Fee-for-Service

The HIPP program helps people get or keep health insurance through their employer by reimbursing the cost of the health insurance premium. HIPP helps by paying for the insurance premium. Visit the HIPP web page for additional information.

To qualify for HIPP:

• You or someone in your home must have Medicaid.
• You must have health insurance or be able to get it through your employer.
• The health insurance must be cost-effective.

Medicaid is a joint federal and state program that helps pay medical costs for individuals with limited income and resources. People with Medicare Part A and/or Part B, who have limited income and resources, may get help paying for their out-of-pocket medical expenses from their state Medicaid program. Iowa has programs that can help pay your Medicare expenses, like your premiums, deductible, and coinsurance.

Under the QMB program, Medicaid only pays Medicare premiums, deductibles, and coinsurance for persons who are qualified Medicare beneficiaries. If you have Medicare Part A and your resources and income are within QMB limits, you could be eligible as a qualified Medicare beneficiary. For additional information, please visit the QMB page.

SLMB will only pay your Medicare Part B premium. The income limit is over 100 percent but less than 135 percent of the federal poverty level. Ask your HHS worker about SLMB. 

Up to 3 days of Medicaid is available to pay for the cost of emergency services for aliens who do not meet citizenship, alien status, or social security number requirements. The emergency services must be provided in a facility such as a hospital, clinic, or office that can provide the required care after the emergency medical condition has occurred.

If your income is too high for Medicaid but your medical costs are so high that it uses up most of your income, you may qualify for payment assistance through the Medically Needy plan. If you qualify, you are responsible for paying some of the costs of your medical expenses. For more information regarding the Medically Needy program, please visit the Medically Needy web page.

Presumptive eligibility (PE) provides Medicaid for a limited time while a formal Medicaid eligibility determination is being made HHS. The goal of the presumptive eligibility process is to offer immediate health care coverage to people likely to be Medicaid eligible, before there has been a full Medicaid determination. Please visit the Presumptive Eligibility web page for more information on this program.

PACE is a program that blends Medicaid and Medicare funding. The PACE program must provide all Medicare and Iowa Medicaid covered services as well as other services that will improve and maintain the member’s overall health status. The focus of the PACE program is to provide needed services that will allow persons to stay in their homes and communities. Please visit the PACE web page for more information regarding this program. 
 

American Indians and Alaskan Natives may choose to enroll in the Managed Care program. If you are a member who identifies as American Indian or Alaskan Native, contact Iowa Medicaid Member Services. Contact information is at the bottom of this page.

This is done through your local Iowa HHS office. Visit HHS Office Locations to find the nearest office. 

You may also contact Iowa Medicaid Member Services. Contact information is at the bottom of this page.
 

Contact Iowa Medicaid Member Services. Contact information is at the bottom of this page.
 

The Iowa Medicaid Member Services unit can place a claims history request for you. Contact information is at the bottom of this page.

You should receive the claims history within 5-7 business days for your request. 

If you need specific copies of bills you will need to contact your provider. Iowa Medicaid does not have copies of your bills.

If you need copies of the bills due to an accident or injury caused by another party, your request will be sent on to Iowa Medicaid's Lien Recovery Department. Someone from the Lien Recovery department will contact you to gather additional information.

First, make sure the provider is aware that you are pregnant. If your provider continues to bill you for co-pays, contact Iowa Medicaid Member Services. Contact information is at the bottom of this page.

First, make sure your provider is aware that your child is under 21 and should not be charged for any co-pays. If this does not help, then please contact the Iowa Medicaid Member Services to have a bill inquiry taken for you. This process can take up to 30 days and you will receive a response by mail advising you of the outcome. 

Member Services' contact information is at the bottom of this page.
 

Contact the Iowa Medicaid Member Services to have a bill inquiry taken for you. This process can take up to 30 days and you will receive a response by mail advising you of the outcome. 

Member Services' contact information is at the bottom of this page.

PAs for prescriptions are processed within 24 hours of them being sent by your provider. If you are requesting PA for a medical service, it could take up to 60 days. Generally, if your provider provides all the necessary information to Iowa Medicaid, the timeframe is generally 10-15 business days.

The Preferred Drug List for Iowa Medicaid changes every three months. Prescriptions you may have received in the past without a prior authorization may have changed, now requiring prior authorization before it can be filled.
 

You will want to contact the doctor that submitted the request. Also, you will receive a denial letter in the mail explaining the reason the PA was denied and offering you the Right to Appeal.
 

Members who are eligible for both Medicare and Iowa Medicaid are required to be enrolled with a Medicare Part D plan. Your Medicare Part D plan is now responsible for your prescription drugs. Iowa Medicaid will only cover psychotropic drugs (mental health medications) and some cold medicines. 

If you are having trouble getting one of your daily maintenance drugs covered you will need to contact your Medicare Part D plan for assistance.

You may obtain this information from either your pharmacy or the provider that wrote the prescription for you.

First, ask the pharmacist for the reason it cannot be filled. Alternatively, contact the provider that wrote the prescription. The provider can contact the Iowa Medicaid Pharmacy Helpdesk to find out if there are any issues in filling the prescription.

Yes. You must first make sure that they are signed up with Iowa Medicaid.

Also, even though a provider is on the list as accepting Iowa Medicaid members, you must check with the provider ahead of time to verify they are accepting new Iowa Medicaid patients.