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Neighbors Growing Together | Sep 20, 2018

Iowa Medicaid enrollees won’t be able to switch to Amerigroup

More than 213,000 Iowans will be affected
By Matthew Patane and Michaela Ramm, The Gazette | Nov 22, 2017

Hundreds of thousands of enrollees in Iowa’s privately managed Medicaid program will not be able to choose between the two remaining providers after AmeriHealth Caritas of Iowa’s withdrawal from the program.

The Iowa Department of Human Services said Tuesday that Amerigroup Iowa — one of the two remaining companies that will manage the state’s Medicaid program for 2018 — does ”not currently have capacity to take any new members,” according to a notice sent to lawmakers and obtained by The Gazette.

“Amerigroup Iowa has informed the department they do not currently have capacity to take any new members, including those who have actively chosen Amerigroup Iowa as their (managed-care organization) after AmeriHealth Caritas’ withdrawal,” the agency’s notice reads.

Department officials announced in late October that AmeriHealth, one of the three companies chosen to run Iowa’s Medicaid program, would withdraw from the program by the end of November. The withdrawal affects more than 213,000 Iowans who are enrolled with AmeriHealth.

Department spokesman Matt Highland said the department is continuing to work with managed-care providers on the transition.

“We will notify members, providers and stakeholders as soon as we have finalized information,” Highland said in an email. He did not comment on when Amerigroup notified the department it couldn’t take the additional enrollees. As of late Tuesday, the department had not posted the notice on its website.

Both Amerigroup and UnitedHealthcare have re-signed contracts with Iowa to continue their management next year.

The department’s notice goes against what it had initially announced. After AmeriHealth said it would withdraw, patients were told they would be assigned to UnitedHealthcare.

but could make the change to Amerigroup.

Now, patients who might have opted to switch to Amerigroup after being assigned to UnitedHealthcare won’t able to do so, and must remain with UnitedHealthcare, the department said.

In addition, the department said in its notice, “all new IA Health Link members will be assigned to UnitedHealthcare. In the future, members again will have a choice in MCOs and will be notified when that choice is available.”

The federal Centers for Medicare and Medicaid Services has approved a suspension of a provision that requires a choice between managed-care organizations, the department said. CMS did not respond to a request for comment, and Highland did not comment as to when the department asked the federal agency for the temporary suspension.

The decision does not affect Iowa Medicaid members who were enrolled with Amerigroup before AmeriHealth announced its withdrawal, the department said.

Amerigroup said Tuesday its “top priority is to coordinate high quality health care for our members.”

“We are focused on ensuring appropriate and effective access to quality care to reasonably and responsibly support both current and potential future members. In addition, we continue to collaborate with state and federal officials to help identify solutions to strengthen Iowa’s Medicaid program,” Amerigroup said in a statement to The Gazette.

In its statement, UnitedHealthcare said it “welcomes the opportunity to serve more than 200,000 additional IA Health Link members.”

“We have the experience, resources and dedicated teams in place to transition our new members while maintaining the high level of service that our existing members have come to expect,” UnitedHealthcare said.

State Sen. Pam Jochum, D-Dubuque, said her daughter, who has disabilities, was under AmeriHealth. Jochum recently moved her daughter under Amerigroup and received confirmation from the department, she said.

“Now I’m reading this notice from the department that we all have to go with (UnitedHealthcare). Here’s the problem: How many of the doctors and providers in our state are signed with United?” Jochum said.

Jochum said “our hands our tied” in terms of whether state lawmakers could do anything to address issues with Iowa’s Medicaid program. Lawmakers could vote to rescind contracts with the providers, but Jochum said Gov. Kim Reynolds would likely veto the move.

“This really rests on the doorstep of Gov. Reynolds,” she said.

Brenna Smith, a spokeswoman for Reynolds, said the governor “is committed to improving quality and access to care, promoting accountability for patient outcomes and creating a more predictable and sustainable Medicaid budget.”

Rep. Liz Mathis, D-Hiawatha, said, “I don’t know what kind of hoops they had to jump through to get CMS to approve this or how long this temporary fix will be and if CMS will start to take a look at this and see that it is a system that is crumbling before our very eyes.

“... This is not a temporary fix, it’s just one more indication that this is a terrible idea gone awry,” Mathis said.

Department officials announced last week Michael Randol has been appointed to direct Iowa Medicaid Enterprise beginning Dec. 4. He previously had led Kansas’s privately managed Medicaid program for five years.

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