When a member is approved for Medicaid, they are assigned to a managed care organization (MCO) and dental plan. Members have 90 days from their initial enrollment to change their MCO or their dental plan for any reason.
After a member has been with an MCO or dental plan for 12 months, they may change their MCO or dental plan for any reason during their Annual Choice Period.
Members who wish to change their MCO and/or Dental Plan during their initial enrollment period or during their Annual Choice period may use the Change Form (94.79 KB) .pdf to submit their choice.
Members who wish to keep their current MCO or dental plan do NOT need to take any action to keep their current plans.
Members who are not within their initial enrollment or Annual Choice period may only change MCOs for reasons of good cause.
List items for Good Cause Reasons
Your provider/dentist of record is not in your MCO's/dental carrier's network.
You need related services to be performed at the same time and not all related services are available within your current MCO's/dental carrier'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 MCO/dental carrier.
Lack of access to services covered under the contract
Poor quality of care given by your MCO/dental carrier
The MCO or dental carrier plan does not cover the services you need due to moral or religious objections.
The team at Iowa Medicaid wants you to be happy with your MCO or dental carrier. If you are requesting to change your MCO or dental carrier due to Good Cause, please follow the steps below.
First, you must contact your current MCO/dental carrier to go through the MCO's/dental carrier's grievance process for resolution.
The MCO grievance process may take up to 30-45 days to process.
The dental carrier grievance process may take up to 30-45 days to process.
Choice Date Cut-off: Members must change their MCO by this date for the change to take effect by the Effective Date
Effective Date: Date the MCO change will take effect
You do not have to change your MCO or dental plan. If you like your current MCO or dental plan, you do not need to do anything.
If you are not changing your MCO or dental plan, you do not need to contact Iowa Medicaid. Your coverage with your current MCO or dental plan will continue without interruption.
You should choose the MCO 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 MCO or dental plan choice, such as the Provider Search Portal, and the MCO and Dental Value-Added-Services Comparison Chart. (449.58 KB) .pdf
You are given an Annual Choice Period to change your MCO or dental plan for any reason. After your Annual Choice Period has ended, and throughout the year, you may only change your MCO or dental plan for reasons of Good Cause.
You will continue to receive Medicaid benefits from your current MCO or dental plan until your coverage begins with your new MCO or dental plan.
As long as your Medicaid eligibility does not change, your benefits will remain the same no matter which MCO or dental plan you select.
If you change your MCO or dental plan, you will receive an ID card from your new MCO or dental plan approximately 1-2 weeks before your coverage begins.
You will continue to use your current MCO or dental plan ID card until you begin coverage with your new MCO or dental plan.
