Members who are not within their initial enrollment or Annual Choice period may only change their health plan for reasons of good cause.
List items for Good Cause Reasons
Some examples include:
Your provider/dentist of record is not in your health and/or dental plan's network.
You need related services to be performed at the same time and not all related services are available within your current plan's provider network. Your primary care provider/dentist or another provider determined that receiving the services separately would subject you to unnecessary risk.
Lack of access to providers experienced in dealing with your health care/dental needs
Your provider has been terminated or no longer participates with your health and/or dental plan
Lack of access to services covered under the contract
Poor quality of care given by your health and/or dental plan
The health and/or dental plan does not cover the services you need due to moral or religious objections.
If you are requesting to change your health and/or dental plan due to Good Cause, you must contact your current health and/or dental plan to go through the health and/or dental plan's grievance process for resolution.
The health plan grievance process may take up to 30-45 days to process.
The dental plan grievance process may take up to 30-45 days to process.
Choice Date Cut-off: Members must change their health plan by this date for the change to take effect by the Effective Date
Effective Date: Date the health plan change will take effect
You do not have to change your health and/or dental plan. If you like your current plan, you do not need to do anything.
If you are not changing your health and/or dental plan, you do not need to contact Iowa Medicaid. Your coverage with your current plan will continue without interruption.
You should choose the health and/or dental plan that best fits your needs, or the needs of your family. There are many resources available on the HHS website to assist in making your health and/or dental plan choice, such as the Provider Search Portal.
