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 Human Services' website.
Preventive Services
| Services | IA Health Link | IA Health & Wellness Plan - IA Wellness Plan | HAWKI |
|---|---|---|---|
| Affordable Care Act (ACA) Preventive Services | Covered | Covered | Covered |
| Routine Check-Ups | Covered | Covered, limitations may apply | Covered |
| Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) | Covered, up to age 21 | Covered, up to age 21 | Not Covered |
| Immunizations | Covered | Covered, limitations may apply | Covered, limitations may apply |
Professional Office Services
| Services | IA Health Link | IA Health & Wellness Plan - IA Wellness Plan | HAWKI |
|---|---|---|---|
| Primary Care Provider | Covered | Covered | Covered |
| Office Visit | Covered | Covered | Covered |
| Allergy Testing | Covered | Covered | Covered |
| Allergy Serum and Injections | Covered | Covered | Covered |
| Certified Nurse Midwife Services | Covered | Covered | Covered |
| Chiropractor | Covered, limitations may apply | Covered, limitations may apply | Covered, limitations may apply |
| Contraceptive Devices | Covered | Covered | Covered |
| Family Planning and Family Planning Related Services | Covered | Covered | Covered |
| Injections | Covered, limitations may apply | Covered, limitations may apply | Covered, limitations may apply |
| Laboratory Tests | Covered | Covered | Covered |
| Child Care Medical Services | Covered, up to age 21 under EPSDT | Not Covered | Not Covered |
| Newborn Child - Office Visits | Covered | Covered | Covered |
| Podiatry | 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 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 | Covered | Covered | Covered |
| Routine Hearing Exam One routine hearing exam per calendar year | Covered | Covered | Covered |
| Specialist Office Visit | Covered, PCP referral may be required | Covered, PCP referral may be required | Covered, PCP referral may be required |
Inpatient Hospital Services
| Services | IA Health Link | IA Health & Wellness Plan - IA Wellness Plan | HAWKI |
|---|---|---|---|
| Preapproval of Inpatient Admissions | Covered, required for non-emergent admissions | Covered, required for non-emergent admissions | Covered, required for non-emergent admissions |
| Room and Board | Covered | Covered | Covered |
| Inpatient Physician Services | Covered, includes anesthesia | Covered, includes anesthesia | Covered |
| Inpatient Supplies | Covered | Covered | Covered |
| Inpatient Surgery | Covered | Covered | Covered |
| Bariatric Surgery for Morbid Obesity | Covered | Not Covered | Covered, limitations may apply |
| Breast Reconstruction, following breast cancer and masectomy | Covered | Covered | Covered, limitations may apply |
| Organ/Bone Marrow Transplants | Covered, limitations may apply | Covered, limitations apply | Covered, limitations may apply |
Outpatient Hospital Services
| Services | IA Health Link | IA Health & Wellness Plan - IA Wellness Plan | HAWKI |
|---|---|---|---|
| Ambulance | Covered | Covered | Covered |
| Urgent Care Center | Covered | Covered | Covered |
| Hospital Emergency Room | Covered | Covered, $8.00 per visit for non-emergent medical services | Covered, 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) | Covered | Not Covered | Not Covered |
Behavioral Health Services
| Services | IA Health Link | IA Health & Wellness Plan - IA Wellness Plan | HAWKI |
|---|---|---|---|
| Assertive Community Treatment (ACT) | Covered | Covered 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 analysis | Covered | Covered, 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 Treatment | Covered | Covered, limitations may apply | Covered |
| Office Visit | Covered | Covered | Covered |
| Outpatient Mental Health and Substance Abuse | Covered | Covered | Covered |
| Psychiatric Medical Institutions for Children (PMC) | Covered | Covered, for 19 to 20 year olds. Limitations may apply | Not Covered |
| Crisis Response and Subacute Mental Health Services | Covered | Covered | Covered |
Outpatient Therapy Services
| Services | IA Health Link | IA Health & Wellness Plan - IA Wellness Plan | HAWKI |
|---|---|---|---|
| Cardiac Rehabilitation | Covered | Covered | Covered |
| Occupational Therapy | Covered | Covered, limited to 60 visits per year | Covered |
| Oxygen Therapy | Covered | Covered, limited to 60 visits in a 12-month period | Covered |
| Physical Therapy | Covered | Covered, limited to 60 visits per year | Covered |
| Pulmonary Therapy | Covered | Covered, limited to 60 visits per year | Covered |
| Respiratory Therapy | Covered | Covered, limited to 60 visits per year | Covered |
| Speech Therapy | Covered | Covered, limited to 60 visits per year | Covered |
Radiology Services
| Services | IA Health Link | IA Health & Wellness Plan - IA Wellness Plan | HAWKI |
|---|---|---|---|
| Mammography | Covered | Covered | Covered |
| Routine Radiology Screening and Diagnostic Services | Covered | Covered | Covered |
| Sleep Study Testing | Covered | Covered, sleep apnea diagnostic services only | Covered |
Laboratory Services
| Services | IA Health Link | IA Health & Wellness Plan - IA Wellness Plan | HAWKI |
|---|---|---|---|
| Colorectal Cancer Screening | Covered | Covered | Covered |
| Diagnostic Genetic Testing | Covered | Covered | Covered |
| Pap Smears | Covered | Covered | Covered |
| Pathology Tests | Covered | Covered | Covered |
| Routine Laboratory Screening and Diagnostic Services | Covered | Covered | Covered |
| Sexually Transmitted Infection (STI) and Sexually Transmitted Disease (STD) Testing | Covered | Covered | Covered |
Durable Medical Equipment
| Services | IA Health Link | IA Health & Wellness Plan - IA Wellness Plan | HAWKI |
|---|---|---|---|
| Medical Equiipment and Supplies | Covered | Covered | Covered |
| Diabetes Equipment and Supplies | Covered | Covered, limitations may apply | Covered |
| Eye Glasses | Covered, limitations may apply | Covered, for ages 19 and 20, limitations may apply | Covered, limitations may apply |
| Hearing Aids | Covered | Covered, for ages 19 to 20, limitations may apply | Covered, limitations may apply |
| Orthotics | Covered, limitations may apply | Not Covered | Covered, limitations may apply |
Long Term Support Services (LTSS) - Community Based
| Services | IA Health Link | IA Health & Wellness Plan - IA Wellness Plan | HAWKI | Prior Authorization Required |
|---|---|---|---|---|
| Care Management - HCBS Waiver and HCBS Habitation Populations Only | Covered | Not Covered | Not Covered | Yes |
| Section 1915(C) Home-and-Community-Based Services (HCBS) | Covered | Not Covered | Not Covered | Yes |
| Section 1915(I) Habitation Services | Covered | Not Covered | Not Covered | Yes |
*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
| Services | IA Health Link | IA Health & Wellness Plan - IA Wellness Plan | HAWKI | Prior Authorization Required |
|---|---|---|---|---|
| ICF/ID (Intermediate Care Facility for Individuals with Intellectual Disabilities) | Covered, limitations apply | Not Covered | Not Covered | No |
| Nursing Facility (NF) | Covered | Not Covered | Not Covered | No |
| Nursing Facility for the Mentally Ill (NF/MI) | Covered | Not Covered | Not Covered | No |
| Skilled Nursing Facility (SNF) | Covered | Covered, limitations apply, limited to a 120 days stay | Not Covered | Yes |
| Skilled Nursing Facility Out of State (Skilled Preapproval) | Covered, limitations apply | Not Covered | Not Covered | Yes |
| Community-Based Neurobehavioral Rehabilitation Services | Covered | Not Covered | Not Covered | Yes |
Hospice
| Services | IA Health Link | IA Health & Wellness Plan - IA Wellness Plan | HAWKI |
|---|---|---|---|
| Hospice | Covered | Covered, limitations apply | Covered |
Health Homes
| Services | IA Health Link | IA Health & Wellness Plan - IA Wellness Plan | HAWKI |
|---|---|---|---|
| Chronic Conditions Health Homes | Covered | Not Covered | Not Covered |
| Integrated Health Homes | Covered | Not Covered | Not Covered |
Home Health
| Services | IA Health Link | IA Health & Wellness Plan - IA Wellness Plan | HAWKI |
|---|---|---|---|
| Private Duty Nursing / Personal Cares per EPSDT Authority | Covered, up to age 21 under EPSDT | Covered, up to age 21 under EPSDT | Not Covered |
Routine Vision Services
| Services | IA Health Link | IA Health & Wellness Plan - IA Wellness Plan | HAWKI |
|---|---|---|---|
| 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
| Covered Age 19 and 20 only: 1 pair of eyeglasses (frames and lenses) every 24 months
| Covered
|
| 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).