On February 16, 2015, Governor Branstad announced efforts to modernize Medicaid through the Iowa High Quality Health Care Initiative. The initiative aims to improve access and care coordination, promote accountability and outcomes and provide a predictable and sustainable Medicaid budget.
Winning bids were awarded by the department to four managed care organizations to provide high quality healthcare services to the majority of Medicaid members beginning January 1, 2016. Those organizations are:
- Amerigroup Iowa, Inc.
- AmeriHealth Caritas Iowa, Inc.
- UnitedHealthcare Plan of the River Valley, Inc.
- WellCare of Iowa, Inc.
Member enrollment packets will be mailed in October through November. The tentative assignment to one of the managed care organizations (MCO) will be included. Efforts will be taken to keep families together under one MCO. Current Medicaid members will have until December 17 to choose their MCO for January 2016, with an additional 90 days after the assignment to change MCOs for any reason.
Iowa Medicaid Member Services will be the enrollment broker and is responsible for providing information and conflict-free choice counseling for members in the selection of a MCO. They can be contacted by calling 1-800-338-8366, 8 am – 5 pm, Monday-Friday, or by email at IMEMemberServices@dhs.state.ia.us
The enrollment broker will offer health plan choice counseling to members. Choice counseling includes answering member questions about each health plan such as:
- Is my provider in the MCO network?
- Is my pharmacy in the MCO network?
- Does the MCO have specialists close to my community?
- Does the plan have value-added services that would benefit me?
- Are there special health programs that would help me?
- Does the MCO have call centers or helplines available beyond regular business hours?
Members may disenroll from their MCO at any time throughout the year for reasons of “good cause.” “Good cause” reasons can include:
- A member’s provider is not enrolled with the MCO and that provider disenrollment impacts the members’ health outcomes
- A member needs related services to be performed at the same time and not all related services are available in the MCO network
- If there is a change ineligibility
To make a change:
- Members call the Iowa Medicaid Enrollment Broker to request disenrollment for “good cause”
- Members tell the enrollment broker which MCO they want to switch to
- If a member has a question about whether they have a “good cause,” they can call the enrollment broker for more information
Iowa Medicaid will host a mix of in-person meetings and webinars branded as “tele-townhall meetings” in 18 locations throughout Iowa. These meetings will provide the public with an opportunity to receive information about the transition, ask questions directly to DHS staff, and receive in-person enrollment assistance. The tele-townhalls will feature a short presentation for those with Internet access and also will be available via conference call. Iowa Medicaid will work with local venues such as public libraries to offer the in-person meetings and tele-townhalls free to the public, in order for a larger audience to view the presentation. These presentations will be designed to provide the public with the ability to participate in the process and address any questions the members have. Iowa Medicaid will track the questions that are asked, and use these meetings to prepare for further communications materials and planned responses.
- Who Should Attend: Medicaid Members Transitioning to the IA Health Link Program, Family Members, Member Representatives
- Locations and Timeframes: The initial schedule includes 18 locations. Additional member educational sessions will be added throughout the fall. Meetings will begin in mid-October.
- Learn More: Find exact meeting dates and times on the flyer online. In the coming weeks, details will be added about which meetings will be available via tele-town hall (webinar and conference call). Check the DHS site in the weeks to come for those details.