Managed Care Ombudsman Program

The quality of care and services you receive is important to your everyday health. However, navigating the managed care system can be complex. The Managed Care Ombudsman Program can help.

The Managed Care Ombudsman Program advocates for the rights and needs of Medicaid managed care members in Iowa who live or receive care in a health care facility, assisted living program or elder group home, as well as members enrolled in one of Medicaid's seven home and community-based services (HCBS) waiver programs (AIDS/HIV, Brain Injury, Children’s Mental Health, Elderly, Health and Disability, Intellectual Disability and Physical Disability).

Iowa's Managed Care Organizations

A managed care organization (MCO) is a health plan that delivers health care through a team of professionals providing for a member’s physical health, behavioral health and long-term care needs. The goal is to improve coordination and quality of care. Iowa currently has three MCOs: Iowa Total Care, Molina Healthcare of Iowa, and Wellpoint Iowa (formerly known as Amerigroup Iowa). Members are able to choose the MCO that best fits their health care needs. Contact information for each of the MCOs is listed below:

Iowa Total Care

Member Services Phone: 833-404-1061

Website: https://www.iowatotalcare.com/

Member Handbook

List of In-Network Providers

Molina Healthcare of Iowa

Member Services Phone: 1-844-236-0894

Member Services Email: IowaMemberServices@MolinaHealthcare.com

Website: https://www.welcometomolina.com/ia

Member Handbook

Wellpoint Iowa (formerly known as Amerigroup Iowa)

Member Services Phone: 1-833-731-2140

Member Services Email: MPSWeb@amerigroup.com

Website: https://www.wellpoint.com/ia/medicaid

Member Handbook

Manual Del Miembro

List of In-Network Providers

Communicate with your MCO

It is important for managed care members to have ongoing communication with their MCO, whether that is through a case manager, the MCO Member Services, or a provider. Your MCO is charged with ensuring that you are receiving the care and services that you need, and to do so your MCO needs to know you. Communicate with your MCO about:

Your health needs and history;

Services and providers that you like or do not like;

Religious and moral beliefs that impact the care you receive;

Concerns or problems you have with a provider or an MCO employee; and

Questions you have about your MCO handbook or your rights and responsibilities.

Put communication in writing

If you decide to file a grievance, appeal or request a fair hearing, always put it in writing. While you may submit a grievance or appeal to your MCO over the phone, it is always best to follow up in writing, documenting the issue; the date you filed the grievance, appeal or requested a fair hearing; and whether there was someone you spoke to about the issue at your MCO or at Iowa Medicaid. Be sure to keep a written copy for your own records. The process for filing a grievance or appeal with your MCO is found in your member handbook. The link to your handbook is listed above by MCO.

Grievances and Appeals

If you file a grievance or appeal with your MCO, the MCO must acknowledge receipt of your grievance or appeal within three business days of receiving it and provide a written notice of the MCO's resolution to you.
MCOs are required to acknowledge receipt of your grievance within three business days and are allowed up to 30 calendar days to provide you a written notice of how the MCO resolved your grievance or 45 calendar days to provide you a written notice of how the MCO resolved your appeal and the date that it was resolved. MCOs may extend the resolution time from 30 days up to 44 calendar days.

Address Changes

If you need to update your address or income information, always contact Iowa Medicaid first.
Iowa Medicaid maintains this information in their system and sends it to your MCO. So always update your information with Iowa Medicaid first. You may also update your address with your MCO so long as you update your address with Iowa Medicaid Member Services first at 800-338-8366.

You can change your MCO

As a managed care member, you have the opportunity to select the MCO that best fits your needs, and you have the right to change your MCO for good cause or during your annual renewal period. In order to change your MCO outside of the annual renewal period, you need good cause. Below are examples of good cause:

Your provider is enrolled with another MCO.

The MCO provides inadequate quality of care, such as poor treatment for your diagnosis or not referring to a specialist when needed.

Your medical services were not provided when needed, such as urgent care not provided within 24 hours or medical services provided in an untimely manner.

You can change your MCO without good cause during your annual renewal period. Iowa Health Link will send you a letter to let you know when your annual renewal period starts with instructions about how to change your MCO if you would like. For more information about when your annual renewal period, call Iowa Medicaid Member Services at 800-338-8366.

Pay attention to choice cut-off dates

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.

Through advocacy, self-empowerment and education by the Managed Care Ombudsman Program, each Medicaid managed care member in Iowa will be treated with dignity and respect and will have his or her rights honored.