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Title 8: Medicaid Page 1 Iowa Department of Health and Human Services Employees’ Manual Chapter A: Administration Overview Revised January 13, 2023 Definitions Overview This chapter provides general administrative information about Iowa’s Medicaid program. The Medicaid program is a health care payor: It pays for health care services and long-term care services and supports vulnerable Iowans who are eligible. The Medicaid program is funded by federal and state governments and is managed by the Iowa Department of Human Services (referred to as “the Department” or “DHS”). The Department’s Medical Services Division leads the Iowa Medicaid Enterprise, which administers the Iowa Medicaid Program. A wide range of medical and health services are available through the Iowa Medicaid program. Services are covered only if they are medically necessary. Medicaid members have free choice of a doctor, dentist, pharmacy, and other providers of services. NOTE: People who are eligible for both Medicaid and Medicare receive prescription drug coverage through Medicare Part D. A provider that chooses to participate in the Medicaid program must accept the payments that Medicaid makes and make no additional charges to the member for services covered under the program. Federal policies for the Medicaid program are in the Code of Federal Regulations, Title 42, Chapter IV, Subchapter C, Parts 430 through 489. Iowa Code Chapter 249A authorizes Iowa’s participation in the program. The policies specific to the Medicaid program are in Iowa Administrative Code (IAC) 441, Chapters 73 through 91. This chapter describes: ▪ Department responsibilities for: • Setting Medicaid eligibility policies and determining member eligibility, • Determining what services are covered and paying claims, and • Meeting Medicaid administrative requirements; ▪ Appeal policies; and ▪ Information about other programs that provide benefits to Medicaid members. Definitions “Aged” means a person who is 65 years of age or older. “Applicant” means a person who is requesting medical assistance on the person’s own behalf, or a person for whom medical assistance is requested, or a person requesting medical assistance on behalf of another person. “Blind” for Non-MAGI-related or Social Security Administration purposes, means a person must have central visual acuity of 20/200 or less in the better eye with the use of corrective lens or visual field restriction to 20 degrees or less.