Opponents ask if Medicaid network is ready

Democrats hope to derail managed-care transition

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Iowa is three weeks away from its March 1 transition date that will move the state’s $5 billion Medicaid program from a fee-for-service system to managed care. And with the deadline moving ever closer, some opponents to the state’s plan are questioning if an adequate provider network has been established.

Gov. Terry Branstad announced plans to transition the state’s Medicaid program over to managed care in 2015. The state — which has more than 560,000 Medicaid recipients — originally set a launch date of Jan. 1, 2016.

But the Centers for Medicare and Medicaid Services, the federal agency that must approve the switch, delayed the move to March 1 after it conducted four days of on-site readiness reviews and concluded the state’s provider network was lacking.

Iowa Department of Human Services data show that about 89 percent of the state’s nearly 30,000 Medicaid providers have signed up with at least one managed-care organization and about 57 percent have signed up with two.

On Thursday, Branstad announced 87,000 provider contracts have been signed.

“Old (fee-for-service) Medicaid had roughly 7,500 doctors in its network for patients,” Branstad said in a news release on Thursday. “The three partner managed-care plans have signed contracts with more than 8,600, 12,200, and 14,600 doctors respectively.”

But some opponents to the transition — including the Iowa Hospital Association and Iowa Senate Democrats — have questioned the accuracy of those numbers.

The thing making some scratch their heads is this: According to the Iowa Board of Medicine, the state had 11,971 active licensed physicians at the end of December 2015 and 6,828 active physicians with work addresses in Iowa.

Amy McCoy, spokeswoman for DHS, said medical licenses and claims processing can’t be compared “apples to apples.”

DHS data is collected based on provider billing numbers, McCoy said — meaning some providers could file claims under several unique numbers such as multiple clinics where they see patients and at the hospital where they have privileges.

“DHS data reports are based on these billing arrangements, not medical licenses,” she said. “And they are compared to the unique numbers used under the fee-for-service network to get the most accurate counts possible.”

Misleading numbers?

“I suppose that kind of accounting would be legitimate if, in fact, it were possible for a physician to be in two or three places at once,” said Scott McIntyre, a spokesman for the Iowa Hospital Association, which represents the state’s 118 hospitals. “Otherwise, it’s a misleading picture of access to care that is not in place.”

McIntyre said Branstad has “manufactured numbers” to show a robust provider network, adding that there are still hospitals across the state that have yet to sign contracts.

“We know hospitals are evaluating their contracting options,” he said. “But even a cursory look at the information on the (managed-care organizations’) websites clearly shows that — even at this late date — a viable statewide network does not exist.”

Sen. Liz Mathis, D-Robins, who sits on the Health Policy Oversight Committee, said the governor’s office is looking at provider contracts through “a different lens.”

“I understand that they’re trying to build public sentiment,” she said. “But if we switch over and we’re not ready, there will be hell to pay.”

Mathis said Iowa Medicaid Director Mikki Stier told legislators last week that about 45 percent of providers have signed contracts with all three managed-care organizations.

“That stood out to me,” she added.

Mathis, along with several other Democratic senators, spoke with federal officials from CMS and the U.S. Department of Health and Human Services late last week about Iowa’s readiness — from provider network adequacy to the reassignment of 130,000 Iowans placed on WellCare of Iowa’s plan after a state arbiter ruled to throw out the company’s contract.

“I asked, ‘If you had to make a decision today to move forward, would you?’” Mathis recalled. The officials’ response, she said, was “We’d be very concerned.”

Also on Thursday Sen. Janet Petersen, D-Des Moines, raised concerns over the number of providers contracted to offer services to the 37,000 children on the state’s Hawk-i program for low-income children.

Petersen, who also sits on the Hawk-i board, said she requested provider numbers from DHS several times over the past few weeks after hearing concerns about provider network adequacy.

Petersen, who obtained the numbers on Thursday, said that about 34,000 health care providers had contracts with either UnitedHealthcare or Wellmark Blue Cross and Blue Shield, the two insurance companies the state contracted with to provide Hawk-i services up until Dec. 31, 2015.

Of those providers, only 2,130, or 6 percent, have signed contracts with all three Medicaid managed-care companies, according to the DHS data, which Petersen provided to The Gazette.

About 18,500 (54 percent) have contracted with UnitedHealthcare of the River Valley; 12,700 (37 percent) have contracted with AmeriHealth Caritas; and 3,100 (9.3 percent) have contracted with Amerigroup Iowa.

“My biggest concern is that we don’t have an adequate network in place for our children,” she said. “It will be more difficult for families find medical care for their kids. When health care is available, it will be less comprehensive.”

Protecting ‘the status quo’

Meanwhile, legislative Democrats on Thursday announced their intention to push legislation next week to “pull the plug” on the governor’s transition plan. But House Speaker Linda Upmeyer, R-Clear Lake, said she did not expect the Republican-run Iowa House would join the Democrats’ efforts.

“I’m certainly not interested in passing any bill that faces a certain veto, so that’s probably not something we’ll do,” said Upmeyer, expressing disappointment that opponents have been delaying and “sabotaging the whole idea simply to protect the status quo.”

She also noted that ending the effort “totally blows up their budget” because up to $55 million in savings was built into this fiscal year’s spending plan.

Branstad spokesman Ben Hammes added that the administration will continue to work to secure CMS approval for the plan to go forward March 1.

“Senate Democrats have played politics with Medicaid from the very beginning. We hope that their bill also includes a Medicaid plan that improves access and coordination while bringing stability to the state budget,” he said. “... Thirty-nine other states can’t be wrong.”

Senate Minority Leader Bill Dix, R-Shell Rock, said Democrats “can’t have it both ways” by seeking to halt Medicaid privatization plan while building the cost-savings assumptions into their spending targets.

“They are not being honest with Iowans,” the Senate Republican leader said.

Gazette Des Moines Bureau reporter Rod Boshart contributed to this story.

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