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Medicaid and CHIP Grievances and Appeals

You may choose someone to act for you; with your written consent, that person (or your provider) can file a grievance or an appeal for you, or ask for a State Fair Hearing.

A grievance is a complaint about your care or experience (how you were treated, trouble getting an appointment, office access). It is not about the denial of a service.

You can file a grievance by phone or in writing. There is no deadline.

  • Call: 1‑866‑629‑6074 (TTY: 711 or 1‑800‑466‑7566)
  • Mail: Iowa Medicaid Complaints and Appeals, P.O. Box 2906, Milwaukee, WI 53201‑2906
     

Someone who was not involved in the first decision will review your grievance and give you a new answer.

When You will Get a Grievance Decision

  • Urgent grievance (fast): Within 72 hours.
    If waiting could risk your health or ability to function
  • All other grievances (standard): Within 30 days.
    We may take up to 14 more days if you ask us, or if we need more information and the extra time helps you. If we take more time, we will tell you in writing.
  • Note: You cannot ask for a State Fair Hearing about a grievance. Fair Hearings are only for appeals after we make an appeal decision. 
     

An appeal is when you disagree with a decision about your care (a service was denied, reduced, or stopped, or we did not decide on time). This is called an Adverse Benefit Determination. You can ask for an appeal by phone or in writing. You must ask for an appeal within 60 days from the date of our denial/reduction letter.

Someone who was not involved in the first decision will review your appeal. A licensed dentist reviews clinical issues.

Your appeal should include the following information:

  • Your name, address, and member ID
  • Why you disagree
  • Any notes or records from your dentist that support your ask
     

Mail this information to: Iowa Medicaid Complaints and Appeals, P.O. Box 2906, Milwaukee, WI 532012906. You can send added information at any time.

You can get a free copy of your case file for free.

When You will Get an Appeal Decision

  • Standard appeal: within 30 days (we may take up to 14 more days if you ask, or if we need more information and the extra time will help you; we will tell you in writing).
  • Fast (expedited) appeal: within 72 hours, waiting could harm your health or ability to function. You, your helper, or your dentist, can ask by phone or in writing.
     

If we plan to stop or reduce a service you already get, you may keep the service while we review your appeal if you ask within 10 days of the letter date (or before your current approval ends). If the final decision is not in your favor, you may have to pay for care you got during the appeal. 

If you do not agree with our appeal decision, you can ask for a State Fair Hearing. You must finish your appeal with us first. Your request for a hearing must be within 120 days after the date of our appeal decision letter. You can ask for a hearing one of the following ways:

  • Phone: 1‑515‑281‑3094
  • Fax: 1‑515‑564‑4044
  • Email: appeals@hhs.iowa.gov
  • Online: hhs.iowa.gov/appeals
  • Mail/Deliver: Iowa Department of Health and Human Services, Attn: Appeals Section, 1305 E. Walnut St, 5th Floor, Des Moines, IA 50319
     

The Iowa Office of Ombudsman investigates complaints against state agencies, including Iowa Health Link managed care organizations, to resolve disputes regarding, for example, denied dental services or coverage issues. Before contacting the Ombudsman, try to resolve the issue with your MCO or dental provider.

How to Contact the Iowa Ombudsman:

  • Phone: 1-515-281-3592 or 1-888-426-6283 (toll-free)
  • Hours: Monday through Friday, 8:00 a.m. to 4:30 p.m.
  • Email: ombudsman@legis.iowa.gov
  • Online Complaint Form: Iowa Ombudsman Website
  • Mail: Iowa Office of Ombudsman Ola Babcock Miller Building, 1112 E. Grand Ave, Des Moines, IA 50319
     
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