Health

Medicaid members regain choice, Amerigroup Iowa once again is actively accepting applications

DHS director reacts to critical Ombudsman report

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

Amerigroup Iowa once again is actively accepting Medicaid members as part of the state’s managed-care system.

It is taking enrollees it previously had said it didn’t have capacity to include as well as accepting new members into the system, said Iowa Medicaid Enterprises Director Mike Randol. He was speaking during Wednesday’s Council on Human Services meeting in Des Moines.

AmeriHealth Caritas, one of the managing-care organizations that handled Medicaid coverage in Iowa, announced in October it would exit Iowa’s market at the beginning of this year.

That same month, Amerigroup announced it did “not currently have capacity to take any new members,” including those approximately 186,000 individuals left behind in AmeriHealth’s exit.

This left UnitedHealthcare of the River Valley as the only option for members.

More than 10,000 Iowans who had been put on fee-for-service at the beginning of this year now have been moved to Amerigroup’s coverage.

The transition so far has gone smoothly, Randol said on Wednesday.

The Department of Human Services is undergoing a search for one or two managed-care organizations to replace AmeriHealth. These companies would begin administering coverage July 1, 2019.

All You Hear Are The Complaints

Department of Human Services Director Jerry Foxhoven during Wednesday’s meeting responded to heavy criticism of managed care, saying a report released earlier this month overemphasized complaints on the state Medicaid system.

“It is a system that is not collapsed,” he said.

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The Iowa Office of the Ombudsman, which is an independent agency that investigates complaints agencies or state and local governments, stated in its report released April 2 that the office had received a 157 percent increase in cases related to managed care.

However, Foxhoven pointed out that the Ombudsman Office only received 225 complaints over the past year. Managed care, which was implemented in April 2016, administers coverage for approximately 640,000 poor and disabled Iowans — making 225 complaints a very small percentage.

“That’s really pretty good,” he said.

Foxhoven equated the state’s Medicaid system to an airliner — customers who lose luggage or have a bad experience will be more vocal than those whose flight was uneventful.

The Ombudsman report gave specific examples of managed-care related cases, including complaints from members that their services had been reduced without an opportunity for appeals.

The DHS Director pushed back, saying the complaints on the reduction of services is “assuming no one should be a reduction of services.”

With 640,000 enrollees — a portion of whom will be on the program for long periods of time, such as those with disabilities or multiple, chronic conditions — it’s important the state’s managed-care program remains sustainable long term, he said.

“If we’re paying for something we shouldn’t be paying for, we need to stop it,” Foxhoven said.

But Foxhoven did emphasize the department tries to fix situations in which the reduction of services is wrong and continues to take a look at individual situations, leaving room for exemptions to policies and working with the managed-care organizations to find a compromise.

l Comments: (319) 368-8536; michaela.ramm@thegazette.com

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