DES MOINES — Iowa’s Medicaid director Wednesday said state officials are working to calm concerns the program’s 700,000 members or their providers might have as they transition through the departure of yet another managed-care organization and a new insurer’s arrival July 1.
Iowa Total Care — a subsidiary of St. Louis-based Centene — will join the managed-care program and UnitedHealthcare will leave, while Amerigroup Iowa continues to provide coverage.
UnitedHealthcare manages coverage for more than 425,000 poor and disabled Iowans on Medicaid.
“I’m sure there’s apprehension and I understand that,” Iowa Medicaid Enterprises Director Michael Randol of the state Department of Human Services told reporters at the start of a series of town halls and provider-training sessions to take place throughout the state this month.
“It’s not an easy thing to do,” said Randol in discussing the changes now confronting Iowans affected by the departure of a managed-care organization for the second time since Iowa privatized its Medicaid system in April 2016.
“My whole goal in this process is to calm their concerns, making sure they understand they’re not losing benefits. Myself and my team, we’re doing everything in our power to make sure this transition is as smooth as possible and we’re holding both of those MCOs accountable.”
Letters will be going out by Friday to UnitedHealthcare members informing them of the changes and choices they face as the existing managed-care organizations continues to honor obligations and responsibilities through June 30.
The letter also will explain the new option for members of signing up with Iowa Total Care or switching to Amerigroup in the coming months.
Iowa Medicaid Enterprises on Wednesday in Des Moines began its series of town halls that run through May 16 for health care providers and Medicaid members to discuss UnitedHealthcare’s plan to exit the state program in less than two months.
The Edina, Minn.-based insurer UnitedHealthcare cited chronic underfunding when it announced in March that it planned to exit the Medicaid program.
State officials, however, have stated that UnitedHealthcare did not want to be held to certain standards and that the managed-care organization had requested financial penalties for not meeting performance criteria be waived.
Until Sept. 30, all IA Health Link members are in an open-choice period, which means they can switch managed-care organizations for any reason. Members have until June 18 for coverage effective July 1.
All prior authorizations will be honored for 90 days, Randol said Wednesday. If UnitedHealthcare did not require a prior authorization for a specific service, the other MCOs will not require them for 90 days.
In addition, when a member receiving home- and community-based services changes a managed-care organization, his or her service plan will be honored until a new assessment is completed and a new plan is developed with the member and their team.
Also, Department of Human Services officials are working to maintain member’s relationships with their case managers. The Iowa Medicaid member services call center will have a list of the managed-care organization’s care managers in the coming weeks, to “maintain member’s relationships with their case managers,” according to a news release Monday.
“The top thing that I want to stress in this transition is that no one is losing benefits. Regardless of which MCO you are assigned to, the Medicaid benefits are the same,” Randol said. “The only variance within the service is maybe the value-added services that each MCO may decide, but the benefits are the same and no one is losing their benefits.
“We have been working very closely and diligently with all three MCOs to ensure a smooth transition for our members. Our main focus is continuity of care.”
Randol expressed confidence the two managed-care organizations that will have contracts with Iowa on July 1 will stay and terms of their new agreements will be finalized soon.
He also expected the state would look for a third managed-care organization to maintain choice and competition at some stage in the future. But he had no timetable other than the expansion would occur after the current service delivery and provider reimbursement system is stabilized.
“I’m very confident that Iowa Total Care will be ready on July 1,” the Medicaid director said. “I’m confident that they will be ready and we will be monitoring very closely both from a member perspective and a provider perspective the integration of Iowa Total Care.”
More information on provider training from Iowa Medicaid can be found on the Department of Human Services website, at https://dhs.iowa.gov/calendar.