Iowa Medicaid and Managed Care Trying to Get Together

I saw the December 14, 2015 Iowa Press Citizen story Iowans warned Medicaid patients may lose doctors by Jason Clayworth. A doctor who was interviewed said that “…the state has done a poor job of providing Medicaid recipients with information about the transition.”

Well, I just got the news from the Iowa Medical Society (IMS) that the Centers for Medicare and Medicaid Services (CMS)  declined to approve the application of Iowa Medicaid move to managed care for January 1, 2016 mainly for that reason, although they might approve it in March. According to the IMS announcement today:

CMS today indicated that it did not believe Iowa is ready to transition its Medicaid program to managed care on January 1, 2016. Citing significant concerns, identified during the recent CMS site visit, over provider network adequacy and patient access to care, federal officials indicated that CMS expects they will ultimately approve Iowa’s managed care waivers, but not until March 1, 2016.

In the letter, CMS identified that the MCO’s provider networks are “not fully developed and lack key providers.” Iowa has not made sure that each MCO has contracted with enough providers to give adequate access to care. According to CMS, “Adequate provider networks are a fundamental component of accessible, quality care for beneficiaries.”

Well, I guess that’s been our concern all along. Specifically, CMS found that, as of December 11:

  • Only one MCO provider network contained more than 42% of non-critical access hospital.
  • Only one MCO provider network contained more than 18% of critical access hospitals and no network contained more than 34% of critical access hospitals.
  • No MCOs reported contracting with more than 36% of elderly waiver agency providers and intellectual disability waiver agency providers for home and community based Long Term Services and Supports (LTSS) services.
  • MCOs had only contracted 13-33% of intermediate care facilities serving individuals with intellectual disabilities, with three of the four plans below 20%.
  • The MCOs had small behavioral health networks. The MCOs only had 27-51% of habilitation service providers under contract and 15-36% of community mental health centers and mental health agencies.

I put the last bullet point in bold-face type because it reminds me of the concerns raised by Dr. E. Fuller Torrey, MD about the managed care effect on mental health care, leading to my comments to the first University of Iowa Hospitals and Clinics informational Forum last week. It came as no surprise that the Forum for today was cancelled in light of the CMS review.

CMS also mentioned issues that patients, providers, and advocates have with this rush to managed care. They’ve received thousands of email messages citing concerns about the poor communication about this transition. Patients have expressed “…frustration, confusion, and fear about the transition to managed care and the lack of information available to them to make decisions required as part of the initial enrollment process.”

CMS also cited the problems getting help through Iowa’s call centers, mentioning the state call center’s 49% abandonment rate and the 10,000 calls dropped in the first nine days of December. Even if patients were able to connect, they couldn’t get enough information about whether or not their providers were even in the MCOs’ networks. CMS expressed concern that Iowa doesn’t yet have a fully functioning LTSS Ombudsman, essential to supporting access to seniors and those with disabilities during the transition.

And they think “…significant confusion could have been avoided if the state had waited until it fully met all of CMS” recommendations before mailing enrollment packets to patients–which CMS had warned about in early November.

There’s an attachment to the CMS letter detailing 16 action plans. I’m not going to repeat them here but the word “communicate” turns up many times in them–which I hope the Iowa Medicaid Enterprise (IME) and the MCOs take to heart. I’m not in favor of this move to managed care, but I’m afraid it’s going to happen. The powers that be will definitely have to get together, though.




    “The delay could bring a complication for agencies providing mental health care. The state for years has contracted with the Magellan company to oversee many mental health services for Medicaid participants. That contract runs out this month, because the new managed-care companies are supposed to coordinate mental health services along with other care.

    Shelly Chandler, executive director of the Iowa Association of Community Providers, said her members are unsure how they will be paid in the meantime for providing mental health care. She expects the state to somehow continue current payments for care of patients already in the system. However, her members’ bigger concern is who will decide whether Medicaid will cover mental health care for new patients starting Jan. 1.

    “If (managed-care organizations) will not be taking over, who will bring the clinical expertise to work with Iowans with serious mental illness in need of critical care during this period?” Chandler said.

    Branstad spokesman Ben Hammes said state Medicaid officials will fill the gap.

    The state leader for one of the managed-care firms said the delay would not hamstring her company’s preparations. “We remain committed to serving Iowa’s most vulnerable citizens. We will continue to hire and train associates to support the state’s efforts to go live on March 1, 2016,” Lauralie Rubel, state president for WellCare, said in an email to the Register.”—Iowa Press Citizen story by Tony Leys on 12/17/2015

    It’s ironic that a representative from the embattled WellCare MCO would try to reassure Iowans of the company’s readiness to serving them, given that, in a 2013 trial, 3 WellCare top executives were convicted and sentenced to prison. WellCare has also paid over $400 million in restitution and fines. Despite WellCare’s past criminal behavior, it has continued in business, with Medicaid contracts in 9 states, including Florida.

    Hammering Iowans with the empty assurance that 39 states already have managed care companies handling state Medicaid programs doesn’t remove the risks of privatization. As Dr. E. Fuller Torrey, MD and colleagues advise, close oversight of the MCOs (or keeping them out, which is near impossible) is advisable in order to protect patients,


%d bloggers like this: