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Title 8: Medicaid Page 10 Iowa Department of Health and Human Services Employees’ Manual Chapter A: Administration Benefits Revised January 13, 2023 Iowa Medicaid Enterprise Benefits Members who are not required to be in managed care and are not PACE enrollees have primary responsibility to find and select providers who accept Medicaid. If a member asks you for help in finding a provider, refer the member to https://hhs.iowa.gov/ime/members/find-a-provider. Coverage of Medicaid services is explained in more detail in 8-M, Medicaid Services, and in 8-F, Coverage Groups. If the member asks you about coverage of a particular service, refer the member to https://hhs.iowa.gov/ime/members/what-services-are-available. Iowa Medicaid Enterprise To learn more about IME and to visit the Contact Directory, go to https://hhs.iowa.gov/ime/about. When Members Are Responsible for Payment of Medical Bills Legal reference: 441 IAC 79.1(13), 441 IAC 79.9(4), 441 IAC 80.4(1), 441 IAC 80.5(1) The member is responsible for paying for all or part of medical services when: ▪ Medicaid does not cover the services. ▪ The member receives services during a period when the member was not eligible for Medicaid. ▪ The provider does not participate in Medicaid. Members are responsible for making sure their providers accept Medicaid. ▪ A specified copayment is required. ▪ The bill is used to meet spenddown for the Medically Needy coverage group. ▪ The member is enrolled in an MCO and uses a provider who is not on the MCO’s list of providers. ▪ The member fails to notify the provider of the member’s Medicaid eligibility during the Medicaid claim-filing period. EXCEPTION: The member is not responsible for payment if the length of time for determination of retroactive eligibility prevents a member from timely informing the provider. ▪ The member is enrolled in the PACE program and uses a non-PACE provider for nonemergency services. For more information on member responsibilities and copayments, go to: ▪ If enrolled in an MCO; https://hhs.iowa.gov/iahealthlink/benefits and click on Member Managed Care Program Handbook. ▪ If fee-for-service (FFS); https://hhs.iowa.gov/ime/members/FFS and click on Your Guide to Medicaid Fee-for-Services (FFS).