A new option for Medicaid members

Thursday, March 14, 2019

A third option will be available to Medicaid members starting July 1, and an open enrollment period has begun to allow recipients to remain with, or select new, from one of three privatively-run Managed Care Organizations providing coverage in Iowa.

Iowa Total Care will join Amerigroup Iowa and UnitedHealthcare of the River Valley to provide options to the more than 620,000 eligible Medicaid recipients. The open enrollment period officially began on March 4 and will continue until June 18. The period will allow participants to make changes between organizations within that timeframe.

"There are a lot of lessons learned over the last few years that will be incorporated during the roll out," said Matt Highland, public information officer for the Iowa Department of Human Services. "We have an extended choice period where we are giving members three months upfront to make a choice, and then there are an additional three months after that. The idea is to allow adequate time, if someone is assigned to a different MCO, and they want to make a change that is what that allows for."

Throughout March members will be assigned to an MCO with the option to change at their discretion. DHS will continue mailing packets with these tentative assignments, information about services and comparisons and contact information for those with questions or concerns. Once the open enrollment period concludes, another period between July 1 and Sept. 30 will allow members to change their organizations for any reason.

"A lot of them will look at the value added programs offered by the MCOs," Highland said. "Those are programs and services above and beyond what Medicaid typically offers. Examples are prenatal care programs and weight loss programs that work to encourage people to actively engage in their health. A key thing that they often look at is their existing relationships with their doctors and case managers.

He added, "For those members with critical health care needs such as those who have cancer, are pregnant or have recently transitioned from a long term care facility back into their community, we will keep them with their current MCO, but they still have the opportunity to change if they want to."

After the Sept. 30 deadline, changes will be allowed for those who fall under the "good cause" regulation. Highland said examples that have fallen under good cause in the past include a provider not being in the enrollee's MCO network, lack of access to a covered service or when providers leave an enrollee's MCO network.

Questions or concerns can be addressed by contacting Iowa Medicaid member services at 800-338-8366 or at iahealthlink.gov. Highland suggested use of email or the automated phone systems may expedite results due to the high call volume currently being experienced.

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