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Neighbors Growing Together | Aug 17, 2018

Feds, state officials say ‘temporary’ decision needs no federal OK

Amerigroup ‘actively ramping up’ to take on new enrollees eventually
By Michaela Ramm, The Gazette | Nov 27, 2017

State and federal officials said Friday Iowa does not need approval to move some 213,000 Iowans on Medicaid to a managed-care organization without offering them a choice.

The officials said they are working together on the issue but did not offer a timeline as to when it would be resolved.

Department of Human Services officials had announced in late October that one of its three insurers in Iowa’s Medicaid program, AmeriHealth Caritas, would exit the program on Dec. 1.

The state’s two remaining Medicaid insurers — Amerigroup Iowa and UnitedHealthcare of the River Valley — both re-signed contracts with Iowa for 2018.

Those enrollees previously covered by AmeriHealth would be transferred to UnitedHealthcare, department officials announced earlier this month. Those beneficiaries then could switch Amerigroup.

However, Tuesday’s notice obtained by The Gazette stated Amerigroup “does not have the capacity to take additional members, including those who have actively chosen Amerigroup Iowa as their (managed-care organization) after AmeriHealth Caritas’ withdrawal.”

That would leave 213,000 Medicaid enrollees with UnitedHealth care as their only choice for a managed-care organization.

This could create complications for some beneficiaries and health care providers, as some doctors and providers have signed with only one or two of the managed-care organizations.

“An ‘approval’ from CMS to suspend choice is not necessary. Iowa has not requested any additional waiver authority as part of this transition, but is in constant communication with CMS,” Department of Human Services spokesman Matt Highland wrote in an email Friday. “Iowa Medicaid is proceeding forward in temporarily suspending choice for Medicaid beneficiaries.

Highland added that Amerigroup is “actively ramping up their capacity, which the department will be monitoring.”

“Once Amerigroup Iowa and the Department are confident they have capacity to take additional members, members will again have choice,” Highland wrote.

Neither Highland or federal officials gave further information on a timeline for the solution.

DHS officials currently are undergoing a search for a new managed-care organization, which won’t be available for beneficiaries until July 1, 2019.



Medicaid enrollees are guaranteed a choice among managed-care organizations according to a provision within federal law, and a state must obtain a waiver from the federal Centers for Medicare and Medicaid Services for any suspension of that provision.

Tuesday’s notice from DHS stated it had approval for a temporary suspension of managed-care organization choice from CMS, which oversees nationwide Medicaid programs.

However, a later email to The Gazette by CMS regional spokeswoman Julie Brookhart, based in Kansas, said the state had not received federal approval.

On Friday, Highland clarified the inconsistency, saying that “using the term ‘approval’ was inaccurate.”

“States generally have the ability to manage their programs in situations such as this within existing statutory and regulatory authorities,” Highland said in Friday’s email. “CMS has offered our full support to Iowa to help provide as smooth an experience as possible for all impacted beneficiaries.”

State or federal officials did not offer clarification on how long the temporary wave of choice would last for beneficiaries.

Iowa has kept the federal office apprised on the state of the Medicaid program since AmeriHealth’s withdrawal, “as well as the challenges associated with the capacity at Amerigroup,” said Johnathan Monroe, a Washington, D.C.-based spokesperson for CMS, in a separate email to The Gazette Friday.

“CMS has been working with the state to address their immediate needs and we have no pending decisions before us for consideration related to this transition,” Monroe said in the email. “CMS intends to continue working with the state to help ensure it comes back into full compliance with the choice provisions in the managed-care regulations in a meaningful and measured way so as not to create further disruption to the beneficiaries and providers.”

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