Two weeks to Iowa Medicaid switch, state senators remain skeptical

DES MOINES - Skeptical state senators were unconvinced Wednesday by assurances from Iowa Medicaid managers that a plan to switch from a public to a privately-run Medicaid system for 560,000 people will be ready to go on April 1, given the uncertainty they say they continue to see among recipients and providers.

'There are more questions than answers,” said Sen. Liz Mathis, D-Robins, chairman of a Senate Human Services Committee that spent nearly 90 minutes quizzing state Medicaid officials about ongoing concerns, inadequate communication and spotty data just two weeks away from the switch-over. 'This transition is really going to be bumpy.”

State Medicaid Director Mikki Stier of the Iowa Department of Human Services outlined her agency's plan for compliance by the three private managed care organizations under state contract to run the program - and timelines for remedies if those compliance goals go unmet by their deadlines.

DHS officials also provided a list of 70 case management providers that have contracts with all three MCOs, along with data on contract status and compliance.

But senators said they want a statewide list of providers to better be able to gauge readiness by April 1.

'I believe the system could just implode,” Sen. David Johnson, R-Ocheyedan, told reporters after the meeting. 'That there are just going to be too many along the margins that will fall first.”

Johnson said he is hearing from doctors who say the most common, least-expensive pharmaceuticals are requiring time-consuming preauthorization; non-profit centers that care for clients with disabilities 'just see danger everywhere” in terms of services being eliminated in the name of system improvements; and recipients who are confused or frustrated.

'These people who call me are very emotional,” said Johnson, who expressed concern over a lack of communication - especially given that the DHS documents provided Wednesday were done so without an opportunity to review them in advance of the meeting. 'It just makes me nervous about what's happening here.”

Stier responded to Sen. Joe Bolkcom, D-Iowa City, that the privately managed Medicaid network is in place to begin the transition April 1. But Senate President Pam Jochum, D-Dubuque, said the DHS provider information she received for her hometown was woefully incomplete and inadequate.

Sen. Bill Dotzler, D-Waterloo, said he sees a 'real disconnect” between what the department says is 'ready to go on April Fools' Day” and what Medicaid members who still haven't received benefit cards are saying.

'We've been told we've been ready to go forever, but we're going to have real problems,” Dotzler told DHS officials and committee members. 'There's so much frustration and fear out there when we talk to people, they break down and cry.”

Stier said her agency has hired an additional seven full-time employees to coordinate the new system, installed a 'pretty robust” monitoring plan, held numerous meetings with providers on billing issues, and conducted statewide webinars and training sessions in a multipronged effort in advance of the April 1 launch.

Mathis told Stier at the conclusion of Wednesday's meeting that legislators still had open-ended questions that she hoped could be addressed in a follow-up meeting next week where DHS officials were asked to provide more complete statewide information about provider contracts with MCOs.

Gov. Terry Branstad first announced the privatization of the state's $5 billion Medicaid program last year, intended to save millions. He initially wanted to launch it Jan. 1, but the federal Centers for Medicare and Medicaid Services ordered a delay until March 1. Then the federal authorities ordered another delay, saying this time the switch would be approved for April 1.