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Feds Back Most of Iowa's Medicaid Expansion Plan

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CEDAR RAPIDS, Iowa - Federal authorities are granting approval to Iowa's proposal to expand low-income health care.

Officials from the Centers for Medicare and Medicaid Service announced Tuesday that Iowa's request was granted with "virtually all the initiatives the state has proposed." But authorities are not giving the Gov. Terry Branstad as much flexibility as he sought to charge premiums to the very poor.

Iowa sought a waiver enabling the state to receive more federal Medicaid money for the proposed Iowa Health and Wellness Plan. The new health insurance program would cover up to 150,000 residents.

The state wanted to charge small monthly premiums to those with incomes over half of the federal poverty line starting in 2015. Federal officials said Iowa could only charge those with incomes above 100 percent of poverty.

The news of the approval drew interest from both those on IowaCare currently and a number of people who assist the working poor in finding affordable coverage.

Mary Sexton, who has participated in IowaCare for one and a half years, was waiting for an appointment Tuesday evening at the His Hands Ministry Free Health Clinic in Cedar Rapids. Sexton said she fully expected some sort of compromise to find coverage for tens of thousands of Iowans like herself. But waiting was still hard.

"When I say I was worried about it, I didn't know where it was going. When you're got doctor's appointments coming up and you can't make it to one because you're right in the middle of a change, that's a problem," Sexton said.

Jeff Tourdot, the Linn County Affordable Care Act education and outreach specialist, was also confident something was going to happen before the limited benefits IowaCare plan expired on December 31st.

"Throughout this entire process, knowing there would be 50,000 individuals enrolled from IowaCare alone I was confident the state and federal government would come to an agreement as we've seen today," Tourdot said.

While the federal government disallowed the small monthly premiums for those at the federal poverty level or below, the biggest change may be where the care is delivered. IowaCare required trips to University of Iowa Hospitals and Clinics in Iowa City. The Iowa Health and Wellness Plan will allow participants to go to any participating doctor or hospital.

Cyndi Ziegler, director of the His Hands Free Medical Clinic, said that was perhaps the number one complaint from IowaCare participants.

"It was a big deal. Transportation was difficult. A doctor's appointment was an all-day thing and a lot of our patients were the working poor and they couldn't take off all day to go to the doctor," Ziegler said.

Ziegler also said the Medicaid expansion may sent some using free medical clinics to regular doctors. But she still expects such clinics to see plenty of people who can't qualify, or can't afford, health insurance.

Iowa Governor Terry Branstad must decide to accept the federal decision or appeal it within 30 days.

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