encourage providers to engage members in completion of the healthy behaviors by offering incentive payments.

Starting in 2015, a small monthly contribution by the member may be required depending on family income, although there are no copayments for health care services and prescriptions under the plan. Some Wellness Plan members will contribute $5 per month, while Iowa Marketplace Choice Plan members will contribute $10 per month. Wellness Plan members with individual earnings less than 50 percent of the Federal Poverty Level ($5,835 per year for an individual, or $7,865 for a family of 2) will not have monthly contributions. IHAWP members who complete the wellness exam and the HRA will not be responsible for a monthly contribution.

Early survey results of IowaCare members who transitioned into IHAWP found that the vast majority (90%) were not aware that completing a wellness exam would be part of the program to have their contributions waived.

Members earning over 49% of the FPL are given a 30-day grace period after the enrollment year to complete the healthy behaviors in order to have the contribution waived. If members do not complete the behaviors after the grace period has ended, members will receive a billing statement and a request for a hardship exemption form. For members of the Wellness Plan, all unpaid contributions will be considered a debt owed to the State of Iowa but will not, however, result in termination from the Wellness Plan. If, at the time of reenrollment, the member does not reapply for or is no longer eligible for Medicaid coverage and has no claims for services after the last premium payment, the member’s debt will be forgiven. For members in Marketplace Choice, unpaid contributions after 90 days result in the termination of the member’s enrollment status. The member’s outstanding contributions will be considered a collectable debt and subject to recovery. A member whose Marketplace Choice Plan benefits are terminated for nonpayment of monthly contributions must reapply for Medicaid coverage. The IME will permit the member to reapply at any time; however, the member’s outstanding contribution payments will remain subject to recovery.

Askelson, N., Wright, B., Bentler, S. E., Momany, E., McInroy, B., Heeren, T., & Damiano, P. Healthy Behaviors Incentive Program Evaluation. : .