Questions multiply for those assigned to WellCare

Julie Heidger has been anxious since she first heard of the state's plan to move its $5 billion Medicaid program that has 560,000 enrollees onto plans managed by four out-of-state, private managed-care organizations on New Year's Day.

She already worried if her children would be able to continue to see their doctors and specialists. Her children's primary health system is the University of Iowa Hospitals and Clinics, which she does not believe has signed any contracts with managed-care organizations yet.

But her anxieties grew tenfold on Friday. That's when she received the enrollment packets for her three children - all of whom are on Medicaid - and discovered that not only were they assigned to three different managed-care organizations, but her four-year-old son Piers - who has cerebral palsy and has a brain injury waiver from the state - was assigned to WellCare of Iowa.

'It made my heart sink,” she said.

That's because on Nov. 25 an administrative judge recommended the state throw out WellCare of Iowa's contract. Judge Christie Scase said the company used improper communication during the bidding process and did not initially disclose its legal troubles. WellCare has faced millions of dollars in fines in other states and three former executives went to prison last year for fraud.

'I'm thankful a judge has stepped forward,” Heidger said. 'But it makes my heart sad that, as parents, we're not being heard.”

In the days following, Gov. Terry Branstad has said the ruling won't slow the transition. He has appointed Janet Phipps, director of the state Department of Administrative Services, to review the finding and render a decision.

But hundreds of thousands of enrollment packets were sent out to Medicaid recipients since last Wednesday, informing 25 percent of enrollees that they were automatically enrolled in WellCare.

If the state decides to toss out WellCare's contract, Iowans put on a WellCare plan will be reassigned to one of the three remaining managed-care organizations, DHS spokeswoman Amy Lorentzen McCoy said.

Medicaid members have until Dec. 17 to select a new managed-care organization or keep the preselected assignment.

'After that, they continue to have 90 days to switch plans for any reason, and for good-cause reasons, throughout the year,” she said. 'If there are any changes in the complement of health plans offered through the Iowa Medicaid program - now or into the future - members will be notified, receive a new tentative assignment and have a period to make a choice if they want a different plan.”

State Sen. Liz Mathis, D-Robins - who has spoken out against the plan and traveled to Washington, D.C., with two other state legislators to ask federal officials to delay the move - said reassigning individuals so close to the Jan. 1 launch date could be chaos.

Mathis sits on the Medicaid transition's Legislative Oversight Committee, which will meet Dec. 7 in Des Moines. Going into that Monday meeting, Mathis said her biggest questions revolve around provider networks and if adequate ones will be established in time.

She's received calls and questions since the initial announcement, she said, but it has increased in the days following the WellCare ruling.

'The main question is, I've got this packet, I've been assigned, I go to call to find answers and that's where the system breaks down.”

That was Heidger's experience. She spent several hours on Monday trying to talk with a DHS representative, but either was disconnected or could not be heard, she said.

Jeff Edberg, whose adopted 13-year-old son Collin has microcephaly, cerebral palsy and hypertonia, could get through but was unable to find someone with any answers, he said.

Collin lives at Hills and Dales, a residential facility that provides 24-hour care - an expensive necessity made easier through Medicaid, Edberg said. But now Collin has been assigned to WellCare, Hills and Dales has not yet signed contracts with any of the four managed-care organizations, and Edberg worries about his son's future.

'We're just left with questions an no answers,” he said. 'This is such a big deal.”