IA Health Link
Medicaid Managed Care
On April 1, 2016, the Iowa Department of Human Services transitioned most Iowa Medicaid members to a managed care program called IA Health Link. Most Iowa Medicaid members are enrolled in IA Health Link, which provides coverage through two managed care organizations (MCOs). Providers who care for Medicaid members must contract with the MCOs.
EPSDT Care for Kids
EPSDT Care for Kids is Iowa's Early and Periodic, Screening, Diagnosis and Treatment program for children who are enrolled in Medicaid. Care for Kids services are free to children enrolled in Medicaid. EPSDT services include:
- health history
- physical exam
- growth and development assessment
- vision and hearing screening
- dental screening and education
- developmental/behavioral screening
- nutrition assessment and education
- laboratory tests including blood lead testing
- anticipatory guidance
- referral for further diagnostic and treatment services
The EPSDT Care for Kids Informing and Care Coordination Handbook is available online.
All providers must follow prior authorization requirements for each MCO. Pharmacy drug claim prior authorizations are handled differently. MCOs must handle prior authorizations within 7 days.
Amerigroup Medical Management:
- Phone: 1-800-454-3730
- Fax: 1-800-964-3627
- Amerigroup Provider Manual
The Iowa Department of Human Services has announced the selection of an additional managed care organization (MCO) to provide services to Iowa’s Medicaid members. The new MCO, Iowa Total Care, will begin providing services for members July 1, 2019. Members will be notified when they are able to select Iowa Total Care as their MCO.
Contact the MCOs
Amerigroup Iowa, Inc.
UnitedHealthcare of the River Valley, Inc.
AmeriHealth Caritas Iowa, Inc.
AmeriHealth Caritas Iowa, Inc. withdrew from Iowa's Medicaid managed care program on November 30, 2017. Use this information to contact them regarding services provided through the withdrawal date.
- Section VI: Grievances, Appeals and Fair Hearings
Iowa 1st Five Initiative
Healthy Mental Development
The 1st Five Healthy Mental Development Initiative is a public-private partnership bridging primary care and public health services in Iowa. The 1st Five model supports health providers in the earlier detection of social-emotional and developmental delays and family risk-related factors in children birth to 5 and coordinates referrals, interventions and follow-up.
Visit the 1st Five website to find links to resources for professionals and parents, program materials and videos, and links to related information.
DHS Medicaid Tools
Providers should continue to use the eligibility tools from the Iowa Department of Human Services (DHS) to determine a member's MCO enrollment. Link to Medicaid Tools for Providers on the DHS website.
Ombudsman Program for Managed Care
The Managed Care Ombudsman Program (MCOP) helps people navigate the managed care system. In addition to its focus on older Iowans, MCOP advocates on behalf of children enrolled in HCBS waiver programs, which include intellectual disability, children's mental health, health and disability, and brain injury waivers.
Visit the MCOP webpage to find links for providers and members, MCOP reports materials, and and information for filing complaints.
Email the MCOP ombudsman:
Grievances and Appeals
Providers may file claim disputes with the managed care organizations (MCOs). Each of the three MCOs has developed and implemented written policies and procedures for claim disputes. You will find information about their grievances and appeals policies and procedures in their provider handbook or manual. Link to these online:
- Chapter 14: Grievances and Appeals
- Chapter 4: Grievances, Appeals and State Fair Hearings
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