Year in review: Iowa’s managed care takes more hits

*This storyline was voted as one of the top storylines of 2017 by Gazette staff. Other top storylines include the debate over the defunding of Planned Parenthood, Iowa's opioid abuse issue, and Branstad's new role as ambassador to China.*

Anyone this past January who may have supposed that year two of Iowa's $5 billion Medicaid managed-care program would be more peaceful than 2016 was in for a bumpy ride.

The rollout of the program in April 2016 for some 600,000 poor and disabled Iowans arrived after two forced delays by the federal Centers for Medicare and Medicaid. By year's end, it had seen all three insurers report losses in the hundreds of millions of dollars and lawmakers, enrollees and providers complaining of delayed, miscoded or nonexistent payments.

This year continued the financial strains. In June, a state Department of Human Services report showed the insurers - for the fourth consecutive quarter - had to pay out more in claims than they could bring in.

By October, AmeriHealth Caritas Iowa said it would throw in towel and exit by the end of November, affecting more than 213,000 Iowans enrolled with the company.

At first, Human Services said the enrollees would be moved to UnitedHealthcare of Iowa but could then switch to Amerigroup Iowa. But Amerigroup said it didn't have the 'capacity” to take on new members.

Soon after, the state said those 10,121 enrollees who chose to move to Amerigroup would be shifted to Iowa's fee-for-service program instead.

At the same time, the state is looking for a new company to replace AmeriHealth. That company isn't expected to be available to take on patients for months.

In mid-November, Michael Randol was named as Iowa's Medicaid program director. He replaced Mikki Stier, who has moved up as the Human Services Department's deputy director.

Randol left a similar post in Kansas after overseeing its own troubled program. The Kansas City Star reported that federal officials in late 2016 said the Kansas program was 'substantively out of compliance” with federal rules.