AmeriHealth Caritas Iowa, Inc. Withdraw and Suspension of MCO Choice

What has changed?
AmeriHealth Caritas Iowa, Inc. is withdrew from the Iowa Medicaid managed care program.
 
Who is affected?
About 9,000 hawk-i members transitioned from AmeriHealth Caritas coverage to coverage with UnitedHealthcare.
 
Does this affect my child?
If you have coverage through Amerigroup or UnitedHealthcare, you are not impacted by this change. If you had coverage through AmeriHealth Caritas, you were sent a packet in the mail which included information on your new MCO.
 
When will this happen?
AmeriHealth Caritas withdrew from the program effective November 30, 2017. Coverage with your new MCO began on December 1, 2017. Check your mail for more information which will arrive soon.
 
Why did this happen?
After months of diligent negotiations, the state and AmeriHealth Caritas were unable to come to mutually agree on future contract rates and terms.
 
Will the other plans leave Iowa?
Amerigroup and UnitedHealthcare have signed contracts that extend through the end of June 2018. Negotiations of the contract period beginning July 1, 2018, will begin in the next several months. Additional health plan options will also be available beginning July 1, 2018.
 
Why can't I change my MCO to Amerigroup?
Amerigroup Iowa is one of the IA Health Link and hawk-i MCOs. However, they are not currently accepting new IA Health Link members.
 
Why isn't Amerigroup Iowa accepting new members?
Amerigroup Iowa does not currently have the capacity to accept additional members to their covered population. UnitedHealthcare is confident in their ability to provide services and is expanding their network and staff to accommodate new members.
 
Amerigroup Iowa is building their capacity. The state continues to actively monitor their capacity.
 
Are there options other than UnitedHealthcare? What are my choices?
At this time, UnitedHealthcare is the only MCO available to new hawk-i members. In the future, you will be able to choose from multiple MCOs. You will be notified when that choice is available. Until then, you must have a 'good cause' reason to change your child's MCO.
 
When will we have choice again?
The Department has put in place a suspension of MCO choice to Amerigroup. In the future, you will be able to choose from multiple MCOs. You will be notified when that choice is available. Until then, you must have 'good cause' reason to change your child's MCO.
 
Can my child keep their case manager?
Your previous case manager may work with UnitedHealthcare. Call UnitedHealthcare and current case manager for more information.
 
Can my child continue to see their doctor?
UnitedHealthcare must honor prior authorizations for 30 days. Your doctor may be in UnitedHealthcare's provider network. If you are not sure about your options, please contact your doctor to verify if they are in UnitedHealthcare's provider network.
 
If your provider is not in UnitedHealthcare's provider network, this would be a 'good cause' reason to change your child's MCO. You must file a grievance with UnitedHealthcare and see if your provider can contract with UnitedHealthcare. If you are not satisfied with the resolution, you may then call hawk-i Customer Service for assistance.
 
Examples include:
  • Lack of access to providers experienced in dealing with your child's healthcare needs.
  • Lack of access to services covered under the contract.
  • Poor quality of care given by your child's MCO.
  • The MCO plan does not cover the services your child needs due to moral or religious objections. 
 
Where can I find more information?
Iowa Medicaid will post and send updates to the:
  • DHS webpage
  • hawk-i webpage
  • Council on Human Services, Medical Assistance Advisory Council, hawk-i Board, Mental Health and Disability Commission, and other partners and stakeholders
  • Medicaid eNews
  • Media updates
  • Legislative updates

 


hawk-i Customer Service (Monday to Friday from 8 a.m. to 6 p.m.)
1-800-257-8563 (Toll Free) 

hawk-i@dhs.state.ia.us
515-457-7701 (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.