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).
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Covered and Value-Added Services
Iowa Covered Benefits
Services
* may be requiredMedicaid
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 21Immunizations
✓
✓
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 applyContraceptive devices
✓
✓
✓
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 applyLaboratory tests
✓
✓
✓
Child care medical services
✓
up to age 21 underNewborn 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 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
✓
PCP referral may be required✓
PCP referral may be required✓
PCP referral may be requiredInpatient Hospital Services
Preapproval of inpatient admissions
✓
Required for non-emergent admissions✓
Required for non-emergent admissions✓
Required for non-emergent admissionsRoom and board
✓
✓
✓
Inpatient physician services
✓
includes anesthesia✓
includes anesthesia✓
Inpatient supplies
✓
✓
✓
Inpatient surgery
✓
✓
✓
Bariatric surgery for morbid obesity
✓
✓
Covered if member has been determined to be medically exempt
✓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 applyAmbulatory surgical center
✓
includes anesthesia✓
includes anesthesia✓
includes anesthesiaChemotherapy
✓
✓
✓
Dialysis
✓
✓
✓
Outpatient diagnostic lab, radiology
✓
✓
✓
Emergency Care
Ambulance
✓
✓
✓
Urgent care center
✓
✓
✓
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
✓
✓
Covered if a Member has been determined to be medically exempt
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)
✓
✓
Covered if member has been determined to be medically exempt
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 applyCrisis 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✓
✓
✓
Sleep Apnea machines ✓
for adults only
✓ Diabetes equipment and supplies
✓
✓
limitations may apply✓
Eyeglasses ✓
limitations may apply✓
for ages 19 to 20, limitations may apply
✓
limitations may applyHearing aids
✓
✓
for ages 19 to 20, limitations may apply✓
Orthotics
✓
limitations may applyNot Covered
✓
limitations may applyBreast Pumps
✓
limitations may apply
✓
limitations may apply
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 applyICF/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
staysSkilled Nursing Facility Out of State (Skilled preapproval)
✓
limitations may apply
Community-Based
Neurobehavioral
Rehabilitation Services✓
✓
medically exempt
onlyHospice
Hospice
✓
✓
limitations may applyHome Health
Private duty nursing/ Personal cares per EPSDT authority
✓
up to age 21 under
EPSDT✓
up to age 21 under
EPSDTHome 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 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
VSP
For vision services call (844) 859-5870 Hours: Monday to Friday, 7:30 a.m. to 6 p.m. Find a vision provider here: vsp.com/molinaIowaMedicaid
Molina only covers dental procedures done in a hospital setting.
- Children’s Medicaid Dental Benefit: Dental services are available to Iowa Medicaid members aged 18 and younger through the Iowa Medicaid Fee-for-Service (FFS) program. These services are not part of those provided by Molina. For questions about your dental benefits, call Iowa Medicaid Member Services at (800) 338-8366.
- Hawki Dental: Dental services are available to Hawki members through a dental carrier. The services are not part of those provided by Molina. For questions about your dental benefits, call Hawki Customer Service at (800) 257-8563.
- Dental Wellness Plan: The Dental Wellness Plan provides dental coverage for adult Iowa Medicaid members aged 19 and older. The services are not part of those provided by Molina. Dental coverage is provided by a dental carrier.For questions about your dental benefits, call Iowa Medicaid Member Services at(800) 338-8366 or visit http://dhs.iowa.gov/dental-wellness-plan.
For more information on Healthy Behaviors for Dental Wellness Plan Members, please read the “Dental Benefits” section in your Member Handbook or call Member Services.
Covered Drugs
You get prescription drugs at little to no cost to you. We cover your medically necessary medicines when filled at a network pharmacy. We also cover some over-the-counter (OTC) medicines with a prescription from your provider.
Generic drugs are drugs that have the same dosage, safety, strength and intended use as a brand-name drug. They usually cost less than brand-name drugs.
We cover all drugs covered by Iowa Medicaid. Iowa Medicaid uses a Preferred Drug List (PDL). Our PDL includes both generic and brand-name drugs. It also gives you facts about a drug and lists any restrictions on them. To fill your prescriptions, you must use a network pharmacy. Be sure to take your member ID card with you. Be sure to fill your prescriptions before you travel out of state.
To find a network pharmacy, see our Provider Directory You can also call Member Services.
Find our PDL at Iowa Medicaid PDL
- Quantity limits –limits the amount of the drug you can fill or refill at a given time or interval.
- Step therapy – requires that you try a certain drug, such as a generic, before your provider can prescribe another drug.
- Prior authorization – means your provider must get approval from Molina before prescribing a drug.
Our PDL can change. Check the PDL when you need to fill or refill a medicine.
Filling a prescription
Getting your prescription filled is easy! To fill your prescriptions, you must use a network pharmacy. Be sure to take your member ID card with you. Be sure to fill your prescriptions before you travel out of state.
To find a network pharmacy, see our Provider Directory You can also call Member Services.
You can get free rides to and from your medical visits. Just call Access2Care at (866) 849-2062 (TTY:711). Please call at least 48 hours in advance before your appointment to schedule a ride.
- Appointments can be in or out of the community where you live.
- Callers should be age 16 or older.
- Members ages 11 and younger must ride with a parent or guardian.
- Members ages 12–16 must ride with a parent or guardian unless Access2Care has a signed Minor Consent form on file. Call Access2Care for a copy of the Minor Consent form.
- Pregnant members of any age and emancipated minors can ride without a Minor Consent form.
- Rides must be set up at least 48 hours prior to the appointment.
Note: Nursing homes are responsible for Non-Emergency Medical Transportation (NEMT) trips within a 30-mile radius of the nursing home. If you are a nursing home resident and need to see a doctor less than 30 miles from your location, your nursing home should provide transportation.