The Ombudsman does not have jurisdiction over Managed Care Organizations (MCOs). We do have jurisdiction over the Department of Health and Human Services, which administers the Medicaid program. Before you make a complaint to us, we want to make sure the person you are complaining about has had an opportunity to review and resolve your complaint.
Contact information is available for MCO members and MCO service providers with complaints or questions.
Medicaid Eligibility
Questions should first be directed at your income maintenance worker or supervisor. If your eligibility is denied, you should appeal. Appeal forms can be located at
Home and Community-Based Waivers
You can appeal a denial or reduction of services first with the MCO, then with DHHS. Additional resources include the Long Term Care Ombudsman at:
https://hhs.iowa.gov/programs/programs-and-services/aging-services/ltcombudsman
Or Disability Rights Iowa at: https://disabilityrightsiowa.org/
Providers
For claim denials and recoupments, contact your MCO provider representative or file an appeal of the decision.
Iowa Medicaid Enterprise Provider Services: https://hhs.iowa.gov/programs/welcome-iowa-medicaid/provider-services
Dental
If you are having issue finding a dental provider, contact your dental carrier at:
https://hhs.iowa.gov/programs/welcome-iowa-medicaid/iowa-medicaid-programs/dental-wellness-plan
If you are denied dental services, you should appeal first with the dental carrier and if unsuccessful, with the State of Iowa.
https://www.deltadentalia.com/webres/File/dwp/dwp-Grievance%20File%20-%20English.pdf
https://docs.mcna.net/forms/ia-member-appeal
What is the Medicaid Capitation Rate?
The Medicaid capitation rate is the rate being paid to the MCO each month to provide services for a member. HHS has provided a convenient dashboard to find that rate for each member's situation. Here are instructions for finding the capitation rate:
Go to the Iowa Medicaid Dashboard and click on the green bar called Financial Summary Dashboard.
The next page has a box called Net Rate Cells – MCOs only. Click the box that says “Click for More Detail.”
Once there, if you know what program you are in, and which MCO you are with, you can determine the monthly rate being paid to the MCO each month.
Already completed this process?
If you have already gone through this process and want to file a complaint with our office, click here:
Tips for Making a Complaint
► Ask if you can speak with a supervisor or manager about your issue.
► Clearly explain what your issue is and what you’d like the outcome to be.
► Write down the names of the people you speak with, when you spoke with them and what they said.
► Make the conversation about what you need, be persistent but remain calm and polite.
► If you are still unsatisfied, ask what appeal and review processes are available and pay close attention to their criteria and deadlines.
Not Sure? Contact Us!
Please contact us directly if you don’t think it would be appropriate for us to require you to go through an available complaint or review process before we consider your complaint. We can consider your specific circumstances before we decide – including the urgency of your complaint or any disabilities or barriers you may be experiencing.
