IA Health Link:
In Iowa, the majority of Medicaid members are enrolled in IA Health Link, a program that gives members health coverage through a managed care organization (MCO). If you are enrolled in one of the programs below, then you are part of the IA Health Link managed care program:
- Low-income families and children
- Iowa Health and Wellness
- Medicaid for Employed People with Disabilities (MEPD)
- Dually eligible Medicaid and Medicare
- Long-Term Care
- Home and Community-Based Services (HCBS) Waivers
The Managed Care Ombudsman Program serves IA Health Link members who reside in or receive long-term care, as well as members enrolled in one of the seven HCBS waiver programs:
- Brain Injury
- Children’s Mental Health
- Health and Disability
- Intellectual Disability
- Physical Disability
A managed care organization (MCO) is a health plan that delivers health care through a team of professionals providing for a member’s physical health, behavioral health and long-term care needs. The goal is to improve coordination and quality of care. Iowa currently has two MCOs: Amerigroup and Iowa Total Care. Members are able to choose the MCO that best fits their health care needs. Contact information for each of the MCOs is listed below:
Amerigroup Iowa, Inc.
- Member Services Phone: 800-600-4441
- Member Services Email: MPSWeb@amerigroup.com
- Website: www.myamerigroup.com/IA
- Member Handbook
- List of In-Network Providers
Iowa Total Care
Communicate with your MCO.
It is important for managed care members to have ongoing communication with their MCO, whether that is through a case manager, the MCO Member Services, or a provider. Your MCO is charged with ensuring that you are receiving the care and services that you need, and to do so your MCO needs to know you. Communicate with your MCO about:
- Your health needs and history;
- Services and providers that you like or do not like;
- Religious and moral beliefs that impact the care you receive;
- Concerns or problems you have with a provider or an MCO employee; and
- Questions you have about your MCO handbook or your rights and responsibilities.
Put communication in writing.
If you decide to file a grievance, appeal or request a fair hearing, always put it in writing. While you may submit a grievance or appeal to your MCO over the phone, it is always best to follow up in writing, documenting the issue; the date you filed the grievance, appeal or requested a fair hearing; and whether there was someone you spoke to about the issue at your MCO or at IME. Be sure to keep a written copy for your own records. The process for filing a grievance or appeal with your MCO is found in your member handbook. The link to your handbook is listed above by MCO.
If you file a grievance or appeal with your MCO, the MCO must acknowledge receipt of your grievance or appeal within three business days of receiving it and provide a written notice of the MCO's resolution to you.
MCOs are required to acknowledge receipt of your grievance within three business days and are allowed up to 30 calendar days to provide you a written notice of how the MCO resolved your grievance or 45 calendar days to provide you a written notice of how the MCO resolved your appeal and the date that it was resolved. MCOs may extend the resolution time from 30 days up to 44 calendar days.
If you need to update your address or income information, always contact IME first.
IME maintains this information in their system and sends it to your MCO. So always update your information with IME first. You may also update your address with your MCO so long as you update your address with IME Member Services first at 800-338-8366.
You can change your MCO.
As a managed care member, you have the opportunity to select the MCO that best fits your needs, and you have the right to change your MCO for good cause or during your annual renewal period. In order to change your MCO outside of the annual renewal period, you need good cause. Below are examples of good cause:
- Your provider is enrolled with another MCO.
- The MCO provides inadequate quality of care, such as poor treatment for your diagnosis or not referring to a specialist when needed.
- Your medical services were not provided when needed, such as urgent care not provided within 24 hours or medical services provided in an untimely manner.
You can change your MCO without good cause during your annual renewal period. IA Health Link will send you a letter to let you know when your annual renewal period starts with instructions about how to change your MCO if you would like. For more information about when your annual renewal period, call IME Member Services at 800-338-8366.
Pay attention to choice cut-off dates.
Members who change their MCO will continue to receive coverage from their current MCO until the MCO change takes effect. Please note, if you change your MCO in the middle of the month, the change may not take effect for two months.