Members Rights and Responsibilities

Responsibilities

• Show your Medicaid card each time you visit your health care provider and make sure their office has a record that you are on Medicaid.
• Confirm that your provider is enrolled with Medicaid. If the provider writing your prescription or providing your care is not a Medicaid provider, Medicaid will not pay for it. Medicaid will not pay for services from a provider who is not enrolled with Medicaid.
• If you can, find out before you ask for a new or special type of treatment, if it requires prior approval from Iowa Medicaid. If it does and the approval is not received, you could become responsible for payment.
• Keep all scheduled appointments - or call to cancel or reschedule. Some providers may stop seeing you if you miss one or more scheduled appointments.
• Seek medical services that are medically necessary. DHS may limit your services if you use Medicaid for services that are not necessary.
• Tell Iowa Medicaid Member Services about any changes to other health insurance coverage. Tell them if coverage ends, you lose or get new coverage or change insurance companies. Call Member Services toll-free at 1-800-338-8366.
• Tell your medical providers about anyone else who may be legally responsible to pay your medical bills.
• Treat your Medicaid number the way you treat your Social Security number—do not loan or sell it to anyone.
• Keep your Medicaid card in a safe place, the way you protect your money or checkbook—out of sight of everyone.

• If you suspect that someone is misusing their Medicaid benefits or someone who is not your provider requests your Medicaid information, please call The U.S. Department of Health & Human Services at 1-800-447-8477 or call Member Services at 1-800-338-8366 or locally (Des Moines area) at (515) 256-4606. View this Medicaid Fraud flyer for more information on how to report suspected Medicaid fraud.

HIPAA and Protected Health Information

HIPAA regulations ensure the privacy and security of your patient information. Learn more about HIPAA protections here: HIPAA Policy

Appeals

You may ask for a hearing if you disagree with a decision that the Department of Human Services has made. The appeal must be filed within 90 days of the date of the notice. Learn more about the appeal process here: Appeals

Exception to Policy

You may request an exception to policy for an item or service that Medicaid would not otherwise cover. Learn more about the process see the exceptions to policy webpage.

Estate Recovery Law

Estate recovery means that after your death the state will recover the cost of your medical bills that Medicaid paid. The state will collect from the assets you have at the time of your death. Estate recovery applies to all persons who get Medicaid on or after July 1, 1994, and are age 55 or older or who live in a medical facility and will most likely not be able to return home. Learn more on the estate recovery law webpage.

Lien Recovery

When an Iowa Medicaid Recipient is injured as a result of an accident and there is a third party that is liable; Iowa Medicaid can recover payment for those related medical claims via a medical assistance lien. The injury may be a result of a vehicle accident, worker's compensation claim, medical malpractice suit (incident dates of July 1, 2011 and after) or slip and fall. The insurance adjuster or attorney shall notify the department of the claim or suit.

Medicaid Trusts

Medicaid trusts, which include Special Needs Trusts and Income Trusts, are created to allow a person to become Medicaid eligible despite having too much income or resources to meet regular eligibility limits. Income Trusts are for persons whose income is more than eligibility limits, but less than needed for health care needs. Special Needs Trusts, including Pooled Trusts, are for disabled persons who have resources over eligibility limits that can be placed in a trust. Learn more on the Iowa Medicaid Trusts webpage.