Medicaid and CHIP Grievances and Appeals

What is an appeal?

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. 

Deadline to appeal

• Within 60 days from the date of our denial/reduction letter. 
   

Who can file

You can file yourself, or you can choose someone to help (family, friend, your dentist, or a lawyer). If you choose someone, sign the Authorized Representative form (not needed for parents/guardians of minors). 

What to include

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

Where to send

• Mail:
  Iowa Medicaid Complaints and Appeals
  P.O. Box 8206
  Des Moines, IA 50301
   

Your case file

You can get a free copy of your case file before we decide on your appeal. You may send more information if something is missing. 

Who reviews it

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

When you get a 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 helps you; we will tell you in writing). 
• Fast (expedited) appeal: within 72 hours when waiting could harm your health or ability to function. You, your helper, or your dentist, can ask by phone or in writing. 
   

Keeping your benefits during an appeal

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 Iowa HHS for a State Fair Hearing. You must finish your appeal with us first.

Deadline: 120 days after the date of our appeal decision letter.

How to ask:

• 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 reviews complaints about state agencies, including issues with Iowa Health Link managed care organizations and dental coverage.

Try to resolve the issue with DentaQuest or your dental office first. If you still need help, contact Ombudsman.

How to Contact the Iowa Ombudsman:

• Phone: 1-515-281-3592 or 1-888-426-6283 (toll-free)
• Hours: Monday–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