What the Medicaid managed-care delay means

Thursday's news that implementation of Medicaid managed care will be delayed two months left many Iowans asking the same thing - what does this mean for my health care coverage?

Gov. Terry Branstad announced plans earlier this year to transition Iowa's $5 billion Medicaid system to a quartet of out-of-state, private care companies starting Jan. 1. But federal officials told the state they don't think Iowa is ready, citing significant gaps in the managed-care organizations' provider networks.

The Centers for Medicare and Medicaid Services - which must approve the plan because Medicaid is funded by both the state and federal governments - delayed the switch until March 1.

The state will continue operating its fee-for-service system for several months, the Iowa Department of Human Services says. That means Medicaid enrollees can continue to see their providers and use their Iowa Medicaid cards, while the state continues to reimburse providers at current rates.

The delay gives the managed-care organizations more time to contract with providers - AmeriHealth Caritas announced Friday that it signed contracts with UnityPoint Health and University of Iowa Hospitals and Clinics - while the 560,000 Iowans on Medicaid get two additional months to select a managed-care company.

Medicaid enrollees were assigned to managed-care organizations, but they now have until Feb. 17 to switch coverage to another company, to begin March 1. For those who chose a company Thursday - the original deadline to have coverage starting Jan. 1 - DHS said enrollees may stick with that company or select a new one.

The two-month delay also carries implications for the state's current budget year, during which the governor and lawmakers built in an assumption that privatized Medicaid managed care would save an estimated $51 million Jan. 1 through June 30.

Senate Majority Leader Mike Gronstal, D-Council Bluffs, said the Legislature's fiscal experts projected in October that the state would have a ending balance of $265 million when the fiscal year ends June 30, 'so we would have more than enough to cover whatever the fiscal impact would be for the fiscal year that we're in.”

Gronstal said it appears likely that the federal government eventually will approve a managed-care approach in Iowa, but for the time being has determined the state is not ready to begin Jan. 1. He said Iowa was attempting to implement managed care at a faster pace than other states have done, which 'doesn't really make sense,” and has created some confusion.

'The administration has had significant difficulties rolling this out - wrong phone numbers, wrong offices listed - it's been a bit of a mess,” Gronstal said Friday, 'so it's time to take a breath on that whole front and make sure that we give patients and families who depend on this time to sign up and make the right kind of decision as to which of the plans they're going to go with.”

House Speaker-select Linda Upmeyer, R-Clear Lake, said it has been unfortunate the state has experienced some 'holdups” in the implementation process, saying the Branstad administration has listened to stakeholders and participants in making changes amid efforts by naysayers 'trying to sabotage the program.”

'Iowans deserve to have a good program. I think we will,” she said.