116 3rd St SE
Cedar Rapids, Iowa 52401
As Rhonda Shouse sat listening in on a disorderly phone call with the Centers for Medicare and Medicaid Services (CMS) on Nov. 10 that had hundreds of Medicaid recipients and advocates on the line - all speaking over one another in the hopes to have their complaints heard and who were periodically put on mute by the moderator - she had one thought.
'Being on that chaotic call, I realized how important it was to get up to that meeting,” she said.
The meeting she means is the Dec. 7 Health Policy Oversight Committee meeting in Des Moines. In that meeting, state legislators will hear updates from the Iowa Department of Human Services and representatives from the four managed-care organizations that are working to move the state's $5 billion Medicaid program that has about 560,000 enrollees onto plans managed by the four out-of-state companies starting on Jan. 1.
So Shouse started planning her trip - and thanks to the help from an anonymous donor, about 150 Medicaid recipients and caregivers from Cedar Rapids, Iowa City and Sioux City will take charter buses to the State Capitol that day, too.
'There are so many people who are so concerned about this issue,” she explained. 'We want to show in numbers who this is impacting.”
Shouse and her 22-year-old daughter are both on Medicaid, she said, adding a recent trip to the doctor determined her daughter needs to see a neurologist.
'But she might not be able to get an appointment by the end of the year,” she said, which brings up a handful of questions to which she doesn't know the answers, including what managed-care company will the two be assigned and will the neurologist be in that network?
'That's not an unusual story,” Shouse said.
She's been frustrated over the lack of information and answers she's been able to find about the move and what it means for her family. She's received the initial introductory letter from the state, she said, but has yet to get an enrollment packet.
Additionally, she's 'religiously” attended meetings held by DHS and contacted state and federal officials.
'Because I'm on disability, I don't have a job,” she said. 'So I've made this my job.”
James Marquart, an advocate for the Medicaid population and also will attend the Dec. 7 meeting, said it's important that the people impacted by the move get to have a voice.
'It's too easy to forget there are people this is affecting,” he said. 'It's nice to be meeting with people from across the state in one spot, too. That way you don't feel alone.”
Iowa's decision to turn over the management of its Medicaid population to private companies is certainly not unique.
More than 39 states and more than half of all Medicaid recipients receive their care from risk-based managed care organizations that contract with state Medicaid programs.
'It's a big trend that's been unfolding over a long period of time,” said Julia Paradise, associate director of the Kaiser Commission on Medicaid and the Uninsured at the Washington, D.C.-based Kaiser Family Foundation, a not-for-profit that focuses on health issues. 'There's a lot of momentum across the country.”
However, Paradise said most managed-care programs started on a more limited basis and phased in populations and services, she said, which is a bit different from Iowa's plan to move about 560,000 enrollees to these plans starting New Year's Day.
'So it will grow as (states) gain a better understanding,” she said. 'This is a population with a lot of need.”
Iowa has set up some safeguards. For the first two years, Medicaid patients who receive long-term care services and supports can keep those services even if their provider is out-of-network. Physical, behavioral and mental health services can be kept for the first six months even if a provider is out-of-network.
Not all of these moves have gone smoothly, she said, pointing to California as an example.
'There were problems with adequate information, education and outreach,” Paradise said, adding continuity with providers and especially important with Medicaid populations - the elderly, the intellectually disabled and low-income women and children.
For a transition to work, she said, it's important the enrollees understand the transition and are able to navigate it.
'Choice is an appealing thing - who can argue with choice,” she said. 'But to exercise it meaningfully, you have to understand your choice and the providers have to be place.”
Getting those providers in place and establishing an adequate provider network is key to receiving approval from CMS - the federal agency that has final say in whether the state will get a waiver.
Last week, Gov. Terry Branstad announced that about one-third of the state's 42,000 Medicaid providers have signed contracts with at least one of the four managed-care organizations.
But one key provider group is missing from that list - hospitals. The Iowa Hospital Association (IHA) - which represents the state's more than 120 hospitals - released a statement Monday afternoon stating an analysis of managed-care organization data as well as information supplied by hospital administrators found that only a handful of hospitals may have signed contracts.
The association, which has come out against the transition, has filed a petition for declaratory judgment and injunctive relief with the Polk County District Court, asking the court to delay the implementation of managed care until a legal conflict is addressed.
'IHA looks forward to representatives of the federal Centers for Medicare & Medicaid Services coming to Iowa to examine in-depth the state's plan to privatize Medicaid and the ability of these companies to meet the needs of 560,000 Medicaid recipients in Iowa,” the statement said.