Medicaid Programs


I AM PART OF THE IOWA HEALTH AND WELLNESS PLAN, WILL I STILL NEED TO FINISH MY HEALTHY BEHAVIORS?

Yes. Iowa Health and Wellness Plan members still need to finish their Healthy Behaviors. These help you stay healthy and save you money. Getting a wellness exam or dental exam is the first of many health services that make sure you get the care you need. Remember, Iowa Health and Wellness Plan members who complete healthy behavior requirements each year will not be charged a monthly contribution in the following year.
 

 Are members who identify as American Indian or Alaskan Native (AI/AN) required to enroll with an MCO?

Medicaid members that are AI/AN, and have not chosen the AI/AN "Race Option" on their Medicaid application will automatically be enrolled with an MCO. In order for members in this population to remain as Fee-for-Service, and not be required to enroll with an MCO, the member will need to take action and contact the Department of Human Services' (DHS) Call Center at 1-877-347-5678 to have their member application revised prior to initial MCO assignment. If the member chooses not to take any action, the member is considered to have "opted in" to the managed care program.
 
For members enrolled in managed care that desire to be switched to Fee-for-Service after correcting their race on their application, the member will then need to also contact the Iowa Medicaid Enterprise Member Services call center at 1-800-338-8366 or locally in the Des Moines area at 515-256-4606 to make this choice.
 
For further information, please see Informational Letter No. 1672-MC dated May 10, 2016.

 

Members in Long Term Care programs, and in nursing facilities, are required to have their Level of Care evaluated. Who will determine a member's Level of Care?

All initial admission Level of Care (LOC) determinations are made by the IME Medical Services Unit for all Medicaid members, regardless if enrolled in managed care or Fee-for-Service (FFS). Admission LOC also includes those discharged from Medicaid greater than ninety days  for reasons other than hospitalization, or those reviews for persons who are admitted to a nursing facility as private pay, then later make application for Medicaid. 
 
Continued stay reviews (CSRs) for medical approval are the responsibility of the member's MCO, unless the member is FFS. Any changes to the LOC determined at the time of the CSR for MCO enrolled members will be forwarded by the MCO to the IME Medical Services Unit for review.
 

For further information, please see Informational Letter No. 1674-MC dated May 25, 2016.

 

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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.