Months in, Iowa providers and beneficiaries tell feds Medicaid switch isn't working

CMS, HHS listen to more than an hour's worth of frustrations

Rhonda Shouse, a Medicaid recipient from Marion, speaks during a Medicaid oversight hearing at the State Capitol in Des Moines on Monday, August 29, 2016. The morning meeting invited providers and Medicaid recipients to speak about their experiences working with the MCOs following Iowa’s transition to managed care in the spring. She says she signed up with AmeriHealth because of the value-added services it offered, but she has yet to receive the gym membership she was promised and needs for her aquatherapy. (Rebecca F. Miller/The Gazette)
Rhonda Shouse, a Medicaid recipient from Marion, speaks during a Medicaid oversight hearing at the State Capitol in Des Moines on Monday, August 29, 2016. The morning meeting invited providers and Medicaid recipients to speak about their experiences working with the MCOs following Iowa’s transition to managed care in the spring. She says she signed up with AmeriHealth because of the value-added services it offered, but she has yet to receive the gym membership she was promised and needs for her aquatherapy. (Rebecca F. Miller/The Gazette)

Five months into the state’s move to Medicaid managed care, federal officials on Monday fielded more than an hour’s worth of complaints and frustrations from beneficiaries and health care providers during a public listening post.

Iowa handed over its $5 billion Medicaid program to three private insurers — Amerigroup Iowa, AmeriHealth Caritas Iowa and UnitedHealthcare of the River Valley — on April 1.

Since the transition, providers have reported late and inaccurate payments, while some beneficiaries have said they’ve experienced gaps in care.

The state, meanwhile, has reported a smooth rollout, with only minor bumps along the way. Gov. Terry Branstad has said the switch will reduce fraud and waste.

State Senate President Pam Jochum, D-Dubuque, and other Senate Democrats requested the conference call.

“A lot of payments — we’ve tracked nearly 30, but don’t know of all of them — have been going to other facilities not associated with ours, and some not even in Iowa,” Iowa Specialty Hospitals and Clinics Dani Valentine told representatives from the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services.

Valentine said hospital staff can’t get straight answers when they call the managed-care organizations and often receive conflicting information when calling about the same missing claim. She added that some of the claims the hospital has received have not been correct.

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Other providers on the call — from durable medical equipment providers to occupational, physical and speech therapists — told the federal officials that prior authorizations have been cumbersome and payments have been incorrect.

Rhonda Shouse, a Medicaid enrollee and administrator of MCO Watchdog — a Facebook group with nearly 2,000 members — told officials that she’s recently run into issues filling a prescription— an issue that was echoed by other beneficiaries and providers on the call.

Shouse said that she tried to refill the prescription about two weeks ago and was told she needed pre-authorization from her MCO. After waiting a week for the pre-authorization, her doctor told her Monday morning it had been denied.

Her doctor provided her with free samples of the drug as a stopgap measure.

“How long are drugmakers and doctors supposed to step in for the MCOs?” she asked. “I’m preparing for a surgery next month. I would hate to have to postpone it because of a preventable hospitalization.”

Sen. Liz Mathis, D-Cedar Rapids, who also listened in to the call, said afterward that she wished the federal officials would have offered more insight and help.

“One person, I think it was Rhonda (Shouse), talked about issues getting medication, and Jim Golden (with CMS) said, ‘Well, you can appeal that,’” she recalled.

“So many providers, who are really smart and have done a lot of work for this, have just exhausted options,” she continued. Calling the MCOs and Iowa Medicaid “have been tried multiple times.”

Legislators will keep shining a light on issues until things begin to get resolved, Mathis added.

“It’s time to take off the gloves,” she said.

Also on Monday, Branstad touted the more than 365 meetings Department of Human Services and MCO representatives have held or attended since the transition was announced in early 2015.

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