Iowa Medicaid managed care gets go-ahead from federal government

Iowa's move to Medicaid managed care was delayed for a second time on Tuesday afternoon when the federal Centers for Medicare and Medicaid Services told the state that it would approve an April 1 start date instead.

'Although we understand the state's preference to move forward on March 1, the April 1 effective date provides additional time for Iowa to complete activities,' stated a letter from Vikki Wachino, director for the Center for Medicaid and CHIP Services at CMS, to Iowa Medicaid Director Mikki Stier.

The letter came one week before the proposed March 1 move.

Gov. Terry Branstad announced a plan to move the state's $5 billion Medicaid program over to out-of-state managed care organizations in early 2015. He initially set a start date of Jan. 1, 2016, but CMS delayed the move to March 1, citing 16 readiness problems, including inadequate provider networks and an inefficient communication plan.

In a separate statement also released on Tuesday, CMS said Iowa has made significant progress since December to improve its call center and provide information to beneficiaries.

'Because of this progress, CMS is approving an April 1 start date for the state's transition to managed care,' the federal agency said. 'CMS's primary focus is on protecting the quality of care delivered to beneficiaries, and we will continue to closely monitor the state's progress.'

In the CMS letter to Stier, the agency said it approved the transition but had a handful of terms and conditions:

l General monitoring — The state must monitor managed-care organization activities, including staffing, enrollee and provider communications, and grievance and appeals.

l Communication and member services — Member helplines must provide timely and accurate information. The state must monitor managed-care organizations' call centers, and place the organizations on corrective action plans if they do not meet requirements.

l Provider networks — CMS believes the provider networks will allow for continuity of care throughout the transition period, but CMS wants the state to monitor the availability of services.

l Case management — The state must provide CMS with a weekly report showing managed-care organizations' progress contracting case-management services. It also must monitor the organizations' compliance with contractually established case manager-to-beneficiary ratio.

l Continuity of care — The state must ensure that beneficiaries are allowed to keep current case managers until at least Sept. 30; require managed-care organizations to take into account beneficiaries existing prescriptions and ensure access during the transition; and require the organizations for the first year to honor existing service authorizations for acute-care and specialty services.

Branstad said in a statement Tuesday that the approval gives patients and providers certainty.

'We're pleased that CMS has approved Iowa's plan to provide a better system for Medicaid patients on April 1,' he said. 'Iowa is ready for a new system that provides access through more doctors and will create a more sustainable Medicaid program for taxpayers.'

Those were sentiments echoed by House Speaker Linda Upmeyer, R-Clear Lake.

'I am optimistic that the move to managed care will bring more predictability to the Medicaid program, while also improving the health and well-being of the patients it serves,' she said.

But for opponents of the plan, the delay came as a relief as it gives more time to set up oversight and fill out provider networks.

Sen. Amanda Ragan, D-Mason City, co-chairwoman of the House-Senate budget subcommittee on health and human services, considered it a significant point that the federal regulators postponed the move for four months.

'There are still 10 points in here,' said Ragan, in referring to the CMS letter sent Tuesday. 'It's still not clear sledding.'

Ragan and Sen. Liz Mathis, D-Robins, chairwoman of the Senate Human Resources Committee, called for robust oversight.

'The Senate is working on tough, bipartisan oversight and accountability protections,' Mathis said. 'Iowans will do a better job than out-of-state corporations when it comes to overseeing the health care safety net we all depend on.'

The oversight bill, SF 2213, will be discussed during a Wednesday Senate Human Resources Committee meeting.

Medicaid recipient and advocate Rhonda Shouse, along with 66 other beneficiaries and caregivers, will be in Des Moines Wednesday to meet with legislators about the transition and attend the committee meeting.

'The decision gives us focus,' she said. 'We can laser in on the fact that we need additional oversight.'

Shouse said she was excited to hear about the delay, adding it was very needed.

'The idea that it would be totally terminated was pretty slim,' she said. 'But the delay confirms what we've been saying all along — we're not ready.'