Which insurers will join Iowa Medicaid? DHS to Announce New Contracts – InsuranceNewsNet | Business Insurance

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Aug 28 – Iowa health care providers serving Medicaid patients hope that increased competition will improve health outcomes, patient choice, and quality of care for poor and disabled Iowans.

But after six sometimes tumultuous years of the privatized Iowa Medicaid program, which saw two for-profit insurers exit due to huge financial losses, providers and critics warn that adding new insurers could cause disruption and confusion for patients. .

“We hope that patients will benefit from proper management and proper care and prompt prior authorizations,” said Joe Lock, president and CEO of the Health Center of Eastern Iowa in Cedar Rapids.

The federally qualified health center serves patients regardless of ability to pay, including children and vulnerable adults, in Benton, Linn, Jones, Iowa and Johnson counties.

About 70 percent of the more than 50,000 patient visits the Eastern Iowa Health Center will see this year will rely on Medicaid for their insurance, Lock said.

“It’s still very difficult for people with severe and profound disabilities of all kinds, and it’s going to be confusing,” he said. “It’s going to be confusing for patients, and it’s also going to be difficult for our staff to help patients navigate things that should be pretty routine and simple. And oftentimes, they just aren’t.”

Lock, however, said he is hopeful that more competition “will make everyone work harder and, ideally, work harder for their patients, which is what everyone wants.”

Which insurers will join Iowa Medicaid? DHS to Announce New Contracts – InsuranceNewsNet | Business Insurance 2022 09 webinar web banner 1

Five insurers have bid to join the more than $6 billion Iowa Medicaid and Children’s Health Insurance Program, or CHIP, as state officials search for another managed care organization.

The Iowa Department of Human Services, which oversees the Medicaid program, is expected to win contracts with up to four bidders to provide care through the Iowa Health Link Medicaid program, meaning up to two additional managed care organizations could join the program. state in the future. near future.

However, the final number of contracts awarded under the acquisition will be at the discretion of DHS, based on its request for proposals.

The contracts are worth approximately $6.5 billion annually. Awards are expected to be announced on Wednesday, August 31, with implementation beginning July 1, 2023.

The new contracts will run for four years with a possible two-year extension.

The five insurance companies that have submitted bids to provide managed care services are:

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— Aetna, a Connecticut-based private insurance company doing business as Aetna Better Health of Iowa

— Current Iowa Medicaid Managed Care Organization Amerigroup Iowa

— CareSource Iowa — CareSource, based in Dayton, Ohio, is a nonprofit managed care organization

— Molina Healthcare of Iowa — The Long Beach, California-based Fortune 500 company provides managed care services to approximately 5.2 million members under the Medicaid and Medicare programs and through state insurance marketplaces.

— UCare Iowa, doing business as Ucare, is a Minneapolis-based nonprofit insurer that provides health coverage and services in Minnesota and western Wisconsin.

Medicaid is jointly funded by the states and the federal government to provide health insurance primarily to low-income people under age 65 and people with disabilities.

Medicaid health benefits in Iowa are currently administered by two managed care organizations: Amerigroup Iowa, an Indiana-based subsidiary of Anthem, and Iowa Total Care, a St. Louis-based subsidiary of Centene.

The Amerigroup contract will end in 2023 and the Iowa Total Care contract will end in 2025.

Through July, Amerigroup and Iowa Total Care served nearly 790,000 Medicaid and CHIP enrollees. Iowa’s Healthy and Well Kids population in Iowa (Hawki) is served by the same managed care organizations and is included in the total Medicaid population.

Approximately 93 percent of all Iowa Medicaid members are enrolled in a managed care plan, with the remaining 7 percent in fee-for-service.

A rocky transition

Iowa’s transition from a state-run system to a managed care model in 2016 that put private insurance companies in charge of administering Medicaid benefits has been difficult.

The federal Centers for Medicare and Medicaid Services postponed the state’s original plan to start managed care on January 1, 2016, saying too many problems remained to safely transfer care for 560,000 poor and disabled residents to three insurance companies. private for profit.

But once implemented in April, Iowa’s new Medicaid program, known as IA Health Link, was plagued by complaints that service was affected, payments were not being made to service providers, and promised savings were never delivered. they materialized.

Two carriers quickly entered and left the market in the early years, due to financial losses and what they described as chronic underfunding from the state.

However, CareSource officials told The Gazette in September of last year that they believe Iowa’s Medicaid Marketplace is now financially viable for at least four managed care plans, and they were excited to help Iowa “reimagine what what Medicaid can do for Iowans.

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“As a nonprofit organization, we focus on our members and the communities we serve rather than shareholders. This makes CareSource unique in Iowa’s current managed care environment,” said President and CEO of CareSource, Erhardt Preitauer, in a statement at the time.

“Our industry-leading social programs, complex care capabilities and core operations will result in better quality and health outcomes for the Iowa Medicaid population while providing a better experience for both members and providers.” who take care of them.”

Last year, State Auditor Rod Sand issued a report alleging that the state’s privatized Medicaid system had illegally denied services or care to beneficiaries of the program, and that the two private insurance companies that ran the system violated the terms of their contracts with the state.

Sand’s report was based on research that examined cases from 2013 to 2019, and said it found a massive increase in illegal denials of care by managed care organizations.

The director of Iowa’s Medicaid program called the audit “incorrect and flawed,” saying the report incorrectly compared the previous “fee-for-service” system to a managed care approach, the Associated Press reported.

Medicaid Director Elizabeth Matney questioned Sand’s methodology, saying the comparison did not take into account improvements built into the managed care organizations’ appeals process.

Since then, things have leveled off, said Lock and Aaron Todd, executive director of the Iowa Primary Care Association in Des Moines.

The association provides technical assistance and training to Iowa’s 13 community health centers and an immigrant health program.

Both said that, in general, payments are made on time and problems are resolved more quickly with managed care organizations that have been more responsive.

Getting there, however, has required beefed-up staffing to work with insurance companies and push them to provide adequate service and timely payments.

“The market is considerably more stable than it has been,” Todd said. “The state has stepped up and is funding the program at a level that is significantly more sustainable than when it was first implemented.”

‘Merry go round’ from different vendors

Adding two or three more MCOs would ensure patient choice and prevent the state from having to provide services directly, should another plan fail or leave the state. However, doing so will be detrimental to many low-income Iowa families, Todd said.

“It will really depend on how the state decides to make this transition,” he said. “Are you going to reassign patients who already have a current plan, or are you going to do it through some kind of attrition process, since there is a turnover of patients with Medicaid?”

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Todd noted that it will be problematic for Iowa Medicaid patients at a time when it is also gearing up for the end of a federal public health emergency that could affect coverage for tens of thousands of Iowa Medicaid and CHIP recipients.

The health emergency required Iowa Medicaid to take certain steps to protect Medicaid recipients during the COVID-19 pandemic. These included waiving monthly premiums, expanding access to certain services, and continuing coverage for those in the program even if their income changes.

Those protections are expected to expire this fall. Once the federal government ends the public health emergency, Iowa DHS returns to its normal eligibility process, which means that thousands of Iowans who are no longer eligible for Medicaid but are still in the program due to the public health emergency could lose benefits and be forced to find other insurance plans.

“We’re going through a big transition period for people, and this comes at the same time,” Todd said. “So it’s very important that the communication is really clear.”

Iowa House Democratic Leader Jennifer Konfrst, D-Windsor Heights, agreed.

“Adding more (managed care organizations) into the mix will certainly add confusion — patient confusion and provider confusion,” Konfrst said Thursday during a weekly Iowa Democratic Party conference call with reporters. “And there needs to be a much better communication system for those people who receive these services.”

Konfrst added that Iowans served by Medicaid don’t have the wherewithal to “wait for this system that we’ve been experimenting with for several years to sort itself out.”

“Iowans deserve a system that works for them,” he said. “And whether we have two, three or four, so far we don’t see it doing what we need it to do.”

Democratic state Sen. Herman Quirmbach of Ames joined Konfrst on the conference call.

“This merry-go-round of different insurance providers has done nothing but destabilize the doctor-patient relationship,” Quirmback said. “I’ve gotten so many calls, so many different cases, from my constituents from people whose continuity of care has been disrupted because of it.

“It’s just been a total failure.”

A DHS spokesperson did not respond to emailed questions in time for this report.

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