Your Medicaid grievances and appeals in Iowa
As a Molina Healthcare member, if you have a problem with your health care or our services, you have a right to file a grievance or appeal. A grievance can be filed when you are unhappy with your care.
If you have a problem with your health care or our services, you have the right to file a complaint. At Molina, we call a complaint a grievance. Some examples of grievances are:
Appeals
You can file an appeal when you do not agree with our findings to:
How to file an appeal:
You can file an appeal by:
How to file a grievance:
For more information check your Member Handbook.
Read your Member Handbook. It explains covered care, programs, rewards and how to use your benefits. Keep it handy when you need care.
Waiver of administrative rule
Providers must send a prior authorization request for a service or medication and indicate on the request for a waiver to administrative rule request, formally known as Exceptions to Policy). The Medical Director will determine if it’s appropriate to ask Iowa Department of Health and Human Services (HHS) for a waiver
For LTSS, if a member asks for a waiver of administrative rule, the case manager reviews it with a Medical Director to determine if it is medically necessary.
If during rounds the Medical Director decides it is appropriate to ask for a waiver of administrative rule, it is then sent to HHS for review. When we receive the result, we share it with the member and their team and update the care plan.
If the Medical Director decides a Waiver of Administrative Rule request is not medically necessary, the Medical Director issues a denial. The member will then get a Notice of Action with appeal rights.
If the Waiver of Administrative Rule is approved, we change the authorization to the terms written in the Waiver of Administrative Rule and will not exceed one calendar year.
Waiver of Administrative Rule rulings made by HHS are final and not able to appeal.