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Benefits Grid

Iowa Total Care provides valuable programs and services so you and your family can stay healthy. You can view healthcare services that are covered by Iowa Health Link (Medicaid) below. See an overview of the programs and services (updated PDF coming soon) available to you.

Refer to the Member Handbook (PDF) for a complete list of the benefits and services available to you.

To learn about the Waiver Program, visit Iowa Department of Health and Human Services' website

Preventive Services

ServicesIA Health LinkIA Health & Wellness Plan - IA Wellness PlanHAWKI
Affordable Care Act (ACA) Preventive ServicesCoveredCoveredCovered
Routine Check-UpsCoveredCovered, limitations may applyCovered
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)Covered, up to age 21Covered, up to age 21Not Covered
ImmunizationsCoveredCovered, limitations may applyCovered, limitations may apply

Professional Office Services

ServicesIA Health LinkIA Health & Wellness Plan - IA Wellness PlanHAWKI
Primary Care ProviderCoveredCoveredCovered
Office VisitCoveredCoveredCovered
Allergy TestingCoveredCoveredCovered
Allergy Serum and InjectionsCoveredCoveredCovered
Certified Nurse Midwife ServicesCoveredCoveredCovered
ChiropractorCovered, limitations may applyCovered, limitations may applyCovered, limitations may apply
Contraceptive DevicesCoveredCoveredCovered
Family Planning and Family Planning Related ServicesCoveredCoveredCovered
InjectionsCovered, limitations may applyCovered, limitations may applyCovered, limitations may apply
Laboratory TestsCoveredCoveredCovered
Child Care Medical ServicesCovered, up to age 21 under EPSDTNot CoveredNot Covered
Newborn Child - Office VisitsCoveredCoveredCovered
PodiatryCovered

Routine foot care is not covered unless it is part of a Member's overall treatment related to certain health care conditions.
Covered

Routine foot care is not covered unless it is part of a Member's overall treatment related to certain health care conditions.
Covered
Routine Eye Exam

One routine vision exam per calendar year
CoveredCoveredCovered
Routine Hearing Exam

One routine hearing exam per calendar year
CoveredCoveredCovered
Specialist Office VisitCovered, PCP referral may be requiredCovered, PCP referral may be requiredCovered, PCP referral may be required

Inpatient Hospital Services

ServicesIA Health LinkIA Health & Wellness Plan - IA Wellness PlanHAWKI
Preapproval of Inpatient AdmissionsCovered, required for non-emergent admissionsCovered, required for non-emergent admissionsCovered, required for non-emergent admissions
Room and BoardCoveredCoveredCovered
Inpatient Physician ServicesCovered, includes anesthesiaCovered, includes anesthesiaCovered
Inpatient SuppliesCoveredCoveredCovered
Inpatient SurgeryCoveredCoveredCovered
Bariatric Surgery for Morbid ObesityCoveredNot CoveredCovered, limitations may apply
Breast Reconstruction, following breast cancer and masectomyCoveredCoveredCovered, limitations may apply
Organ/Bone Marrow TransplantsCovered, limitations may applyCovered, limitations applyCovered, limitations may apply

Outpatient Hospital Services

ServicesIA Health LinkIA Health & Wellness Plan - IA Wellness PlanHAWKI
AmbulanceCoveredCoveredCovered
Urgent Care CenterCoveredCoveredCovered
Hospital Emergency RoomCoveredCovered, $8.00 per visit for non-emergent medical servicesCovered, emergency services for non-emergent conditions are subject to a $25 copay if the family pays a premium for the Hawki program
Non-Emergency Medical Transportation (NEMT)CoveredNot CoveredNot Covered

Behavioral Health Services

ServicesIA Health LinkIA Health & Wellness Plan - IA Wellness PlanHAWKI
Assertive Community Treatment (ACT)CoveredCovered when the member has been determined to be medically exempt pursuant to 441 IAC subrule 74.12(3)Not Covered
Behavioral Health Intervention Services (BHIS), including applied behavior analysisCoveredCovered, residential treatment is covered when the member has been determined to be medically exempt pursuant to 441 IAC subrule 74.12(3)Not Covered
(b)(3) services (intensive psychiatric rehabilitation, community support services, peer support, and residential substance use treatment)Covered (MCO Members only)Covered when the member has been determined to be medically exempt pursuant to 441 IAC subrule 74.12(3)Not Covered
Inpatient Mental Health and Substance Abuse TreatmentCoveredCovered, limitations may applyCovered
Office VisitCoveredCoveredCovered
Outpatient Mental Health and Substance AbuseCoveredCoveredCovered
Psychiatric Medical Institutions for Children (PMC)CoveredCovered, for 19 to 20 year olds. Limitations may applyNot Covered
Crisis Response and Subacute Mental Health ServicesCoveredCoveredCovered

Outpatient Therapy Services

ServicesIA Health LinkIA Health & Wellness Plan - IA Wellness PlanHAWKI
Cardiac RehabilitationCoveredCoveredCovered
Occupational TherapyCoveredCovered, limited to 60 visits per yearCovered
Oxygen TherapyCoveredCovered, limited to 60 visits in a 12-month periodCovered
Physical TherapyCoveredCovered, limited to 60 visits per yearCovered
Pulmonary TherapyCoveredCovered, limited to 60 visits per yearCovered
Respiratory TherapyCoveredCovered, limited to 60 visits per yearCovered
Speech TherapyCoveredCovered, limited to 60 visits per yearCovered

Radiology Services

ServicesIA Health LinkIA Health & Wellness Plan - IA Wellness PlanHAWKI
MammographyCoveredCoveredCovered
Routine Radiology Screening and Diagnostic ServicesCoveredCoveredCovered
Sleep Study TestingCoveredCovered, sleep apnea diagnostic services onlyCovered

Laboratory Services

ServicesIA Health LinkIA Health & Wellness Plan - IA Wellness PlanHAWKI
Colorectal Cancer ScreeningCoveredCoveredCovered
Diagnostic Genetic TestingCoveredCoveredCovered
Pap SmearsCoveredCoveredCovered
Pathology TestsCoveredCoveredCovered
Routine Laboratory Screening and Diagnostic ServicesCoveredCoveredCovered
Sexually Transmitted Infection (STI) and Sexually Transmitted Disease (STD) TestingCoveredCoveredCovered

Durable Medical Equipment

ServicesIA Health LinkIA Health & Wellness Plan - IA Wellness PlanHAWKI
Medical Equiipment and SuppliesCoveredCoveredCovered
Diabetes Equipment and SuppliesCoveredCovered, limitations may applyCovered
Eye GlassesCovered, limitations may applyCovered, for ages 19 and 20, limitations may applyCovered, limitations may apply
Hearing AidsCoveredCovered, for ages 19 to 20, limitations may applyCovered, limitations may apply
OrthoticsCovered, limitations may applyNot CoveredCovered, limitations may apply

Long Term Support Services (LTSS) - Community Based

ServicesIA Health LinkIA Health & Wellness Plan - IA Wellness PlanHAWKIPrior Authorization Required
Care Management - HCBS Waiver and HCBS Habitation Populations OnlyCoveredNot CoveredNot CoveredYes
Section 1915(C) Home-and-Community-Based Services (HCBS)CoveredNot CoveredNot CoveredYes
Section 1915(I) Habitation ServicesCoveredNot CoveredNot CoveredYes

*The HCBS Person Centered Service Plan is the Prior Authorization request that is submitted through the Community-Based Case Manager or Integrated Health Home Care Coordinator. 

Long Term Support Services (LTSS) - Institutional

ServicesIA Health LinkIA Health & Wellness Plan - IA Wellness PlanHAWKIPrior Authorization Required
ICF/ID (Intermediate Care Facility for Individuals with Intellectual Disabilities)Covered, limitations applyNot CoveredNot CoveredNo
Nursing Facility (NF)CoveredNot CoveredNot CoveredNo
Nursing Facility for the Mentally Ill (NF/MI)CoveredNot CoveredNot CoveredNo
Skilled Nursing Facility (SNF)CoveredCovered, limitations apply, limited to a 120 days stayNot CoveredYes
Skilled Nursing Facility Out of State (Skilled Preapproval)Covered, limitations applyNot CoveredNot CoveredYes
Community-Based Neurobehavioral Rehabilitation ServicesCoveredNot CoveredNot CoveredYes

Hospice

ServicesIA Health LinkIA Health & Wellness Plan - IA Wellness PlanHAWKI
HospiceCoveredCovered, limitations applyCovered

Health Homes

ServicesIA Health LinkIA Health & Wellness Plan - IA Wellness PlanHAWKI
Integrated Health HomesCoveredNot CoveredNot Covered

Home Health

ServicesIA Health LinkIA Health & Wellness Plan - IA Wellness PlanHAWKI
Private Duty Nursing / Personal Cares per EPSDT AuthorityCovered, up to age 21 under EPSDTCovered, up to age 21 under EPSDTNot Covered

Routine Vision Services

ServicesIA Health LinkIA Health & Wellness Plan - IA Wellness PlanHAWKI
Exams 

Covered

1 complete preventive eye exam every 12 months

Covered

1 complete preventive eye exam every 12 months

Covered

1 complete preventive eye exam every 12 months

Eyewear

Covered

Age 1 and under: up to 3 pairs of eyeglasses every 12 months, up to 16 gas permeable contact lenses every 12 months

Age 1-3: up to 4 pairs of eyeglasses every 12 months, up to 8 gas permeable contact lenses every 12 months

Age 4-7: 1 pair of eyeglasses every 12 months, up to 6 gas permeable contact lenses every 12 months


Age 8 and over: 1 pair of eyeglasses every 24 months, 2 gas permeable contact lenses every 24 months

Covered

Age 19 and 20 only: 1 pair of eyeglasses (frames and lenses) every 24 months

 

 

 

 

 

 

 

 

 

Covered

$100 retail allowance toward eyeglasses and contact lenses every 12 months

 

 

 

 

 

 

 

 

 

Repairs

Covered

Age 20 and under: replacement for eyeglasses lost or damaged beyond repair is not limited.

Age 21 and over: replacement for eyeglasses lost or damaged beyond repair is limited to once every 12 months.

 

 

 

 

Covered

Age 19 and 20 only: replacement for eyeglasses lost or damaged beyond repair is not limited.

 

 

 

 

 

 

Not Covered

 

 

 

 

 

 

 

 

 

Learn about your vision benefits with our Vision Benefits FAQ (PDF). Visit our Vision Care website for more information. You can also refer to your Member Handbook.

Excluded Services

Services not covered include the following:

  • Services or items used for cosmetic purposes only
  • Acupuncture
  • Infertility services
  • Dental services

Iowa Total Care does not pay for services not covered. This is not a complete list of excluded services. If you wish to know if a service is covered, please call Member Services at 1-833-404-1061 (TTY: 711).