State Marketplace Profiles: Iowa
Final update made on November 18, 2013 (no further updates will be made)
Establishing the Marketplace
On December 14, 2012, Governor Terry Branstad (R) informed federal officials that Iowa would pursue a State-federal Partnership Marketplace.1 Iowa will assume plan management functions in the Marketplace and will continue to perform Medicaid and CHIP eligibility determinations. The state intends to transition to a fully State-based Marketplace in 2016.
Contracting with Plans: The Iowa Insurance Department (IID) is responsible for Qualified Health Plan (QHP) certification and uses the System for Electronic Rate and Form Filing (SERFF) to facilitate the process. Six carriers are certified to participate on Iowa’s Marketplace; four offer plans in the individual Marketplace and five offer small group coverage. Two carriers provide statewide coverage, while the rest participate in smaller regional markets.2 Insurers are allowed to rate by age, tobacco use, and geography; there are seven geographic rating areas in the state.3 Information on plans and rates available to individuals and small businesses can be found on HealthCare.gov.
IID will monitor plan management activities to ensure that QHPs meet quality and performance expectations and will partner with CCIIO to determine the best means of displaying QHP quality reporting to consumers. IID will also perform reviews of form and rate filings, network adequacy, and accreditation, licensure, and solvency standards. Iowa will not require plan standardization.4
Dental and Vision Benefits: Dental benefits may be embedded in QHPs or offered as stand-alone products.5 All insurers offering health insurance coverage in Iowa, both inside and outside the Marketplace, must disclose whether the plan covers pediatric dental benefits.6 Plans may have high actuarial value (85%) or low actuarial value (70%). Four dental carriers offer stand-alone dental plans on the Marketplace.2 Information on dental plans for individuals and small businesses is available on HealthCare.gov.
Risk adjustment, Reinsurance, and Risk corridors: Iowa has decided to allow the federal government to administer the risk adjustment and reinsurance programs for the Marketplace.7
Consumer Assistance and Outreach: In May 2012, Governor Branstad signed HF 2645 establishing licensing requirements and criteria for Navigators to be determined by the Insurance Commissioner.8 Since Iowa is not engaging in a consumer assistance partnership, the state is not operating an In-Person Assister program and relies on the federally-run Navigator program to provide in-person assistance. In August 2013, the Department of Health and Human Services selected three organizations in Iowa to serve as Navigators and awarded the grantees a total of $599,999 to perform education activities and enrollment assistance for individuals and small businesses.9 A map of Navigator service areas is available on the IID website. Iowa’s 14 community health centers received a total of $1.5 million in funding from the Health and Resources Services Administration (HRSA) to hire 26 additional workers to support outreach activities and facilitate enrollment.10 Other organizations who wish to assist consumers applying for Marketplace coverage may apply to become volunteer Certified Application Counselors (CACs). Licensed agents and brokers that register and complete the federal training course may sell health insurance coverage through the Marketplace.
In September 2013, the IID held the first in a series of 20 community events to educate consumers about the Marketplace. Events are scheduled statewide and will take place through the end of November.11 In October 2013, the IID issued a Request for Proposals (RFP) for a contractor to implement a television and radio advertising campaign using existing advertisements created by the Centers for Medicare & Medicaid Services (CMS). An awardee will be selected in November, and the advertisements will be broadcast from December 1, 2013, through March 31, 2014.12 In November 2013, the IID issued a RFP for one or more contractors to develop and implement a statewide outreach campaign targeting uninsured Iowans and small businesses. The outreach campaign will include online, television, and radio advertising; in-person town hall meetings; stakeholder webinar trainings; educational online videos; and a state Marketplace website. The IID will select one or more vendors in mid-December, and the campaign will run from January 2, 2014 through March 31, 2014. If the open enrollment period is extended, the contract will be amended in order to continue the campaign beyond March 2014.13
Small Business Health Options Program (SHOP) Marketplace: In November 2012, the state commissioned a report to review the statutory, regulatory, and administrative SHOP Marketplace requirements and to discuss major design and procurement decisions.14 Employers with 50 or fewer employees are eligible to participate on the SHOP. In Iowa, 75% of employees must enroll in the SHOP Marketplace in order for the employer to participate.15 Five carriers offer coverage to small businesses and plans are available on all four metal level tiers.
Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Marketplace, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. Since Iowa has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Wellmark (Blue Cross Blue Shield)- Alliance Select, PPO.
In September 2010, the Iowa Department of Public Health received a federal Exchange Planning grant of $1 million. In November 2011, the Department received a federal Level One Establishment grant of $7.7 million to secure additional staff, identify and begin to establish systems and program capacity, build information technology infrastructure, and initiate a business and operational plan. Iowa received a second Level One Establishment grant for $26.6 million in August 2012, which it planned to use for further development of a new eligibility system. In January 2013, Iowa was awarded a third Level One grant for $6.8 million to develop a consumer assistance program. In October 2013, the state received a fourth Level one grant for $17.5 million to support the transition to a State-based Marketplace in 2016.16
On March 5, 2013, Iowa received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a State-federal Partnership Marketplace.17 Enrollment into Marketplace coverage began on October 1, 2013. The federal government is operating the online eligibility and enrollment system, and consumers must use the federal portal to apply for coverage online.
Governor Branstad Letter to Secretary Sebelius. December 14, 2012.
“Six Health Insurers Apply To Offer Health Care Coverage on Iowa’s Health Insurance Marketplace.” Iowa Insurance Division.
Iowa Insurance Division. Geographic Rating Areas.
Iowa Design Review Evidence: State Partnership Model, Section 4.0- Plan Management. November 14, 2012.
Summary Sheet for QHP Application and Stand-alone Dental Plans. Iowa Insurance Division. May 30, 2013.
Memo re: Treatment of Pediatric Dental Coverage Provided Through Stand Alone Dental Plans. April 26, 2013.
Iowa- Issuer Frequently Asked Questions Risk Adjustment and Reinsurance. Iowa Insurance Division.
House File 2465. An Act Relating to State and Local Finances. May 18, 2012.
The Check-Up. July-October 2013. Iowa Department of Public Health.
“IID Kickoff Event for Outreach and Education on Health Exchange Saturday." Iowa Insurance Division. September 2013.
Request for Proposal: IID 2013-14 Marketplace-1 Fed Ad Placement. October 18, 2013.
Request for Proposal: IID 2013-14 Marketplace-2 Community Outreach Campaign. November 1, 2013.
Planning for the Small Business Health Options Program. CSG Government Solutions. November 30, 2012.
Key Facts About the Small Business Health Options Program (SHOP) Marketplace. Centers for Medicare and Medicaid Services.
Iowa Affordable Insurance Exchange Grant Awards List.
Letter from Secretary Sebelius to Governor Branstad. March 5, 2013.