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Neighbors Growing Together | Aug 15, 2018

CMS says it hasn’t OK’d suspension of MCO choice

State planned to move 213,000 enrollees from AmeriHealth to UnitedHealthcare
By Michaela Ramm, The Gazette | Nov 24, 2017

CEDAR RAPIDS — Only a little more than a week before Iowa Medicaid enrollees are to be shifted from departing AmeriHealth Caritas to UnitedHealthcare of the River Valley, the federal Centers for Medicare and Medicaid Services said it has not approved the temporary suspension of a provision that requires a choice between managed-care organizations.

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

This would leave about 213,000 Medicaid enrollees without a choice on their managed-care provider. The Affordable Care Act requires certain criteria to be met for health plans to be offered on a state’s program, including a guaranteed sufficient choice for providers, according the National Conference of State Legislatures.

According to the DHS notice sent to lawmakers Tuesday, CMS “approved a temporary suspension of (managed-care organization) choice, providing stability to the program.”

However, in a news release sent late Wednesday, DHS said the department “has been in communication with the Centers for Medicare and Medicaid Services (CMS) to keep them informed of what is happening, and will continue to do so.”

Julie Brookhart, public affairs specialist with CMS, said in an email Wednesday to The Gazette that the federal office has not approved a temporary suspension of choice.

In a follow-up email, Brookhart did not elaborate, instead saying “the communication between Iowa and CMS is not releasable.”

Brookhart did note that, regarding AmeriHealth’s exit from the Iowa Medicaid program, “at this time, CMS is in a pre-decisional phase regarding this issue.”

Requests for further clarification from CMS were not immediately answered.

AmeriHealth — one of three companies chosen to run Iowa’s Medicaid program — announced in late October it was withdrawing from the state’s Medicaid program at the end of this month.

Both UnitedHealthcare and Amerigroup re-signed contracts with the state for next year.

The approximately 213,000 Medicaid enrollees on AmeriHealth would be transferred to UnitedHealthcare and eligible for coverage Dec. 1, DHS officials announced earlier this month. Those who wished to move to Amerigroup instead could do so by March 1.

DHS is currently searching for a new Medicaid insurer, which won’t be available for Iowan until July 1, 2019.

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