Legislators worried over Medicaid transition

With AmeriHealth Caritas Iowa?s departure ? one of the three private insurers managing the state?s Medicaid program ? only three weeks away, legislators expressed concerns regarding the transition during an oversight meeting Wednesday.

Iowa?s Department of Human Services announced at the end of October that it could not reach an agreement with AmeriHealth ? the Medicaid insurer that not only has the highest number of members, but the highest concentration of special-needs members. It will raise the remaining two managed-care organization?s capitation rates ? the per-member, per-month fees ? by 3.3 percent.

The state said Tuesday that is would move all 214,000 AmeriHealth members to UnitedHealthcare of the River Valley plans. Consumers who would rather switch to Amerigroup Iowa can do so by Nov. 16 and be eligible for coverage Dec. 1, the state said.

Medicaid members have until March 1 to finalize their choices.

?What happened? Why are you leaving?? asked State Sen. Liz Mathis, D-Robins, during a five-hour Health Policy Oversight Committee meeting, which included members from both the Senate and House.

?It comes down to very simple statement,? AmeriHealth?s Cheryl Harding said. ?Not to minimize this because it was not an easy decision. But after months of much negotiation, we really couldn?t get to an agreement on future rates and terms ? it is not about our commitment to the members we serve, it?s not about the running of the program.

?We couldn?t get to an agreement to rates and terms.?

While the company?s exit means hundreds of its employees soon will be out of work, Harding said AmeriHealth workers will remain in Iowa for the next year to pay outstanding provider claims, resolve member appeals and work with DHS.

Meanwhile, UnitedHealthcare and Amerigroup Iowa are working to hire additional staff, especially case managers; to contract with providers that may only be part of AmeriHealth?s network; and to evaluate staffing needs.

?We?ve had over 300 applications come through the door and interviewed 50 people yesterday,? UnitedHealthcare?s Kim Foltz said. ?We are certainly working with a sense of acceleration and a sense of urgency.?

The state and insurers promised a smooth transition, but providers told legislators on Wednesday that plenty of questions and concerns remain.

?So with the Dec. 1 deadline rolling around ... there are some significant issues involved with that,? said Craig Syata, policy director for the Iowa Association of Community Providers. ?We are not here to complain about managed care or anything, but we are here to work productively.?

The group represents 150 health care providers around the state that work with Iowans who have disabilities, mental health issues or brain injuries. About 80 percent of the clients the organizations serve are on AmeriHealth, he added. Syata proposed extending authorizations for client services, waiving reimbursement penalties for out-of-network providers and extending a grace period to providers working to get credentialed ? the collecting and verification of provider qualifications.

More recently, Democratic legislators have floated the idea of carving out the long-term services and supports population ? the most complex and costly Medicaid group ? and moving it back into a traditional fee-for-service program outside of managed care. And several attempted to get the insurers to admit that putting this group into managed care was a mistake.

AmeriHealth has more than 23,300 beneficiaries receiving long-term services and supports, compared with Amerigroup?s 7,700 and UnitedHealthcare?s 6,500.

Long-term enrollees include elderly Medicaid beneficiaries as well as those with disabilities receiving waiver services.

Amerigroup and UnitedHealthcare responded by saying that other states are beginning to move those populations into managed-care plans, and the insurers appropriately manage these populations elsewhere.

?The specifics of should we or shouldn?t we have to lie with the state,? AmeriHealth?s Harding said. ?It can be very successful with all the right situations.?