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Some Iowans who haven't completed physical exams will face premiums for Medicaid expansion

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DES MOINES, Iowa — As Iowa's modified Medicaid expansion hits the one-year anniversary mark, some enrollees will be asked to pay small monthly premiums because they have not yet completed a required physical exam and health questionnaire.

For Gov. Terry Branstad, setting these health requirements was a key provision for expanding Medicaid in Iowa using funding from President Barack Obama's health care overhaul. The state received federal approval to make modifications to the traditional Medicaid terms, including setting health requirements and charging contributions.

Branstad spokesman Jimmy Centers said in a statement that the governor "continues to believe that a critical component of improving the health and wellness of Iowa is having citizens take ownership of their health."

More than 119,000 people are enrolled in Iowa's expanded Medicaid program, known as the Iowa Health and Wellness plan. Under the program, the state created a health plan for some poor residents and used federal dollars to pay for other low-income Iowans to get private insurance on the health care exchanges.

Anyone in the plan with an income over 50 percent of the poverty level — or $11,925 annually for a family of four — is required to complete a physical exam and an online health survey annually, or they will be charged a monthly contribution of $5 or $10. Just over 17,000 have completed both tasks so far, according to Amy Lorentzen McCoy, spokeswoman for the Department of Human Services.

Starting this month, nearly 13,000 people will be charged for contributions. That's out of about 20,000 who are income-eligible and have been in the plan for a full year.

If people don't pay for several months, some could lose their coverage, but McCoy stressed that people who can't pay may seek hardship exemptions and other help from the state.

"We want people to have coverage. This is a good thing for them. But we also want there to be an incentive to go get those healthy behaviors done. That's going to lead to better population health overall," McCoy said.

The program does not require people to meet any health standards beyond the annual physical and questionnaire.

Health incentives are increasingly becoming a part of private health insurance plans, typically coupled with rewards or penalties. But critics question how effective such programs are at improving outcomes and noted that some low-income people might have a hard time completing the tasks because they don't have Internet access or transportation options.

Lydia Mitts, a policy analyst with Families USA, a non-partisan health care advocacy group, expressed concern that such incentives might cut off people who need health coverage.

"There's not strong evidence to show this is an effective strategy to get people to engage in healthy behaviors. We have a lot of concerns that programs like this could create additional barriers," Mitts said.

McCoy said the state does not expect many will be kicked off the plan.

"We do not anticipate many people at all will lose coverage," she said. "We are trying to make it as user friendly as possible."

Rep. Walt Rogers, R-Cedar Falls, was part of a group of lawmakers that helped strike the expansion deal. He said he thinks setting health goals is important so that "people have skin in the game."

Sen. Joe Bolkcom, D-Iowa City, said health goals were valuable but stressed that the state should study the numbers and provide more education about the program if needed.

"I think the idea is a well-intended idea to encourage people to perform healthy behaviors and perform checkups," Bolkcom said. "I don't think this group is trying not to be healthy."

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