Iowa agencies providing elderly care run into Medicaid billing issues

Many of the state's agencies caring for the elderly are running into huge billing issues, resulting in millions of dollars of unpaid Medicaid claims and forcing some to take out loans to stay in operation.

The state handed over its $5 billion Medicaid program, with 560,000 beneficiaries, to three private insurers April 1. Since the move, providers - from Meals on Wheels to rehabilitation therapists - have reported billing problems ranging from incorrect fees to denied claims.

During a Thursday news conference highlighting the importance of Medicaid managed-care oversight - which starts July 1 - Sen. Liz Mathis, D-Cedar Rapids, said she spoke with an executive at the Iowa Health Care Association, which represents home care agencies, nursing homes and assisted living facilities. The executive told her that 150 members have called in the past two days because MCOs are rejecting claims and not paying for millions of dollars of care.

'Health care providers are businesses,” Mathis said. 'They pay taxes, employ people, contribute to our communities and care for people.”

Four agencies spoke Thursday at the news conference, and all reported having problems obtaining consistent answers from MCOs - with many phones calls and emails going unanswered, they said.

Kim Lambert, owner of Carroll Area Nursing Service in western Iowa, said about 92 percent of her 90 Medicaid clients have selected AmeriHealth Caritas Iowa as their MCO, but the agency has received no payments from the insurer.

'That equals $292,000 owed,” she said. 'I've already taken out one loan.”

Lambert said she has spoken with multiple representatives from AmeriHealth and eventually was told the problem appears to be a contracting issue on the managed-care organization's end. She also was informed she likely wouldn't be paid until the end of July.

Pat Giorgio, founder of Cedar Rapids senior living facility Evergreen Estates, said fewer than 40 percent of her facility's claims have been properly paid. She spoke with her banker before the transition to take out an extra $100,000 line of credit in case she ran into any bumps during the first few months. That money, however, is drying up, she said.

'Six months from now, I won't be able to continue operations the way I do if this continues. This is not sustainable,” Giorgio said.

A representative from AmeriHealth could not be reached for comment.