Member Rights & Responsibilities

Rights and Responsibilities

As a Molina member, you have certain rights. You also have responsibilities. They are listed below.

Your rights:

To be treated with respect, dignity, and privacy.
To receive information on Molina Healthcare of Iowa, its services, providers and members rights and responsibilities.
To fully participate in the community and work, live and learn to the fullest extent possible.

To participate in decisions regarding your health, including the right to refuse treatment.
To receive information on available treatment options and alternatives in a manner appropriate to the Member’s condition and ability to understand.
To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
To request and receive a copy of your medical records at no cost, and to be able to request corrections.
To exercise your rights without any adverse treatment from Providers or Molina Healthcare of Iowa.

To file a grievance and/or appeal.
To be able to choose primary care practitioners, including specialists as your PCP if you have a chronic condition, within the limits of the plan network, including the right to refuse care from specific practitioners.
To propose your ideas for Molina’s Member rights and responsibilities policy
The right to be treated with respect, dignity, and privacy
To seek second opinions

To get help with care coordination from the PCP’s office
To express a concern or appeal about Molina Healthcare of Iowa or the care we provide, and to receive a response in a reasonable period
To choose your healthcare professional and LTSS Providers to the extent possible and appropriate
To be given healthcare services
To get healthcare services that are similar in amount and scope to those given under Medicaid FFS, which includes the right to get healthcare services that will achieve the purpose for which the services are provided

To get services that are fitting and are not denied or reduced due to diagnosis, type of illness, or medical condition
To be provided information in a manner and format the can understand, including enrollment notices, informational materials, and instructional materials
To get free oral interpretation services for all non-English languages and written translation available in each prevalent non-English language
To be notified interpretation services are available and to receive information on how to access them
To get adequate and timely information on Molina’s Physician Incentive Plan upon request

To submit an exception request for consideration by Iowa HHS for items or services not covered

Your responsibilities:

Show your Medicaid card each time you visit your health care provider and make sure their office has a record that you are on Medicaid.
Confirm that your provider is enrolled with Medicaid. If the provider writing your prescription or providing your care is not a Medicaid provider, Medicaid will not pay for it. Medicaid will not pay for services from a provider who is not enrolled with Medicaid.

If you can, find out before you ask for a new or special type of treatment, if it requires prior approval from Iowa Medicaid. If it does and the approval is not received, you could become responsible for payment.
Keep all scheduled appointments - or call to cancel or reschedule. Some providers may stop seeing you if you miss one or more scheduled appointments.
Seek medical services that are medically necessary. DHS may limit your services if you use Medicaid for services that are not necessary.
Tell Iowa Medicaid Member Services about any changes to other health insurance coverage. Tell them if coverage ends, you lose or get new coverage or change insurance companies. Call Member Services toll-free at (844) 236-0894.
Tell your medical providers about anyone else who may be legally responsible to pay your medical bills.

Treat your Medicaid number the way you treat your Social Security number—do not loan or sell it to anyone.
Keep your Medicaid card in a safe place, the way you protect your money or checkbook—out of sight of everyone.
If you suspect that someone is misusing their Medicaid benefits or someone who is not your provider requests your Medicaid information, please call The U.S. Department of Health & Human Services at (800) 447-8477 or call Member Services at (844) 236-0894 or locally (Des Moines area) at (515) 256-4606. View this Medicaid Fraud flyer for more information on how to report suspected Medicaid fraud.