Cedar Rapids woman runs into guardianship issues under managed care

CEDAR RAPIDS - Cindy Smothers has been trying since December to be listed as her son's guardian with AmeriHealth Caritas Iowa. So far, she's had lots of conversations and some headaches but no luck.

AmeriHealth, along with two other managed-care organizations, or MCOs, took over management of the state's $5 billion Medicaid program with more than 560,000 enrollees on April 1. A month into managed care, Smothers, who has been her son's guardian for more than 13 years, is still running into problems.

Her adult son, Tyler, 31, has mental and physical disabilities, she said. He lives at home, and while he's verbal and aware of what's going on around him, he's unable to handle money or make his own health care decisions, she said.

'If I'm not on file as his guardian, they can't even share his information with me,” she said.

She's spoken with the Iowa Department of Human Services, Iowa Medicaid and AmeriHealth three to four times each in hopes of resolving the problem, she said, and brought the necessary paperwork into local DHS offices on two occasions.

'I am a strong advocate for my son,” Smothers said. 'I always have been. I worry about the people who don't have that.”

She's contacted state senators and representatives, including Rep. Art Staed, D-Cedar Rapids, who then forwarded her information on to DHS Director Chuck Palmer and Iowa Medicaid Director Mikki Stier, she said. The two quickly responded and worked to resolve the problem, she said, but every time she believes it's fixed, someone at AmeriHealth tells her she's not listed as Tyler's guardian.

'It is just so frustrating,” she said, explaining her next step is to call the Managed Care Ombudsman, a program designed to advocate for the rights of those with mental health problems, brain injuries, intellectual and physical disabilities, and the elderly who are Medicaid managed-care enrollees.

Amy McCoy, DHS spokeswoman, said she will pass the case along to the state's rapid response team, which works to correct problems with the Medicaid transition.

McCoy added that guardianship information was kept in several locations under the state-run fee-for-service system. During the move to managed care, the state created a new tool that would pull all that information into one place, theoretically making it easier for the state and MCOs to have access to it.

'It may be that call centers need to be educated with the look up tool.” she said.

AmeriHealth did not respond to The Gazette's requests for comment.