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Mt. Pleasant News   Wash Journal
Neighbors Growing Together | Dec 17, 2017

Reynolds aims for ‘continuity of service’

By Michaela Ramm, The Gazette | Nov 29, 2017

Since AmeriHealth Caritas Iowa announced in late October it would exit the state’s Medicaid managed-care program, Molli Struebing of Dubuque has been working to find coverage for her son.

Kai Lowell, 30, who lives with Struebing, has received coverage through AmeriHealth since the state’s Medicaid program was privatized in April 2016.

Struebing said her son has Ehlers-Danlos syndrome, a connective tissue disorder, as well as cerebral palsy and Asperger’s syndrome. He also takes medication to control his seizures and gastrointestinal issues.

“I’m feeling panicked,” Struebing said. “He’s been doing so well for a few years that we’d hate for him to backslide.”

In the past week, 10,121 Iowans were told they would not have their coverage overseen by the two remaining managed-care organizations but will be handled by the state’s fee-for-service program.

On Tuesday, Gov. Kim Reynolds the Department of Human Services has put together a transition plan for the state’s managed-care program.

“Our goal is to make it as seamless as possible, to make sure that we continue to offer continuity of service again to Iowans who really need a coordinated care and need that extra help, and to really do everything we can to eliminate as much disruption as possible,” Reynolds said.

AmeriHealth — one of the state’s three managed-care providers — announced it would withdrawal from the Medicaid program on Dec. 1. UnitedHealthcare of the River Valley and Amerigroup have re-signed contracts for 2018.

DHS officials stated in early November that all former AmeriHealth members would be transferred to UnitedHealthcare. But members could switch to Amerigroup before Nov. 16.

Struebing said none of Lowell’s Dubuque-based doctors — including his primary care physician, a gastroenterologist, a neurologist and an eye specialist — were on UnitedHealthcare, so they made the switch to Amerigroup.

But last week, a DHS notice was sent to state lawmakers stating that Amerigroup did not “have capacity to take any new members,” according to the notice obtained by The Gazette.

DHS posted on its website Monday that the 10,121 members such as Kai Lowell who chose Amerigroup now would be covered by the Iowa Medicaid Fee-for-Service, a program in which services are paid separately. These members will receive coverage through Iowa Medicaid Fee-for-Service “until Amerigroup has capacity” to handle more people, DHS spokesman Matt Highland said.

A small percentage of Medicaid members remained on the fee-for-service program after the state privatized its program back in April 2016.

According to a notice sent to lawmakers Tuesday and obtained by The Gazette, roughly 40,000 members remain in the fee-for-service program on a monthly basis. This includes those on the Program of All-Inclusive Care for the Elderly, native Alaskans, native Americans and those who use Medicaid on a secondary basis.

Despite the confusion that Struebing said surrounds these announcements, she is hopeful for the fee-for-service program. Lowell has been a Medicaid member for six years and was in the state’s fee-for-service program before the 2016 changeover.

While her son was on that program, Struebing said Lowell snapped his ankle and needed major corrective surgery from an orthopedic surgeon.

The program “was wonderful, it really was. We had no issues whatsoever,” Struebing recalled. “We were able to have his ankle done here in Dubuque because it was fee-for-service.

“All the doctors were taking it, all the specialties were.”

When he broke a wrist while under AmeriHealth, Lowell had to go to the University of Iowa Hospitals and Clinics for the procedure as no orthopedist in Dubuque accepted Medicaid.

But now, Struebing said she’s still uncertain if her son could see his doctors under this new fee-for-service program.

“We’ll have to see if those doctors are going to take it,” she said.

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