Member Handbook, Provider Directory, Preferred Drug List and Forms

Iowa Total Care wants you to have the resources you need. They will help you take control of your health. These include the Iowa Preferred Drug List (PDL) and our provider directory. Learn more below.

Iowa Medicaid Member Manuals

Here are links to the manuals and forms available to you.

• Member Handbook (PDF) 
• Preferred Drug List
• Provider Directory
  • Central Region (PDF) - covers Appanoose, Benton, Boone, Butler, Cerro Gordo, Dallas, Davis, Floyd, Franklin, Grundy, Hardin, Iowa, Jasper, Jefferson, Keokuk, Lucas, Mahaska, Marion, Marshall, Mitchell, Monroe, Polk, Poweshiek, Story, Tama, Van Buren, Wapello, Warren, Wayne, Worth counties.
  • East Region (PDF) - covers Allamakee, Black Hawk, Bremer, Buchanan, Cedar, Chickasaw, Clayton, Clinton, Delaware, Des Moines, Dubuque, Fayette, Henry, Howard, Jackson, Johnson, Jones, Lee, Linn, Louisa, Muscatine, Scott, Washington, Winneshiek counties.
  • West Region (PDF) - covers Adair, Adams, Audubon, Buena Vista, Calhoun, Carroll, Cass, Cherokee, Clarke, Clay, Crawford, Decatur, Dickinson, Emmet, Fremont, Greene, Guthrie, Hamilton, Hancock, Harrison, Humboldt, Ida, Kossuth, Lyon, Madison, Mills, Monona, Montgomery, O’Brien, Osceola, Page, Palo Alto, Plymouth, Pocahontas, Pottawattamie, Ringgold, Sac, Shelby, Sioux, Taylor, Union, Webster, Winnebago, Woodbury, Wright counties.

Iowa Medicaid Member Forms

*Before filling out the forms below, right-click on the link and choose “Save Link As” to save it to your desktop. This will make sure the file shows the information correctly.

• Authorized Representative Designation Form (PDF)
• Grievance & Appeal Form (PDF)
• Health Risk Screening: Adult Form (Ages 18–64) - Coming soon; contact Member Services.
• Health Risk Screening: Child Form (Ages 6 Months – 17 Years) - Coming soon; contact Member Services.
• Health Risk Screening: Infant Form (Less than 6 Months) - Coming soon; contact Member Services.
• Language Access Services Request Form (PDF)
• PCP Change Form (PDF)
• Revocation of Authorization to Disclose Health Information (PDF)
• Release of Information Form (PDF)

Any documents and items offered in electronic format can be requested in paper format. To request a document in paper format, please contact Member Services at 1-833-404-1061 (TTY: 711).

Once you have completed your request, the paper format item(s) will be mailed within 5 business days from the date of the request.