Iowa Medicaid Director says state is ready for managed care

Some senators remain concerned about Medicaid transition

Enrollment information for managed-care organizations, including WellCare, in Iowa's Medicaid privatization plan, photographed in Cedar Rapids on Friday, Dec. 18, 2015. (Liz Martin/The Gazette)
Enrollment information for managed-care organizations, including WellCare, in Iowa's Medicaid privatization plan, photographed in Cedar Rapids on Friday, Dec. 18, 2015. (Liz Martin/The Gazette)

Iowa’s Medicaid director on Tuesday said she’s confident the state is ready for the March 1 transition that would move 560,000 Medicaid enrollees and nearly 30 providers from a fee-for-service plan over to a trio of out-of-state managed-care companies.

But a handful of state legislators expressed concerns.

Iowa Medicaid Director Mikki Stier and Department of Human Services Director Charles Palmer went before the Health and Human Services Appropriations Subcommittee in Des Moines to give an update on Iowa’s readiness for the managed-care transition.

Gov. Terry Branstad announced in early 2015 that the state would move its $5 billion Medicaid program over to managed care, originally targeting a Jan. 1 start date. But in mid-December, the Centers for Medicare and Medicaid Services — the federal agency that still must approve the transition — delayed the switch until March 1.

CMS cited 16 readiness concerns, from an inadequate provider network to poor communications between the state and the providers and beneficiaries, as reasons for the delay.

On Tuesday, Stier ran through a list of actions the state has taken in the months since, including beefing up Iowa Medicaid call centers, reaching out to the state’s 70 case management agencies and better training of the ombudsmen offices. Stier also told the committee that the number of providers to sign contracts has more than doubled since Dec. 31, and maintained the state had been ready for the move back in Jan. 1.

But several senators — including Sen. David Johnson, R-Ocheyedan — voiced concerns over the adequacy of the provider network. Last week, Johnson sided with Democrats to vote in favor of a bill that would terminate contracts with the managed-care companies.

“The provider network has doubled since Dec. 31, but you feel you were ready then,” said Sen. Amanda Ragan, D-Mason City. “I think that says so much.”

DHS said that about 60 percent of current Medicaid providers have signed contracts with all three managed-care organizations, 70 percent have signed contracts with at least two and 90 percent have signed contracts with at least one.

Sen. Liz Mathis, D-Robins, asked Stier if CMS has given her or other DHS officials any indication that Iowa is meeting the metrics set before it. Mathis along with other senators spoke with CMS officials about two and a half weeks ago about where Iowa stood with the readiness criteria.

“I asked them, ‘If you had to make a decision today, would you?’” she said. “They said the networks are not adequate, and they are seriously concerned. I get that you have to say we were ready Jan. 1 — that’s your job. But CMS is saying something very different to us.”

Stier said all requirements have been completed, and CMS is continuing to monitor the development of the provider network.

Also on Tuesday, WellCare of Iowa said it will not pursue any additional appeals but instead will look for future growth opportunities outside Iowa.

That came after a Polk County District Judge upheld the state’s decision to throw out the company’s Medicaid managed-care contract.

WellCare was awarded a contract along with Amerigroup Iowa, AmeriHealth Caritas Iowa and UnitedHealthcare of the River Valley in August. A state arbiter tossed out its contract in December, saying the company had improper communications with state officials and failed to disclose information regarding $137.5 million in fines it paid to resolve false claims settlements.

“While we disagree with the decision and are disappointed with this ruling, the time has come to move forward,” said Blair Todt, WellCare’s senior vice president, chief legal and administrative officer. “WellCare maintains the ruling does not accurately reflect the facts or the integrity of Iowa’s procurement process. While some procedural mistakes were made, the state acknowledged these mistakes did not impact its award decision and has never once questioned WellCare’s ability to provide quality care for Iowans.”


Today is the deadline for Medicaid recipients to choose a managed-care organization for coverage to begin March 1.

Here in the Corridor, all three major hospitals — Mercy Medical Center in Cedar Rapids, UnityPoint Health-St. Luke’s Hospital and University of Iowa Hospitals and Clinics — now have signed contracts with the three remaining managed-care organizations.



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