The state of Iowa has two signed State Plan Amendments with CMS for 2703 Health Home programs. The first State Plan Amendment has a statewide coverage area and extends a medical home model of care delivery to low income adults with two or more chronic diseases or individuals with one chronic condition who are at-risk of developing a second condition. These chronic conditions include: hypertension, overweight, heart disease, diabetes, asthma, substance abuse, mental health.
The second State Plan Amendment creates a health home model focused on adults and children with serious and persistant mental illness (SPMI). A team of professionals work together to provide whole-person, patient-centered, coordinated care for all situations in life and transitions of care to adults with serious mental illness and children with serious emotional disorders. This SPA has a coverage area that includes five counties: Dubuque, Polk, Linn, Warren, and Woodbury.
The Health Homes are paid a per-member-per-month (PMPM) rate based upon the number of chronic conditions of the member, in addition to the regular fee for service payments:
Tier 1 (1-3 chronic conditions) $12.80
Tier 2 (4-6 chronic conditions) $25.60
Tier 3 (7-9 chronic conditions) $51.21
Tier 4 (10 or more chronic conditions) $76.81
Magellan Health Services is contracted as the state's Behavioral Health Organization and offers telehealth services, integrated health homes, crisis intervention services, and peer support services. Medicaid funding for mental health and substance abuse services is provided by IME and is based on enrollment. Magellan is paid a PMPM rate and is at-risk for the cost of Medicaid services. A specific, capped percent of Medicaid funding is set for Magellan's administrative costs.
IDPH funding for substance abuse services is a set annual amount from federal block grants and state appropriations, regardless of the number of clients who present for services.
Cost savings were also found for the first 18 months of Iowa’s program. Estimates indicated that on average, $132 in Medicaid spending was saved in the first month of each beneficiary’s enrollment in the health home program. Estimated cost savings increased thereafter by about $11 per additional month of enrollment in the health home program. In the first 18 months of the program in Iowa, total savings of about $9.0 million were achieved, or nearly 20 percent of total projected Medicaid spending on health home enrollees.
Results were mixed:
