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After months of protests, multiple delays from the federal government and a legal battle or two, Medicaid managed care is finally here.
On Friday, the state handed over management of its $5 billion Medicaid program to three out-of-state private insurers — AmeriHealth Caritas Iowa, Amerigroup Iowa and UnitedHealthcare of the River Valley.
Gov. Terry Branstad first announced in early 2015 his plan to move the Medicaid system and more than 560,000 beneficiaries from fee-for-service over to managed care. The state cited rising costs for the move — Medicaid costs have ballooned from about $2.4 billion in 2004 to $4.9 in 2015 — adding the switch could save millions in the first six months.
But the move has been a controversial one — the Iowa Hospital Association asked a judge to delay the move; about 100 Medicaid recipients rallied at the State Capitol; and Iowa Senate Democrats have come out in fierce opposition.
'I am deeply concerned that we are not ready yet,' said Senate President Pam Jochum, D-Dubuque, who indicated her hope had been that CMS officials would delay Iowa's Medicaid managed care startup until July 1. 'We've been hearing horror stories for a while, but now the system is actually in play.'
Possible billing confusion
Amy McCoy, Department of Human Services spokeswoman, said around midday that Friday — the first day of the transition — was pretty quiet.
We're here to help. Click the image above to check out an interactive explanation of Iowa's new Medicaid managed care system.
McCoy said it's important for Medicaid recipients to alert DHS or their managed-care organization (MCO) of any problems that pop up regarding coverage or providers.
'There will be bumps in the road,' she said. 'I think will see a lot of activity in May when providers start submitting claims.'
That sentiment was echoed by Sen. Liz Mathis, D-Cedar Rapids. Mathis said there's likely to be confusion about billing, especially among smaller providers. She's also heard reports from smaller providers who are having problems getting credentialed by the MCOs.
Providers are credentialed when they meet certain requirements, such as background checks or necessary certifications, Mathis said. But the MCOs have different requirements and processes, she added.
Mathis said some of her concerns were calmed after this past Wednesday's Senate Human Resources committee, when DHS officials, including Iowa Medicaid director Mikki Stier, discussed the metrics and data the state plans to collect from the MCOs. The state will gather claims processing data, prior-authorization information, including denials, and outcomes data, among other information.
And if certain compliance measures are not met, Iowa will withhold up to 2 percent of capitation rates — or the monthly fee the state pays the MCOs based on the number of Medicaid recipients enrolled in each plan.
'I'm a data person,' Mathis said. 'I like to see trends.'
But Mathis and other senators are frustrated over the lack of oversight. The Senate passed a bill in early March that included provisions to enhance the role and responsibilities of the Health Policy Oversight Committee, execute a comprehensive review of program integrity and create a special fund to finance system improvements and support for recipients.
The bill failed to make it through a House committee by the so-called funnel deadline.
'I don't like that this is going to launch as we're about to adjourn and we don't have any oversight,' Sen. David Johnson, R-Ocheyedan, said during the Wednesday meeting.
There have been some mishaps on the recipient side of things as well, said Rhonda Shouse, a Medicaid beneficiary and advocate. Shouse helps manage the Facebook group MCO Watchdog, which has nearly 1,500 members who are Medicaid recipients, caregivers or providers.
Some group members posted they received Medicaid cards from the MCO they were tentatively enrolled in rather than the plan they later selected, she said.
'When they called IME (Iowa Medicaid Enterprise), there were told they could switch and have coverage start in May,' she said.
Shouse herself said she received a Medicaid card from Amerigroup but a confirmation letter from AmeriHealth. She had to call member services to confirm she was enrolled in the correct MCO.
'People are just scared,' she added. 'They don't know who they're signed up with.'
McCoy from DHS said some members may have received the wrong cards if they selected plans too close to the selection deadline. She suggested these recipients call IME to straighten out the problem.
Dealing with complex cases
Iowa now has shifted about 92 percent of its Medicaid population — including the more than 5,000 individuals on waiver services who require long-term care services — into managed-care plans.
That decision — to move such a large portion of the Medicaid population, including the intellectually disabled, the elderly and those with other disabilities, into managed care all at once — worries advocates the most.
Families such as the Edbergs, whose 13-year-old son Colin has physical and developmental disabilities. Colin lives in an intermediate care facility in Dubuque and has more than 10 providers, said his father, Jeff Edberg.
Edberg worries Colin's services will be cut and has been frustrated by the lack of answers he's been able to get from the MCOs.
'My son isn't sick,' he said. 'He has severe disabilities, and the MCO system is designed to cover sick people.'
Iowa Medicaid Enterprise
AmeriHealth Caritas Iowa
Gazette Reporter Rod Boshart contributed to this article.