Two Iowa Medicaid managed-care organizations again report millions of dollars in losses

Two of three private insurance companies managing Iowa's nearly $5 billion Medicaid program again reported millions of dollars in losses, documents filed with the Iowa Insurance Division show.

Also on Wednesday, the Iowa Department of Human Services released its second quarterly report since the transition took place, which Gov. Terry Branstad touted as the most 'thorough and transparent look” at the Medicaid program.

Amerigroup Iowa and AmeriHealth Caritas both reported losses of more than a hundred million dollars, according to third-quarter financial statements effective Sept. 30 filed with the state. UnitedHealthcare of the River Valley is not an Iowa company and therefore does not post the same documents with the insurance division.

Amerigroup reported losses of more than $147 million, while AmeriHealth reported losses of more than $132 million.

Iowa handed its Medicaid program with nearly 600,000 recipients over to the managed-care organizations on April 1.

In early November - about seven months into the program - the state announced it would increase capitation rates, or the per-member per-month fees it pays the MCOs for the first rate period, which ends June 30, 2017, by about $33 million. The increase on the state's end also came with an additional $94.5 million from the federal government.

Iowa officials pointed to rising prescription drug prices and unexpected costs of new Medicaid enrollees as the primary factors for the rate increase.

AmeriHealth could not be reached for comment, while Amerigroup pointed to parent company Anthem's recent statements made during its third-quarter earnings call in November.

During that call, Joe Swedish, Anthem's chairman, president and chief executive officer, told analysts that the company experienced greater losses than forecast in Iowa.

'We are in the process of having deep discussions with the state regarding the possibility of adjustments (to rates),” he said in the call. 'I commented in our discussions just a moment ago that we have realized some positive effect from that discussion, and quite frankly we're hoping for more. Unfortunately, the recent rate increase still is inadequate.”

He went on to say that the company is hopeful for a positive outcome.

'We are concerned about the actuarial soundness of the rates. And that has been expressed by all the MCOs from the get-go,” he said.

Meanwhile, the 79-page report that includes data from July to September and released ahead of the second Health Policy Oversight Committee on Dec. 13, projects the program to-date is saving the state about $29.7 million. The report, in a bar chart, shows that projected costs without managed care would cost the state $372 million compared with the $343 million it instead has spent under managed care.

It also includes capitation payments, which include federal and state dollars, made to the three MCOs that total more than $1.7 billion.

The governor's office on Wednesday pointed to several positive metrics, including more than 230,000 health risk assessments being completed and more than 25,000 adults and children who have been assigned health care coordinators.

DHS also reported it has seen a waiting list reduction for Home and Community Based Services waivers drop by about 2,200.

Other highlights from the report include:

l The MCOs paid hospitals more than $256 million in claims; physicians more than $80.8 million in claims; and home and community-based services more than $176 million in claims.

l 100 percent of pharmacy pre-authorizations were completed within 24 hours. Amerigroup, on average, approved 77 percent of pre-authorizations; AmeriHealth approved 63 percent; and UnitedHealthcare approved 80 percent.

l All three health plans exceeded the contractual expectation that 90 percent of payment claims be paid within 14 days.

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