Health

Looming change in Iowa Medicaid program stirs worry

Town hall meant to soothe concerns held in Cedar Rapids

Iowa Medicaid Director Michael Randol addresses health care providers during a town hall Friday at Kirkwood Community College in Cedar Rapids. State officials are hosting a series of town halls across Iowa for health care providers and Medicaid members to discuss UnitedHealthcare’s plan to exit the state program. (Liz Martin/The Gazette)
Iowa Medicaid Director Michael Randol addresses health care providers during a town hall Friday at Kirkwood Community College in Cedar Rapids. State officials are hosting a series of town halls across Iowa for health care providers and Medicaid members to discuss UnitedHealthcare’s plan to exit the state program. (Liz Martin/The Gazette)
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CEDAR RAPIDS — Despite the state Medicaid director’s efforts to soothe concerns over the privately managed program, members and providers involved with Iowa Medicaid say they are dreading an upcoming transition.

Iowa Medicaid Director Michael Randol spoke Friday in Cedar Rapids in the latest of a series of town halls across the state intended to assure Iowans there will be no major disruptions when one managed care organization exits the state program and another joins.

“The goal of these meetings is really to go out and meet with members, meet with providers face-to-face to be transparent in this process and be very candid with them,” Randol told The Gazette.

Randol emphasized in the meeting that benefits for members will not change, and that state officials are working to ensure a smooth transition for providers and members alike as UnitedHealthcare prepares to leave the program.

UnitedHealthcare, which manages care for more than 420,000 members who rely on Medicaid for health coverage, announced in March it planned to exit the managed care program.

Company executives cited the loss of millions of dollars since joining the managed care program — a reasoning state officials criticized.

According to the Governor’s Office and Department of Human Services, UnitedHealthcare was facing financial penalties for not meeting certain requirements.

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UnitedHealthcare plans to leave June 30, a day before Iowa Total Care is set to join the program. Amerigroup Iowa, the other company helping manage the program, will continue to provide coverage.

Randol said during the meetings he is “confident” Iowa Total Care will be prepared to join the program by then.

Members are in an open-choice period until Sept. 30. In addition, he said, prior authorizations from the former company will be honored for 90 days.

Randol said officials also are working to ensure continuity for members’ case managers. A roster has been set up for members to check so they know which managed care organization their current case manager will work for.

Some providers were unsatisfied by the meetings, including Tracy Gray, director of operations for Always Best Care, a senior service provider that has 130 patients, most on Medicaid.

Gray said officials provided information on what to expect from the upcoming transition, “but they don’t seem to have a whole lot of answers to the questions that we’ve asked.”

“I think a lot of people still want to know why. Why is this such a mess?” Gray asked. “There’s not any continuity, and that’s the problem. You’re talking about a client base that really needs continuity, more than anything, and you’re taking that away from them every time you mess with this.”

This is the second time a Medicaid managed care insurer has exited the state’s program. AmeriHealth Caritas left in 2017, and most of its former clients were taken up by UnitedHealthcare.

Now, many of UnitedHealthcare’s members will have to make the switch once again.

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For Tyler Smothers, 34-year-old Cedar Rapids resident, this will be his third switch — first from AmeriHealth to UnitedHealthcare, and now onto another managed care organization.

Tyler Smothers is on the intellectual disability waiver under Medicaid, said his mother, Cindy Smothers, but he is primarily on her employer-based insurance.

Cindy Smothers said she is fearful the switch could result in a number of services her son receives under Medicaid — such day habilitation, respite and transportation — being cut. She said these services are necessary for her to continue working full-time, and provide her son with quality health care under private insurance.

“My biggest concern is knowing what happened with UnitedHealthcare and knowing what happened with AmeriHealth, how long before Amerigroup says, ‘I can’t take any more people who have significant needs?’” Smothers said.

When asked about raising reimbursement rates to ensure services aren’t cut, Randol pointed to lawmakers, saying the program needs more state funding in order to raise the managed care organizations’ rates.

An additional $150 million allocated to Iowa Medicaid this year brings the program to financial soundness, Randol said.

As Always Best Care has gone through the disruptions, Gray said its patients have had their services frequently cut. The provider also has had difficulty getting claims paid on time.

“AmeriHealth has been out of the game for almost a year and a half, and they still owe us $30,000,” she said.

But they have signed a contract with Iowa Total Care, she said.

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The clients “still need taking care of,” Gray said. “At the end of the day, I don’t do this for the money.”

More town halls are scheduled for Sioux City and Council Bluffs on Monday and Tuesday respectively. A town hall will be held Thursday in Davenport at the Davenport Public Library. The provider meeting will be at 4 p.m. then the member meeting at 5:15 p.m.

l Comments: (319) 368-8536; michaela.ramm@thegazette.com

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