Iowa Total Care, Molina, and Wellpoint to serve 95 percent of Medicaid members
ALTOONA — The Iowa Department of Health and Human Services (HHS) announced its intent to award new Medicaid Managed Care contracts to three health insurance companies for six years.
State officials said that synchronized contracts mark the first time all three managed care organizations operating in the Iowa Health Link program will share the same end date. The alignment affects Iowa Total Care, Molina Healthcare of Iowa, and WellPoint Iowa, formerly Amerigroup Iowa.
"Iowa Total Care has demonstrated a commitment to continuous quality improvement and innovation—making them a valued partner for Iowa Medicaid," Iowa HHS Director Kelly Garcia said in a statement announcing the intent to award.
Medicaid Managed Care Organizations Explained
Managed Care Organizations (MCOs) coordinate healthcare services for Medicaid beneficiaries under fixed monthly payments from the state, replacing the traditional fee-for-service model where providers bill the state directly.
The Iowa legislature voted to privatize Medicaid in 2016, transitioning most beneficiaries from fee-for-service to the Iowa Health Link managed care program. The program now covers physical, behavioral, and long-term care services under unified management.
Three managed care organizations operate statewide, each maintaining provider networks across Iowa's 99 counties. According to federal data, the 95% enrollment rate represents one of the highest managed care penetration rates among state Medicaid programs nationally.
The remaining 5% of Iowa Medicaid members receive services through traditional fee-for-service arrangements, primarily those enrolled in Medicare Savings Programs or receiving specialized waiver services.
Provider Networks and Services Comparison
Iowa Total Care Provider Network
Iowa Total Care maintains contracts with major hospital systems statewide, including University of Iowa Hospitals and Clinics, MercyOne, and UnityPoint Health. The MCO provider network includes more than 30,000 healthcare professionals.
Rural access remains a priority for the Centene subsidiary. The company reports maintaining primary care provider availability within 30 miles for 95% of members in rural counties. Specialty care access varies by region, with telehealth filling gaps in underserved areas.
Recent network additions include expanded behavioral health providers and substance abuse treatment facilities, addressing historical gaps in mental health services access under managed care Medicaid.
Molina Healthcare Provider Access
Molina Healthcare of Iowa built its network around federally qualified health centers and community-based providers. The approach reflects the company's focus on serving Medicaid members with chronic conditions and complex care needs.
The MCO's provider directory shows particular strength in urban areas, with comprehensive specialist coverage in Des Moines, Cedar Rapids, and Davenport. Rural members access care through a combination of local providers and telehealth services.
Molina's care management model assigns nurse coordinators to high-risk members, facilitating appointments and medication adherence. The company reports reducing emergency department utilization by 15% among enrolled members with chronic conditions.
Wellpoint Iowa Network Coverage
Wellpoint Iowa transitioned from the Amerigroup Iowa brand while maintaining existing provider contracts. The company's network emphasizes partnerships with independent physician practices and rural health clinics.
The MCO contracts with 98% of Iowa hospitals and maintains agreements with major specialty groups. Network adequacy reports filed with the state show compliance with time and distance standards for primary care, though some rural counties face specialist shortages.
Wellpoint's value-based contracts with providers tie reimbursement to quality metrics, incentivizing preventive care and chronic disease management. The payment model aims to reduce barriers to care while controlling costs.
Contact information for the three MCOs:
- Iowa Total Care: 1-833-404-1061, https://www.iowatotalcare.com/
- Molina Healthcare: 1-877-651-9214, https://www.meetmolina.com/ia-medicaid
- Wellpoint Iowa: 1-833-731-2140, https://www.wellpoint.com/ia/medicaid
Contract Alignment Benefits for Medicaid Recipients
The June 30, 2031, unified end date for all three MCO contracts represents a significant administrative change for the Iowa Department of Health and Human Services.
Previously, contracts expired at different times, complicating negotiations and creating potential disruptions for Medicaid members when companies entered or exited the market. AmeriHealth Caritas withdrew from Iowa in 2017, followed by UnitedHealthcare in 2019, both citing financial losses.
"The aligned contracts provide stability for both our members and provider community," a spokesperson for the Iowa HHS said. "This approach allows for more effective program management and consistent implementation of policy changes."
Provider organizations welcomed the synchronized timeline. The Iowa Medical Society noted that aligned contracts reduce administrative burden on physician practices that must negotiate with multiple MCOs.
Choosing and Changing MCOs
New Iowa Medicaid members receive automatic assignment to one of the three managed care organizations based on geographic location and capacity. The Iowa Medicaid Enterprise uses an algorithm that considers the county of residence and current MCO enrollment levels.
Members receive enrollment packets explaining their assigned health plan and rights to change MCOs. The initial 90-day choice period allows transfers without providing reasons or justification.
The Iowa Health Link program processed 42,000 MCO changes during fiscal year 2024, most occurring during initial choice periods.
Annual enrollment and good cause changes
After the initial 90 days, members enter locked enrollment lasting 12 months. Changes require waiting for the annual 60-day enrollment window or demonstrating "good cause" circumstances.
Annual enrollment periods vary by member, based on initial Medicaid eligibility dates. Members receive notices 60 days before their enrollment anniversary, explaining choice options and deadlines.
Good cause provisions allow changes when:
- Primary care providers leave MCO networks
- Specialists needed for ongoing treatment don't participate
- Members document poor quality of care
- MCOs deny services based on moral or religious objections
- Members move outside MCO service areas
The grievance requirement means members must first attempt resolution with their current MCO before requesting transfers. This process can delay changes by 30-60 days.
Making the switch
Iowa Medicaid Enterprise Member Services processes MCO change requests through a standardized system. Members initiate changes by calling 1-800-338-8366 (statewide) or 515-256-4606 (Des Moines area) between 8 a.m. and 5 p.m. weekdays.
Good cause requests require documentation such as:
- Provider termination letters
- Specialist referrals for out-of-network providers
- Medical records supporting continuity of care needs
- Grievance decisions from current MCOs
Processing typically takes 10 business days for reasonable cause determinations. Approved changes take effect on the first day of the following month. Denied requests include appeal rights through the state's fair hearing process.
Member advocates report that the process works smoothly for annual choice periods but creates challenges for good cause changes. Documentation requirements and grievance mandates can delay needed transfers, particularly for members with limited English proficiency or cognitive impairments.
What Iowa Medicaid Members Should Know About Coverage
Comprehensive Medicaid managed care benefit packages include most medical services that Iowans need. Hospital, inpatient, and emergency care receive full coverage without prior authorization for true emergencies.
Primary and specialty physician services require no copayments for Medicaid members. This benefit includes preventive care, chronic disease management, and acute illness treatment. Laboratory tests, imaging studies, and diagnostic procedures receive coverage when medically necessary.
Despite initial implementation challenges, behavioral and long-term care services transitioned to managed care oversight. MCOs now coordinate:
- Inpatient psychiatric hospitalization
- Outpatient mental health counseling
- Substance abuse treatment programs
- Nursing facility placement
- Home and community-based waiver services
Additional covered services include physical therapy, occupational therapy, speech therapy, durable medical equipment, hospice care, and non-emergency medical transportation. Prior authorization requirements vary by service and MCO.
Services NOT covered by MCOs
Several critical services remain outside the Medicaid managed care system, creating potential confusion for members navigating multiple coverage sources.
Prescription drugs for Medicare-Medicaid dual eligibles require separate Medicare Part D enrollment. The Medicaid MCO cannot cover medications for members with Medicare, requiring coordination between programs.
Dental services for adults operate through separate contracts with Delta Dental of Iowa or Managed Care of North America (MCNA), not through MCOs. Members must contact Iowa Medicaid Enterprise at 1-800-338-8366 to identify their dental plan.
Other carved-out services include:
- School-based health services
- Targeted case management for specific populations
- Money Follows the Person transition services
- Native American health services through Indian Health Service facilities
Special Considerations for Medicare-Medicaid Dual Eligibles
Coordination between Medicaid managed care and Medicare creates complexity for Iowa's 65,000 dual-eligible beneficiaries.
Medicare maintains primary payer status, with the Medicaid MCO covering deductibles, coinsurance, and copayments.
MCOs pay hospital deductibles ($1,632 in 2025) and daily coinsurance amounts for Part A services. Part B services require MCO payment of the 20% coinsurance after Medicare's 80% payment.
Medicare Advantage enrollment adds another coordination layer. Members must ensure providers accept their Medicare Advantage plan and their Medicaid MCO. Network mismatches can limit access to care or create unexpected costs.
Providers navigate both systems, potentially delaying care.
Medicaid planning advocates can help recipients understand their payment responsibilities, prevent billing confusion, and ensure access to covered services.
Final Thoughts for Iowa Medicaid Members
The synchronized Medicaid managed care contracts through 2031 signal stability for 95% of Iowa Medicaid beneficiaries enrolled in managed care. Members should experience no immediate changes to benefits or provider networks when new contracts begin on July 1, 2025.
Understanding MCO options and enrollment rights helps Medicaid recipients choose plans that best meet their healthcare needs.
For members with serious health conditions or long-term care requirements, consider professional Medicaid planning assistance when tackling MCO selection to ensure optimal coverage under Iowa Medicaid's new managed care system.