Iowa senators hopeful Jan. 1 Medicaid changeover gets delayed

DES MOINES - Three Democratic senators say they emerged from Wednesday's meeting with federal officials reviewing Iowa's planned switch to managed care for Medicaid recipients 'somewhat positive” that the Jan. 1 implementation may be delayed until concerns are addressed.

Senate President Pam Jochum of Dubuque and Sens. Amanda Ragan of Mason City and Liz Mathis of Robins, members of the Legislature's Health Policy Oversight Committee, say they spent nearly 75 minutes discussing concerns with officials of the federal Centers for Medicare & Medicaid Services (CMS), who are considering Iowa's waiver request to convert a $5 billion Medicaid system to a managed care network for 560,000 enrollees run by four private companies.

The legislative trio said CMS officials plans to conduct four site visits in Iowa next month to look into concerns raised about provider networks, staffing, case management and accounting systems that they raised - concerns that were the subject of 3,000 emails and phone calls from Iowans worried about the Jan. 1 transition.

'Right now CMS has very deep and serious concerns about Iowa's readiness,” Jochum told reporters during a conference call.

'They have truly great concerns about whether or not Iowa is ready to do that Jan. 1,” she added. 'It was clear they had a pretty good handle on what's going on in Iowa. They know that there is a bit of chaos.”

Mathis said federal overseers are finding 'inconsistencies” with what Branstad administration officials are telling them about the plan compared to what health care providers and Medicaid patients in Iowa are saying during listening posts, while Ragan said there is growing evidence that would be 'very unrealistic” for Iowa to make this shift so quickly from its current fee-for-service approach.

'There are serious concerns,” Ragan said. 'We have a very short amount of time, Jan. 1, and how something like this can be implemented in this short of a time really is becoming very unrealistic that we see and that was what we were here today to tell the folks. I think they were very receptive to what we had said and listened and that made us feel good and I think all Iowans should feel good about that.”

Earlier this week, Gov. Terry Branstad said he recently had productive discussions with CMS officials in Washington D.C. about the planned changeover to privately run managed care, which he contended was modeled after similar programs in 26 other U.S. states. However, Jochum said Iowa is one of only five states where all Medicaid enrollees are being shifted into managed care plans.

Branstad said state Department of Human Services (DHS) officials have used a thoughtful, deliberative process modeled after other states' experience in concert with federal guidelines to come up with a phased-in Medicaid system designed to deliver better outcomes for patients and while being more predictable for the state than the current 'antiquated” system. He also expressed concern that some health care providers are using 'scare tactics” and misinformation to undermine his administration's effort to begin the transition to a privately managed Medicaid service delivery system beginning Jan. 1.

'Senate Democrats have been trying to have it both ways during the entire Medicaid modernization process,” Branstad spokesman Ben Hammes said in a statement Wednesday. 'Not only did Senate Democrats double the projected savings in Senate File 505, the HHS budget, the measures they approved also include unprecedented oversight, additional long-term care ombudsman support and administrative rule-making authority.

'We hope that Democrat senators will work as hard at helping Iowa patients as they have at partisan politics. We will never stop working to improve Medicaid for patients,” Hammes added. 'Gov. Branstad remains confident, after a very encouraging meeting with Secretary Burwell last week, that our patient-centered Medicaid plan will be implemented on Jan. 1, 2016 with our two-year phase-in measures for our most vulnerable Medicaid patients.”

According to DHS spokeswoman Amy McCoy, the initial Medicaid modernization proposal set the state's program at $4.2 billion based upon fiscal 2014 numbers. She said the revised recommendation for the current fiscal year puts the program at $5 billion for about 600,000 members - with 25,000 to 40,000 remaining on a fee-for-service basis rather than assigned to a managed care organization.

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