Frequently Asked Questions

Last Updated: 10/2023

If you are in any of the Fee-for-Service (FFS) programs, the information below is

relevant to you. If you are looking for information regarding the Iowa Health Link

program, access the Iowa Health Link Frequently Asked Questions.

ELIGIBILITY AND SERVICES

What do I do if I have lost my Medicaid card or never received one?

You may contact Iowa Medicaid Member Services by phone or email. The phone

number is 1-800-338-8366 or 515-256-4606 (when calling locally in the Des Moines

area), Monday through Friday, 8 a.m. to 5 p.m. For telephone accessibility assistance

if you are deaf, hard-of-hearing, deaf-blind, or have difficulty speaking call Relay Iowa

TTY at 1-800-735-2942. The email address is IMEMemberServices@dhs.state.ia.us.

You also can contact your Income Maintenance (IM) worker at your local HHS

office. A new card should be sent out within seven days of your request.

How do I verify if I am currently eligible for Iowa Medicaid?

You may contact Iowa Medicaid Member Services by phone or email. The phone

number is 1-800-338-8366 or 515-256-4606 (when calling locally in the Des Moines

area), Monday through Friday, 8 a.m. to 5 p.m. For telephone accessibility assistance

if you are deaf, hard-of-hearing, deaf-blind, or have difficulty speaking call Relay Iowa

TTY at 1-800-735-2942. The email address is IMEMemberServices@dhs.state.ia.us.

How do I know if a service is covered or not?

All services are based on medical necessity. Your doctor is the best person to

determine the medical necessity of a procedure. The provider will need to contact

Provider Services to explain what services you are in need of. Provider Services will

help your doctor to determine if this service is covered.

Who do I contact if I am cancelled from Iowa Medicaid?

Contact your IM worker at your local Department of Human Services. Your IM

worker is the only one that can assist you with questions about your eligibility.

I need a certificate showing the dates I was eligible for Iowa Medicaid. How do I get

one?

You may contact Iowa Medicaid Member Services by phone or email. The phone

number is 1-800-338-8366 or 515-256-4606 (when calling locally in the Des Moines

area), Monday through Friday, 8 a.m. to 5 p.m. For telephone accessibility assistance

if you are deaf, hard-of-hearing, deaf-blind, or have difficulty speaking call Relay Iowa

TTY at 1-800-735-2942. The email address is IMEMemberServices@dhs.state.ia.us.

You will receive it within 5-7 business days from the date of your request.

I just had a baby how do I enroll them with Iowa Medicaid?

You will want to contact the IM Customer Service Center (IMCSC) at 1-877-347-

5678 as soon as possible. The IMCSC will assist you in enrolling your baby with Iowa

Medicaid.

My friend has different services covered then I do, why is that?

Members on Iowa Medicaid do not necessarily have the same types of coverage as

coverage is determined by income and medical necessity as determined by your

provider. It depends on which program within Iowa Medicaid you have been enrolled

in.

I am being told that I have another insurance listed on my file. How do I get that

removed?

You may contact Iowa Medicaid Member Services by phone or email. The phone

number is 1-800-338-8366 or 515-256-4606 (when calling locally in the Des Moines

area), Monday through Friday, 8 a.m. to 5 p.m. For telephone accessibility assistance

if you are deaf, hard-of-hearing, deaf-blind, or have difficulty speaking call Relay Iowa

TTY at 1-800-735-2942. The email address

is IMEMemberServices@dhs.state.ia.us. It will take up to 10 business days from the

date Iowa Medicaid Member Services receives your request to have the other

insurance updated.

How do I find out the insurance information for an absent parent insurance policy?

Iowa Medicaid Member Services is unable to release this information. You will need

to contact Child Support Recovery at 1-888-229-9223.

What services don't I need a referral for?

There are several services that do not require a referral. These services are:

• Dental Services

• Chiropractic services

• Ambulance services (must be medically necessary)

• Family planning services

• Emergent services

• Vision services

• Prescription services

• Early Periodic Screening, Diagnosis & Treatment (EPSDT) for individuals under

the age of 21.

How does the smoking cessation program work?

For further information on the smoking cessation program, please

visit: http://dhs.iowa.gov/ime/providers/csrp/SmokingCessation.

PROGRAMS

I received a letter saying I can sign up for the Medicare Savings Program, what is

that?

If you qualify, Iowa Medicaid can help assist with paying your premiums for you

Medicare Part A and/or Part B. There are two programs that qualify under the

Medicare Savings Program. They are Qualified Medicare Beneficiary (QMB) and

Specified Low-Income Medicare Beneficiary (SLMB). QMB will pay for your Medicare

premiums, co-pays and deductibles. SLMB will only pay for your Medicare Part B

Premiums.

How do I sign up for the Medicare savings program?

This is done through your local Department of Human Services. If you do not know

how to get in contact with your local office, a list of phone numbers is available on

our Member Services Contacts website. To inquire about your local HHS contact

information, you may also contact Iowa Medicaid Member Services by phone or

email. The phone number is 1-800-338-8366 or 515-256-4606 (when calling locally in

the Des Moines area), Monday through Friday, 8 a.m. to 5 p.m. For telephone

accessibility assistance if you are deaf, hard-of-hearing, deaf-blind, or have difficulty

speaking call Relay Iowa TTY at 1-800-735-2942. The email address

is IMEMemberServices@dhs.state.ia.us.

How do I check to see if I have met my spenddown for Iowa Medicaid?

You may contact Iowa Medicaid Member Services by phone or email. The phone

number is 1-800-338-8366 or 515-256-4606 (when calling locally in the Des Moines

area), Monday through Friday, 8 a.m. to 5 p.m. For telephone accessibility assistance

if you are deaf, hard-of-hearing, deaf-blind, or have difficulty speaking call Relay Iowa

TTY at 1-800-735-2942. The email address is IMEMemberServices@dhs.state.ia.us.

BILLING

I need copies of bills that Iowa Medicaid paid that should have been paid by another

insurance, how do I get them?

The Iowa Medicaid Member Services unit can place a claims history request for you.

You may contact Iowa Medicaid Member Services by phone or email. The phone

number is 1-800-338-8366 or 515-256-4606 (when calling locally in the Des Moines

area), Monday through Friday, 8 a.m. to 5 p.m. For telephone accessibility assistance

if you are deaf, hard-of-hearing, deaf-blind, or have difficulty speaking call Relay Iowa

TTY at 1-800-735-2942. The email address is IMEMemberServices@dhs.state.ia.us.

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.

I am pregnant and being charged co-pays. What should I do?

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 by phone

or email. The phone number is 1-800-338-8366 or 515-256-4606 (when calling

locally in the Des Moines area), Monday through Friday, 8 a.m. to 5 p.m. For

telephone accessibility assistance if you are deaf, hard-of-hearing, deaf-blind, or have

difficulty speaking call Relay Iowa TTY at 1-800-735-2942. The email address

is IMEMemberServices@dhs.state.ia.us. Iowa Medicaid Member Services will then

contact the provider charging you co-pays to explain that you should not be charged

for any co-pays while you are pregnant.

My child under 21 keeps being charged co-pays, what can I do?

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 billing department 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.

I am receiving a bill and I was eligible at the time of service, what do I do?

Please contact the Iowa Medicaid Member Services billing department by phone, e-

mail, or letter. The phone number is 1-800-338-8366 or 515-256-4606 (when calling

locally in the Des Moines area), Monday through Friday, 8 a.m. to 5 p.m. For

telephone accessibility assistance if you are deaf, hard-of-hearing, deaf-blind, or have

difficulty speaking call Relay Iowa TTY at 1-800-735-2942. The email address

is IMEMemberServices@dhs.state.ia.us. The address is:

Iowa Medicaid

Member Services

PO Box 36510

Des Moines, IA 50315

Iowa Medicaid Member Services will begin a bill inquiry to research the reason you

are being billed. The process can take up to 30 days and you will receive a response

by mail.

How do I get reimbursed for expenses paid out of pocket?

Iowa Medicaid does not reimburse members. You will want to contact the Iowa

Medicaid Member Services billing department so that the charges can be looked into.

This process can take up to 30 days and you will receive a response by mail advising

you of the outcome.

How do I get reimbursed for transportation expenses?

Medicaid members can have their non-emergency transportation costs reimbursed

by Medicaid. Transportation reimbursement helps when you need transportation to

a doctor appointment or therapy treatment. A Transportation Broker helps Iowa

Medicaid provide this service. Transportation may be provided by a public transit

system, a private company, a non-profit organization, a volunteer, or some other

person. You must schedule all your non-emergency transportation needs with the

broker before your trip to be eligible for reimbursement. Please

visit https://dhs.iowa.gov/ime/members/medicaid-a-to-z/NEMT for further

information. Non-emergency transportation is not available to Iowa Health and

Wellness Plan members.

PRIOR AUTHORIZATION (PA)

How long does it take for a prior authorization (PA) to be approved?

PAs for prescriptions are processed within 24 hours of them being sent by your

provider. If you are trying to get a PA for a medical service it could take up to 60

days. Generally, if your provider provides all information to Iowa Medicaid the

timeframe is generally 10-15 business days.

I have been getting a RX for a long time without needing approval, why do I need

approval now?

The Preferred Drug List for Iowa Medicaid changes every three months.

Prescriptions you may have gotten in the past without a prior authorization may

change, requiring you to receive a prior authorization before it can be filled.

My PA was not approved, how do I find out why?

You will want to contact your doctor that had made the prior authorization request.

Your doctor may already know or has access to the department that handles PA's.

Also, you will receive a denial letter in the mail explaining the reason the PA was

denied which offers you the Right to Appeal.

PRESCRIPTIONS

If I am eligible for both Medicare & Medicaid, why doesn't Medicaid pay for my

prescriptions any longer?

Members that 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 now 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.

How do I find out what medications are covered?

You may obtain this information from either your pharmacy or the provider that

wrote the prescription for you.

I can't get my RX filled at the pharmacy. What should I do?

First, ask the pharmacist for the reason it cannot be filled. The pharmacist has that

information immediately. If that does not work, contact the provider that wrote the

prescription. The provider can contact the Pharmacy Helpdesk to find out if there

are any issues in filling the prescription.

PROVIDERS

Can I see providers that are out of state?

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

contact Iowa Medicaid Member Services by phone or email. The phone number is 1-

800-338-8366 or 515-256-4606 (when calling locally in the Des Moines area),

Monday through Friday, 8 a.m. to 5 p.m. For telephone accessibility assistance if you

are deaf, hard-of-hearing, deaf-blind, or have difficulty speaking call Relay Iowa TTY

at 1-800-735-2942. The email address is IMEMemberServices@dhs.state.ia.us. You

may also find further information on existing Iowa Medicaid Providers on the HHS

website at: http://dhs.iowa.gov/ime/members/find-a-provider.

Also, even though a provider is on the list as accepting Iowa Medicaid members, you

must check with them ahead of time to verify that they are accepting new Iowa

Medicaid patients.

If I am out of state how do I find a provider that will accept Iowa Medicaid?

There is a list of the available out of state providers available on the HHS

website, http://dhs.iowa.gov/ime/members/find-a-provider. You may also contact

Iowa Medicaid Member Services for more information.