Benefits and Services

As a member of the Molina Healthcare of Iowa, you will receive a variety of medical benefits and services. Some services may require prior approval. Please work with your healthcare provider to determine if the specific service you need is covered. You may contact Molina to find providers you can see for your medical care described below by calling our Member Services at (844) 236-0894 (TTY: 711).

  • Covered and Value-Added Services

    Iowa Covered Benefits

    Services
    * may be required

    Medicaid

    Iowa Health and Wellness Plan (IHAWP)

    Hawki

    Covered

    Covered

    Covered

    Preventive Services

    Affordable Care Act (ACA)
    preventive services

                                        

    Routine check-ups


    limitations may apply

    Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)


    up to age 21

    Immunizations


    limitations may apply




    Professional Office Services

    Primary Care Provider

    Office visit

    Allergy testing

    Allergy serum and injections

    Certified nurse midwife services

    Chiropractor


    limitations may apply


    limitations may apply


    limitations may apply

    Contraceptive devices

    Dentists or routine dental exam

    Diabetic self-management training

    Once per member, lifetime maximum

    10 hours of outpatient, self-management training within a 12-month period plus follow-up training of up to 2 hours annually

    Family planning and family planning related services

    Gynecological


    limitations may apply

    Injections


    limitations may apply


    limitations may apply


    limitations may apply

    Laboratory tests

    Child care medical services


    up to age 21 under

    Newborn child: office visits

    Podiatry

    Routine foot care is not covered unless it is part of a member’s overall treatment related to certain healthcare conditions.

    Routine foot care is not covered unless it is part of a member’s overall treatment related to certain healthcare conditions.

    Routine eye exam
    One routine vision exam per calendar year.

    Routine hearing exam
    One routine vision exam per calendar year.

    Specialist office visit

    v
    PCP referral may be required


    PCP referral may be required


    PCP referral may be required

    Inpatient Hospital Services

    Preapproval of inpatient admissions


    Required for non-emergent admissions


    Required for non-emergent admissions


    Required for non-emergent admissions

    Room and board

    Inpatient physician services


    includes anesthesia


    includes anesthesia

    Inpatient supplies

    Inpatient surgery

    Bariatric surgery for morbid obesity

    limitations may apply

    Breast reconstruction,
    following breast cancer
    and mastectomy

    limitations may apply

    Organ/bone marrow transplants


    limitations may apply


    limitations may apply

    limitations may apply

    Outpatient Hospital Services

    Abortions

                       ✓

    Certain circumstances must apply


    Certain circumstances must apply


    Certain circumstances must apply

    Ambulatory surgical center


    includes anesthesia


    includes anesthesia


    includes anesthesia

    Chemotherapy

    Dialysis

    Outpatient diagnostic lab, radiology

    Emergency Care

    Ambulance

    Urgent care center

    May require prior authorization

    Hospital emergency room


    $8.00 per visit for non-emergent medical services

                       ✓

    emergency services for non-emergent conditions are subject to a $25 copay if the family pays a premium for the Hawki program

    Transportation Services

    Emergency medical transportation

    Emergency transportation is subject to review for medical necessity


    Emergency transportation is subject to review for medical necessity

    Emergency transportation is subject to review for medical necessity

    Non-Emergency Medical Transportation

    Behavioral Health Services

    Assertive Community Treatment (ACT)


    Covered if member has been determined to be medically exempt.

    Behavioral Health
    Intervention Services
    (BHIS), including applied
    behavior analysis


    Residential treatment is covered if member has been determined to be medically exempt

    (b)(3) services (intensive psychiatric rehabilitation, community support services, peer support, and residential substance use treatment)

    Inpatient mental health and substance abuse treatment


    limitations may apply

    Office visit

    Outpatient mental health and substance abuse

    Psychiatric Medical
    Institutions for Children
    (PMIC)


    For 19 to 20 year olds. Limitations may apply

    Crisis Response and Subacute Mental Health Services


    Covered if
    member has been
    determined to be medically exempt.

    Outpatient Therapy Services

    Cardiac rehabilitation

    Occupational therapy

                       ✓

    Limited to 60 visits per year

    Oxygen therapy


    Limited to 60 visits
    in a 12-month period

    Physical therapy


    Limited to 60 visits per year

    Pulmonary therapy


    Limited to 60 visits per year

    Respiratory therapy


    Limited to 60 visits per year

    Speech therapy


    Limited to 60 visits per year

    Radiology Services

    Mammography

    Routine radiology screening and diagnostic services

    Sleep study testing


    Sleep apnea diagnostic services only

    Laboratory Services

    Colorectal cancer screening

    Diagnostic genetic testing

    Pap smears

    Pathology tests

    Routine laboratory screening and diagnostic services

    Sexually Transmitted Infection (STI) and Sexually Transmitted Disease (STD) testing

    Durable Medical Equipment (DME)

    Medical equipment and
    supplies

    Diabetes equipment and supplies


    limitations may apply

    Eyeglasses


    limitations may apply


    for ages 19 to 20, limitations may apply


    limitations may apply

    Hearing aids


    for ages 19 to 20, limitations may apply

    Orthotics


    limitations may apply

    Not Covered


    limitations may apply

    Sleep apnea device

    for adults only

     

    Long-Term Services and Supports (LTSS) - Community-Based

    Case management

    for individuals with a developmental disability and HCBS waiver populations only

     

     

    Section 1915(C) Home-
    and Community-Based
    Services (HCBS)

    Section 1915(I)
    Habilitation Services


    Covered if member has been determined to be medically exempt.

    Private duty nursing/Personal cares per EPSDT authority

    Covered up to age 21 under EPSDT

    Covered up to age 21 under EPSDT

     

    Chronic Condition Health Homes


     

    Integrated Health Homes


    Covered if member has been determined to be medically exempt.

    Long-Term Services and Supports (LTSS) - Institutional

    ICF/ID (Intermediate Care Facility for individuals with Intellectual Disabilities)


    limitations may apply

    ICF/MC
    Intermediate Care Facility for Medically Complex

    limitations may apply

    Nursing Facility (NF)

     

    Nursing Facility for the Mentally Ill (NF/MI)

    Skilled Nursing Facility (SNF)


    limitations may apply
    limited to 120 day
    stays

    Skilled Nursing Facility Out of State (Skilled preapproval)

    limitations may apply

    Community-Based
    Neurobehavioral
    Rehabilitation Services


    medically exempt
    only

    Hospice

    Hospice


    limitations may apply

    Home Health

    Private duty nursing/ Personal cares per EPSDT authority


    up to age 21 under
    EPSDT


    up to age 21 under
    EPSDT

    Home Health Aide

    Skilled Nursing

    Occupational Therapy (OT)

    Physical Therapy (PT)

    Speech-Language Pathology

    The list above does not show all your covered benefits. To learn more about your benefits, call Member Services at (844) 236-0894 (TTY: 711). If you are an Iowa Health and Wellness Plan member who is determined by Iowa Medicaid to be medically exempt, you will qualify for Iowa Health Link benefits.

    Physician Administered Preferred Drug List

    Value-Added Services:

    See full Value-Added benefit list here.

      • Free Healthy Rewards Program: gift cards for completing various annual visits and screenings for eligible members
      • Free access to community resources on health, financial support, education, emergency resources, legal support, housing, employment opportunities, transportation, and food security.
      • Free smartphone and service plan for eligible members
      • Free transportation services
      • Free long-term care caregiver transportation for eligible members (4 one-way trips)
      • Free Healthy Living Benefit: Variety of Assistive Devices and Adaptive Aids for eligible members ($60 per Unit)
      • Free home delivered meals for members who have been discharged from the hospital
      • Free healthy foods program for eligible members
      • Free pregnancy rewards program
      • Free annual community baby shower events and education for eligible members
      • Free Doula services for eligible members (8 Doula visits)
      • Free car or booster seat for eligible members
      • Free home delivered meals for high-risk pregnant women
      • Free over-the-counter-pharmacy products ($ 30 worth of items)
      • Free smoking cessation products for eligible members
      • Free online WW (Weight Watchers)
      • Free sponsored membership fees for members under the age of 19 to YMCA or Can Play
      • Free ACE Assessment for members under the age of 18
      • Free HSED exam vouchers
      • Free gift card for passing HSED exam
      • Free assistance to secure legal guardianship for eligible members (up to $500 per eligible member)

      See the list of items you can purchase with Healthy Rewards.

    MolinaHelpFinder.com: Community resources