Iowa Wellness Plan - Medicaid 1115 Demonstration

Section of Medicaid law waived: Section 1902(a)(14) as it incorporates Section 1916.

CMS Waiver Language: To the extent necessary to enable the state to charge premiums beyond applicable Medicaid limits to the Iowa Wellness Plan demonstration populations above 50 percent of the federal poverty level and to enable the state to charge premiums for all Dental Wellness Plan enrollees above 50 percent of the federal poverty level. Combined premiums and cost-sharing is subject to a quarterly aggregate cap of five percent of family income.

Summary: This waiver allows Iowa to charge premiums beyond Medicaid limits to the Iowa Health and Wellness (IHAWP) population for those above 50% of the federal poverty level (FPL) and to charge premiums to the DWP population above 50% of the federal poverty level.

All premiums and cost-sharing are subject to a cap of 5% of family income.

Additional Links

• Federal Poverty Level (FPL)
• Dental Wellness Plan
• Iowa Health and Wellness (IHAWP)

Section of Medicaid law waived: Section 1902(a)(4)(A) as implemented in 42 CFR 431.53

CMS Waiver Language: To the extent necessary to relieve the state of the responsibility to assure transportation to and from providers for adult expansion group beneficiaries. Medically frail beneficiaries and those eligible for Early Periodic Screening, Diagnosis and Treatment (EPSDT).

EPSDT services are exempt from this waiver of non-emergency medical transportation (NEMT). 

Summary: Most of this waiver allows Iowa to exclude non-emergency medical transportation (NEMT) from coverage for the IHAWP population, except for EPSDT services. IHAWP members who have a medically frail status have access to NEMT services.

NOTE: This waiver is scheduled to sunset on December 31, 2026. Iowa will cover NEMT for all of the IHAWP population beginning January 1, 2027.

Additional Links

• Methods of Administration
• EPSDT Services
• NEMT 

Section of Medicaid law waived: Section 1902(a)(17)

CMS Waiver Language: To the extent necessary to permit the state to provide reduced cost sharing for the newly eligible population through an $8 copay for non-emergency use of the emergency department. This copay will not apply to other Medicaid populations; copays applied to other Medicaid populations will not be imposed on this population.

Summary: This waiver allows Iowa to charge an $8 copay for non-emergency use of the emergency department to the IHAWP population.

Section of Medicaid law waived: Section 1902(a)(17)

CMS Waiver Language: To the extent necessary to permit the state to contract with a single dental benefit plan administrator to provide dental services to beneficiaries affected by the Iowa Wellness Plan section 1115 demonstration.

Summary: This waiver allows Iowa to contract with one Prepaid Ambulatory Health Plan (PAHP), or dental insurance provider, to administer the Dental Wellness Plan. Iowa maintains this waiver but is not using it at this time.

Section of Medicaid law waived: Section 1902(a)(23)(A)

CMS Waiver Language: To the extent necessary to permit the state to require enrollees to receive dental services through a carved-out contracted dental benefit with no access to other providers.

Summary: This waiver allows Iowa to provide dental services through PAHPs, or dental insurance providers. 

Section of Medicaid law waived: Section 1902(a)(10)(B)

CMS Waiver Language: To the extent necessary to enable the state to provide benefit packages to demonstration populations that differ from the state plan benefit package. To the extent necessary to enable the state to provide different dental benefits to Dental Wellness Plan enrollees subject to the requirements in the STCs.

Summary:  This waiver allows Iowa to offer IHAWP members Medicaid coverage that varies from the standard Medicaid coverage and dental benefits to the DWP that vary based on stipulations outlined in the Special Terms and Conditions. 

Section of Medicaid law waived: Section 1902(a)(10) and 1902(a)(34)

CMS Waiver Language: To the extent necessary to enable the state not to provide three months of retroactive eligibility for state plan populations. The waiver of retroactive eligibility does not apply to pregnant women (and during the 60-day period beginning on the last day of the pregnancy), infants under age 1, and (effective January 1, 2020) children under 19 years of age. The earliest that a retroactive eligibility period for children under age 19 will begin will be January 1, 2020, for an application filed on or after January 1, 2020.

The waiver of retroactive eligibility also does not apply to applicants who are eligible for nursing facility services based on level of care, who had been a resident of a nursing facility in any of the three months prior to an application, and who are otherwise eligible for Medicaid. For persons who are exempted from the waiver due to eligibility for nursing facility services, retroactive eligibility would be provided for any particular months in which the applicant was a nursing facility resident.

Summary: This waiver allows Iowa to limit retroactive eligibility to three months of coverage for pregnant women, children, and individuals in a nursing facility.

NOTE: Beginning January 1, 2027, retroactive coverage for pregnant women, children and individuals in a nursing facility will be limited to two months.  

As part of the Medicaid 1115 demonstration, Iowa is required to hold an annual forum to:

• Provide public transparency and opportunity for feedback.
• Report on access, quality, member experience, and dental care.
• Include notable themes from member comment.

Notice of the forum date for 2027 and supporting document will be posted here, ahead of next year’s forum.

Recent Forums

In April 2026, Iowa Medicaid hosted public forums as part of the Medicaid Member and Medicaid Provider Town Halls.

• Iowa Wellness Plan (IWP) Demonstration (948.73 KB) .pdf

As part of the Medicaid 1115 demonstration, Iowa is required to work with an independent evaluator to assess the program according to a CMS approved evaluation plan.

Iowa contracts the University of Iowa for this evaluation. The most recent report is the Interim Report.