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Health

Senators talk with managed-care organizations about Iowa Medicaid transition

State hopes to resolve problems with compassion, and quickly

Enrollment information for managed-care organizations in Iowa's Medicaid privatization plan, photographed in Cedar Rapids on Friday, Dec. 18, 2015. (Liz Martin/The Gazette)
Enrollment information for managed-care organizations in Iowa's Medicaid privatization plan, photographed in Cedar Rapids on Friday, Dec. 18, 2015. (Liz Martin/The Gazette)

DES MOINES — A Medicaid recipient in central Iowa with a rare form of cancer receiving treatments at the Mayo Clinic was given conflicting answers on how the treatments would continue.

Another, who is schizophrenic, saw delays in getting a necessary injectable medication.

A disabled Iowan in the northwest part of the state had trouble scheduling non-medical transportation to a job at a McDonalds.

“You keep referring to a warm transfer” from fee-for-service to managed care, said Sen. Janet Petersen, D-Des Moines. “I believe many Iowans would disagree with this.”

Peterson and other state legislators fired questions and complaints from constituents at Department of Human Services representatives and at the heads of the three managed-care organizations (MCOs) that have contracted with the state to administer its $5 billion Medicaid program, during a Senate Human Resources committee hearing on Wednesday afternoon.

Also Read: Managed Care Year One: For Edbergs, finding a primary care doctor was harder than expected

During the hourlong meeting, legislators talked with the state and MCOs about the first 13 days of the transition and the switch to managed care.The state handed over its Medicaid program with more than 580,000 beneficiaries to three out-of-state private companies on April 1.

“We’ve had no major system issues,” Iowa Medicaid Director Mikki Stier said. “However, with something this large and of this magnitude,” there will be challenges. “We’re making sure to resolve problems with compassion and as quickly as possible.”

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Stier said the state has about 100 employees staffing the Iowa Medicaid call centers. So far, it has received 18,000 member calls and 7,800 provider calls.

Confused by how the new Medicaid system works?

We're here to help. Click the image above to check out an interactive explanation of Iowa's new Medicaid managed care system.

“It’s key that we make sure we triage those member calls — if we need to transfer to the MCO, we do. If it’s a critical incident or a complex patient, we pull in other divisions to handle the member,” Stier said.

The MCOs also have worked quickly to resolve problems, MCO leaders said. AmeriHealth, for example, worked directly with the provider and Medicaid beneficiary who was having issues getting an injectable medication, and then retrained staff to ensure proper information will be given out in the future.

But senators still voiced their dissatisfaction at the end of the meeting.

Sen. Dave Johnson, R-Ocheyedan, asked why a hospital in northwest Iowa still hadn’t contracted with two of the three MCOs, while Sen. Liz Mathis, D-Cedar Rapids, said Gov. Terry Branstad is contributing to some of the confusion with the physician numbers he’s reported.

Mathis pointed to a statement from Branstad’s office on Friday that said there were 7,512 physicians in the fee-for-service Medicaid network, while MCOs have contracted with 16,821 physicians.

The Iowa Board of Medicine’s most recent annual report said there were 6,828 physicians with Iowa work addresses, Mathis said, adding she understands a doctor may be counted multiple times if he or she bills from more than one place.

“But can someone from (Iowa Medicaid) please tell the governor’s office that we don’t have 16,000 doctors?” Mathis asked.

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Earlier Wednesday, the Council on Human Services — a policymaking and advisory board for the Department of Human Services — met with AmeriHealth Caritas Iowa market President Cheryl Harding to discuss the transition roll out and the MCO’s provider network.

“This is the biggest priority for the organization — that the go-live goes smoothly,” she said. “We’re watching every day, every hour. However, with every go-live there are some bumps.”

AmeriHealth provides managed care to Medicaid or Medicare populations to 6.9 million people in 16 states, Harding said. The MCO has about 205,000 Medicaid enrollees in Iowa, she added, including 58 percent of the long-term services and support population (waiver services), 21 percent of the Hawk-i population and 34 percent of the remaining Medicaid population.

In addition, it has contracted with nearly 100 percent of long-term-services and support providers in the state, every Iowa-based hospital system and key border hospitals outside the state, including University of Nebraska Medical Center. Harding said the group has also worked to secure contracts with two Dubuque-based primary care provider groups, Medical Associates and Internal Medicine.

“That was an area of state frankly all three MCOs weren’t having great success in,” she said.

Harding also told the council about the MCO’s plans to open wellness centers in Cedar Rapids, Des Moines and Sioux City. Locations and opening dates have not been finalized, according to an AmeriHealth spokesman.

Harding stressed that these centers will not deliver medical services as will the clinic Amerigroup Iowa plans to open in Des Moines. Rather, it will be a facility where AmeriHealth enrollees can go to receive wellness tips and education.

The wellness centers will not have exercise equipment, but Harding said similar AmeriHealth facilities in Washington, D.C., and South Carolina offer exercise classes such as Zumba and yoga.

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The Council on Human Services also will be meeting with market presidents from both UnitedHealthcare and Amerigroup at upcoming meetings.

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We value your trust and work hard to provide fair, accurate coverage. If you have found an error or omission in our reporting, tell us here.

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