Benefits and Services


 

HOW DO I KNOW IF A SERVICE IS COVERED WITH IA HEALTH LINK OR NOT?

MCOs are required to cover, at a minimum, all of the services that Iowa Medicaid currently covers. All of your benefits that you were eligible before IA Health Link will stay the same after enrolling with an MCO, unless your eligibility changes. Your provider will work with the MCOs to determine if the service is covered.
 
For further information on your benefits, please see the Managed Care Covered Benefits Comparison Grid on the DHS webpage under the 'Resources' tab on the left-hand navigation menu.
 

Are my pharmacy services covered under managed care?

Pharmacy services for members enrolled in managed care are covered by the MCOs.
 

are my dental services covered under managed care?

Members enrolled in managed care do not receive their dental coverage from their MCOs. You will receive your dental coverage from Iowa Medicaid or the Dental Wellness Plan. If you did not have dental coverage before your enrollment in managed care, you will not have coverage after. 
 

DO I HAVE A CO-PAY?

IA Health Link members may have a co-pay ranging from $1 to $8 depending on their coverage group. their MCO and the type of service. The MCOs require a co-pay for non-emergent ER visits. In the case of a true emergency, the member is not responsible for a co-pay. For additional information members should contact their MCO directly.

Members Exempt From Co-Pays:

  • American Indians
  • Alaskan Natives
  • Family Planning Waiver
  • Pregnant Women
  • Medicaid Members under 21

WHAT IF I HAVE AN EMERGENCY AND THE HOSPITAL IS NOT IN MY MCO’S NETWORK?

An emergency is considered any condition that could endanger your life or cause permanent disability if not treated immediately. If you have a serious or disabling emergency, you do not need to call your provider or your MCO. Go directly to the nearest hospital emergency room or call an ambulance. The following are examples of emergencies:
  • A serious accident
  • Poisoning
  • Heart attack
  • Stroke
  • Severe bleeding
  • Severe burns
  • Severe shortness of breath
Contact your MCO for all follow-up care. Do not return to the emergency room for the follow-up care. Your provider will either provide or authorize this care. 
 

WHAT ABOUT URGENT CARE?

Urgent care is when you are not in a life-threatening or a permanent disability situation and have time to call your managed health care provider. If you have an urgent care situation, you should call your provider or MCO to get instructions. Some examples are:
  • Fever
  • Stomach pain
  • Earaches
  • Upper respiratory infection
  • Sore throat
  • Minor cuts and lacerations

I HAVE AN UPCOMING APPOINTMENT AND NEED TO SCHEDULE NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT), WHO DO I CONTACT?

Members who need to schedule trips should contact their assigned MCO.

Members may also contact their MCO directly with any questions they may have regarding NEMT services

WHICH NEMT COMPANY DOES MY MCO USE?

Each of the MCOs has selected a transportation vendor. Members may contact their assigned MCO's non-emergency medical transportation (NEMT) broker at the numbers below to schedule their NEMT services:

Member's MCO NEMT Contact Information
Amerigroup Iowa, Inc.

NEMT Broker: Logisticare 
Phone: 1-844-544-1389

UnitedHealthcare Plan of the River Valley, Inc.

NEMT Broker: MTM
Phone: 1-888-513-1613

 

EVEN THOUGH MY MCO IS NOT COVERING MY DENTAL SERVICES, WILL TRANSPORTATION TO MY DENTAL APPOINTMENTS STILL BE PROVIDED BY MY MCO?

Yes, even though your MCO does not cover your dental services, they will cover transportation to your dental services.
 

HOW DO I ARRANGE A RIDE FOR A DENTAL APPOINTMENT, OR OTHER NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT)?

Please contact your MCO, or your MCO's NEMT Broker directly; they will help with your transportation needs.
 

I RECENTLY GAVE BIRTH, WILL MY NEWBORN RECEIVE MCO COVERAGE? IF SO, HOW DO I ENROLL MY NEWBORN?

In situations where an MCO enrolled Medicaid member gives birth, the newborn is automatically enrolled with the mother's MCO. The mother must notify their DHS Income Maintenance Worker of the birth and complete the necessary enrollment application. Once the newborn is determined eligible and the MCO assignment has occurred, the mother will have 90 days from the date the newborn's managed care coverage begins to change the newborn's MCO for any reason. The choice period end date will be listed on the newborn's MCO enrollment letter within the IA Health Link MCO enrollment packet.

ARE SMOKING CESSATION SERVICES STILL AVAILABLE WITH MY MCO?

Smoking cessation services are available for members enrolled with an MCO. If you wish to learn more about your benefits, you will need to contact your primary care provider for assistance in contacting your MCO in following your MCOs counseling requirements. You can also find more information about your MCO's smoking cessation services at:
Amerigroup Iowa, Inc.: www.myamerigroup.com/ia
UnitedHealthcare Plan of the River Valley: http://www.UHCCommunityPlan.com/ia
 

WHAT IS THE LONG TERM SERVICES AND SUPPORTS (LTSS) OMBUDSMAN PROGRAM?

This is a program to assist members receiving long term care services. The goal of the LTSS ombudsman program is to provide information about Medicaid managed care options and member's rights. The office of ombudsman serves as a resource for answers regarding managed care rules and to investigate complaints made by, or on behalf of, members. 
 

WHO IS THE LTSS OMBUDSMAN PROGRAM FOR? 

In Iowa, the LTSS Ombudsman program was established to advocate for the rights and wishes of Medicaid managed care members who either:
  1. Receive care in a Health Care Facility 
  2. Are in an Assisted Living Program
  3. Reside in an Elder Group Home
  4. Members enrolled in one of the HCBS waiver programs
  • AIDS/HIV 
  • Brain Injury
  • Children's Mental Health
  • Elderly
  • Health and Disability
  • Intellectual Disability
  • Physical Disability

I AM NOT IN ONE OF THE POPULATIONS LISTED, CAN I RECEIVE HELP FROM THE LTSS OMBUDSMAN PROGRAM?

No. The program acts as an advocate for members classified as Long Term Care Member(listed above). Members who are not in this population may contact their MCO's member services department directly for further assistance with their program and benefits. If a member is still having questions or concerns, they may contact Iowa Medicaid Member Services for further assistance.

WHY WOULD I CONTACT THE LTSS OMBUDSMAN?

  • Ask for assistance resolving a concern that impacts the quality of care provided by your MCO;
  • Learn more about the rights of Medicaid members enrolled in a LTSS managed care plan;
  • Clarify state or federal regulations on managed care policies;
  • Obtain information about or assistance with a specific topic, such as the process for choosing or changing an MCO and care plan choices;
  • Learn about other available resources, such as legal assistance, in-home services and nutrition consultation, or request a speaker.

HOW DO I CONTACT THE LTSS OMBUDSMAN?

You may call the LTSS Ombudsman at: 866-236-1430
 
 
Iowa Medicaid Member Services (Monday to Friday from 8 a.m. to 5 p.m.)
1-800-338-8366 (Toll Free) 
515-256-4606 (Des Moines Area)
515-725-1351 (Fax)
 
For telephone accessibility assistance if you are deaf, hard-of-hearing, deaf-blind, or have difficulty speaking, call Relay Iowa TTY at 1-800-735-2942.
 
Llame al 1-800-735-2942, a Relay Iowa TTY (teléfono de texto para personas con problemas de audición, del habla y ceguera) si necesita asistencia telefónicamente.