AmeriHealth Caritas Iowa to move some special needs enrollees to in-house case managers

AmeriHealth Caritas Iowa - the only private Medicaid insurance company still contracting with outside case management agencies - plans to reassign and shift beneficiaries receiving long-term services and supports to in-house case managers, according to a letter detailing the change obtained by The Gazette.

The managed-care company told case management agencies it has contracted with that, over the next several months, some AmeriHealth Medicaid members will be reassigned from their current case manager to an AmeriHealth case manager. AmeriHealth did not respond to The Gazette's questions, including number of beneficiaries affected or why the company was making the change.

Both Amerigroup Iowa and UnitedHealthcare of the River Valley already have opted to use in-house case managers while AmeriHealth has used a hybrid model of contracting with outside companies as well as employing its own.

The companies recruited and hired case managers working within county departments or at case management agencies in 2015 and early 2016 in the lead up to the April 1 transition.

Case managers help assess an individual's needs as well as find and coordinate services, from transportation and meal delivery to home health resources and skilled health care services such as physical or occupational therapy.

Critics say moving those services from an external agency to in-house can create a conflict of interest as the case manager tasked with deciding what services a client is in need of receives a paycheck from the company that's paying for those services.

AmeriHealth has the highest number of Medicaid enrollees, with more than 212,000 beneficiaries, according to the most recent Department of Human Services quarterly report.

The insurer also has the biggest share of the state's special needs population - with more than 9,300 adults and 1,800 children with special needs compared with Amerigroup's 1,315 adults and 490 children and UnitedHealthcare's 857 adults and 408 children.

That puts the company's average cost per member per month significantly higher than its counterparts, with AmeriHealth spending about $4,779 per member in the second quarter compared with Amerigroup spending $2,932 per member and UnitedHealthcare spending $1,914.

l Comments: (319) 398-8331; chelsea.keenan@thegazette.com