Choosing a Managed Care Organization (MCO)


I Have Received my enrollment packet, what do I need to do now? Or how long do I have to change my MCO?

If you are happy with the health plan that has been assigned to you, you do not need to do anything. If you do not like the MCO that has been tentatively assigned to you, you have 90 days from the date your managed care coverage begins to change your MCO for any reason, and for "Good Cause" reasons after that.
 

What is my "Choice Period End Date"?

Your choice period end date is listed on your MCO Enrollment Letter that is in your IA Health Link enrollment packet. Members must change their MCO by this date for the change to take effect the following month. You will also have 90 days from the date your managed care coverage begins to change your MCO for any reason.
 

How do I know which MCO is right for me?

You should choose the MCO that best fits your needs, or the needs of your family. There are many resources available on the DHS website to assist in making your MCO choice, such as the Provider Search Portal, and the MCO Plan Summary. All are available on the IA Health Link webpage, under 'Resources' on the left-hand navigation menu.
 

How do I make my MCO choice?

Members can make their MCO choice one of the following ways:
  • Mail the enrollment form included in your enrollment packet to: 
Member Services
P.O. Box 36510
Des Moines, IA 50315
  • Call Iowa Medicaid Member Services at 1-800-338-8366 or 515-256-4606 (when calling from within the Des Moines area), Monday through Friday, 8 a.m. to 5 p.m.
    • 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.
  • Fax your enrollment form to 515-725-1351
  • Members may also make an MCO choice by sending an email to IMEMemberServices@dhs.state.ia.us with the following information:
    • Member's Name
    • Member's Date of Birth
    • Member's State ID Number
    • Member's Address on File
    • Reason for MCO Change
      • If you do not provide all five pieces of information, we will not be able to process your MCO choice.

What if I didn't make a change but now I want to?

You have 90 days from your choice period end date to change your MCO for any reason. You may only change your MCO for "Good Cause" reasons after that. 
 
If you would like to change your MCO due to "Good Cause," you must first contact your current MCO to go through the MCO's grievance process for resolution. If your issue has not been resolved following the decision of your grievance, you may call Iowa Medicaid Member Services. 
 

What are some examples of "Good Cause" reasons?

  • Your provider is not in your MCO's provider network.
  • You need related services to be performed at the same time and not all related services are available within your current MCO's provider network.
  • Your provider has been terminated or no longer participates with your MCO.
  • Poor quality of care given by your MCO
If you would like to change your MCO due to "Good Cause," you must first contact your current MCO to go through the MCO's grievance process for resolution. If your issue has not been resolved following the decision of your grievance, you may call Iowa Medicaid Member Services. 
 

When will my choice take effect?

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.
 
Members wishing to change their MCO selection will have the following choice cut-off dates for the 2018 year:
 

How to Read this Chart:
Effective Cover Date: Date that MCO change will take effect.
Choice Cut-Off Date: Members must change their MCO by this date for the change to take effect by the Effective Date.
 
For example: The last day to make an MCO choice for coverage effective June 1, 2018, is May 17, 2018. If a member changes their MCO between May 18, 2018, and June 18, 2018, this change will not take effect until July 1, 2018.
 
Important Note:
Members who  change their MCO after the choice cut-off date will continue to receive coverage from their current MCO until the MCO change takes effect.
 

What is the Confirmation of Coverage Letter?

The Confirmation of Coverage Letter lists members within your household and their chosen or assigned MCO, as well as the contact information for their MCO. The MCO listed on this letter will be the MCO that you will begin receiving coverage from on your enrollment date. 
 

I selected a different MCO than what the letter states?

Iowa Medicaid may not have received your MCO selection prior to sending out your Confirmation of Coverage Letter, but we can update your chosen MCO.
 
If you would like to select a different health plan, you will have 90 days from the date your managed care coverage begins to change your MCO for any reason. After that, members may change their MCO throughout the year for reasons of "Good Cause." 
 
If a member would like to confirm their MCO choice, or change their MCO, they may contact Iowa Medicaid Member Services at 1-800-338-8366 or 515-256-4606 (when calling from within the Des Moines area), Monday through Friday, 8 a.m. to 5 p.m.
 
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.
 

Will I get a new ID card?

IA Health Link program members have two or three cards.
  1. You will keep your current Iowa Medicaid card for dental services or Fee-for-Service. Your Iowa Medicaid identification number will remain the same.
  2. You will receive an MCO ID card from your selected MCO. Your Iowa Medicaid identification number will remain the same however, your MCO may assign you a separate MCO identification number.
  3. If you are enrolled in the Dental Wellness Plan, you will receive a dental carrier ID card for all dental services.

Please bring your Iowa Medicaid and MCO ID cards to your medical appointments. If you have lost your Iowa Medicaid ID card, or have not yet received your Iowa Medicaid ID card, you can contact Iowa Medicaid Member Services at 1-800-338-8366 or 515-256-4606 (when calling from within the Des Moines area), Monday through Friday, 8 a.m. to 5 p.m.

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.
 

When will my MCO ID card arrive?

You should receive an ID card from your health plan before your MCO enrollment date. If you (do not/did not) make a choice, you will receive an ID card from the MCO assigned to you which is listed on your Confirmation of Coverage Letter
 
If your MCO coverage has begun and you have not yet received your MCO ID card, please reach out to your MCO immediately for assistance.
 

Who am I getting my ID card from?

After your initial MCO slection period had ended (your choice period end date on your MCO Enrollment Letter within your IA Health Link enrollment packet) you will receive a Confirmation of Coverage Letter from the Iowa Medicaid Enterprise. The Confirmation of Coverage Letter will confirm your health plan, and you will get a card from the plan listed on the letter before your MCO coverage begins.
 
Members who do not know their MCO assignment or have not received their Confirmation of Coverage Letter, please call the Iowa Medicaid Member Services at 1-800-338-8366 or 515-256-4606 (when calling from within the Des Moines area), Monday through Friday, 8 a.m. to 5 p.m.
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.
 

What do I do if my ID card is not from the MCO that I selected?

If you made a selection or your eligibility changed after the choice period end date, you may have received a card in error. We based our mailing on that initial selection date. To verify your current MCO selection, please call Iowa Medicaid Member Services at 1-800-338-8366 or 515-256-4606 (when calling from within the Des Moines area), Monday through Friday, 8 a.m. to 5 p.m.
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.
 

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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.