Evaluation of the IowaCare Program

IowaCare is a public health insurance program that extends coverage up to 200% of the Federal Poverty Level (FPL). It provides limited benefits to adults age 19-64. Enrollees must use a provider network of the University of Iowa Hospitals and Clinics (UIHC) and Broadlawns Medical Center’s Community Care Program. Mental and behavioral inpatient services are available through the state’s four Mental Health Institutions. Monthly premiums range from $0-$75. During Fiscal Year 2007, IowaCare successfully enrolled almost 30,000 people for at least one month.

For this evaluation, outcomes of care, such as inpatient and outpatient utilization of services, were evaluated using IowaCare administrative enrollment and claims files. Enrollee perceptions of the IowaCare program were evaluated using mailed and telephone surveys. Provider perceptions of the IowaCare program were evaluated in focus groups and personal interviews with providers and administrators at UIHC, Broadlawns and the 4 MHIs.

In general, the program is meeting the needs of about two-thirds of enrollees; the other third have some problems accessing services. One-third of enrollees went outside the network for urgent care. Common health problems included heart disease, hypertension, back pain, and depression. Common chronic conditions identified by enrollees were dental problems, followed by back and neck problems, arthritis, and hypertension. There was considerable need for prescription drugs, a non-covered service, and broader dental care coverage. Of enrollees who paid a premium, over half indicated they had trouble making the payments. Provider interviews revealed that facility administrators understand and facilitate the program, while physicians have little understanding of how the program affects their patients.