5 years of managed care in Iowa: State says Medicaid has stablized however sufferers disagree

Kelly Garcia became director of the Iowa Department of Human Services on November 1, 2019. (Liz Martin / The Gazette)

Years after privatization, Iowa still has a deep divide when it comes to the state’s Medicaid program.

This year marks the fifth year that Iowa has revamped its Medicaid program, moving it from a state system to a managed care model, where the reins have been turned over to private, non-state insurance companies. Today, the $ 5 billion program administers more than 700,000 poor and disabled Iowan’s health services annually.

The program has stabilized in the tumultuous rollout and upheaval in the years since then, allowing them to focus on improving the health outcomes of Iowans on Medicaid, according to government leadership.

“We’re not having the same type of conversation we were having four or five years ago,” Elizabeth Matney, director of Iowa Medicaid, said in a Gazette interview. Matney, recently named to the role, will begin on June 1st.

And, according to Kelly Garcia, director of the Iowa Department of Human Services, the managed care program accomplishes what officials intended when they switched to managed care – improve Iowan’s health and save state money.

“We are stable,” said Garcia.

Nevertheless, the criticism of the program has not stopped. Complaints from providers about low reimbursements are reminiscent of the same complaints made four and five years ago. Proponents say Medicaid members, especially those in need of long-term support, struggle to get the care they need.

“Iowans have become more vulnerable to privatization,” said Jenn Wolff, a disability attorney behind the #UpgradeMedicaid initiative.

Garcia said the department is still hearing those concerns, but stressed that the program is in a better place than it was a year ago.

“That happens, but it’s not what happened even when I arrived in the state eight months ago,” she said. “And we’ve seen a signal from DHS that we’re focusing on holding our managed care organizations accountable.”

Garcia came to Iowa in November 2019 after serving in various roles with the Health and Human Services Commission in Texas.

Some opponents of the state’s managed care program continue to question the claim that switching from a government-run Medicaid system to a privatized model will save the state money, which was first stated by the then government. Terry Branstad. During Senate comments prior to the five-year milestone, Senator Janet Petersen, D-Des Moines said the program cost taxpayers millions while the insurance companies running the program made big profits in fiscal 2020 and 2021.

According to the latest report, capital payments to managed care organizations were $ 1.36 billion in the second quarter of the state’s fiscal year 2021.

“We were promised savings and Iowans were promised better access to services and better health. That’s not true, ”Petersen told The Gazette.

Governments disagree with claims that there is no data to show that the program is saving money.

“We’ve been distributing data for years, but we could ‘so what? ‘Explain better. Question, ”said Matney.

Elizabeth Matney

The state is saving money compared to the previous program, Garcia told The Gazette last week. Your department is making renewed efforts to improve its data collection systems – including one that is more than 40 years old – to improve accessibility and usability for employees and the public.

“The system is not lacking in data, it really is the ease and availability,” said Garcia, who also serves as the director of the Iowa Department of Public Health.

“I think our vendors, our customers, lawmakers, and our full range of stakeholders don’t see us using this information the way they want, and I think internally we don’t have what we want,” she said. “So let’s build this.”

However, state officials have not indicated how much money the state is saving compared to the previous state program.

Then-Medicaid director Michael Randol, who left the position in August, said moving to managed care saved the state $ 140.9 million for fiscal 2018 – contradicting previous estimates that the savings brought to a low value.

Challenges plagued the program since day one

The switch to managed care didn’t come about without what a state official at the time called bumps on the road. Even before the change, the Federal Centers for Disease Control and Prevention intervened to delay the transition because of concerns about the state’s readiness.

The federal health authorities gave their approval in early 2016, and the program changed management on April 1 of this year.

The program continued to be plagued by challenges. Managed care organizations left the program due to chronic underfunding, beginning with AmeriHealth Caritas’ exit in late 2017 and followed by UnitedHealthcare of the River Valley in 2019.

Two managed care organizations, Amerigroup and Iowa Total Care, currently administer the program. State officials say a third insurer could join the program as they near contract negotiations for Amerigroup, whose current contract is set to expire in mid-2023.

But the sudden withdrawals of these former insurers created upheaval in Medicaid member services, patients and lawyers say.

Early on, Iowans claimed they had been denied essential health care and providers complained that they had not received full or partial reimbursement for their services. At one point, the Iowa Ombudsman’s office hired a full-time representative to respond to Iowans’ complaints about the managed care program, Ombudsman Kristie Hirschman said in 2017.

Managed Care in Iowa

April 1, 2016 – Iowa’s Medicaid program moves to managed care.

October 2017 – AmeriHealth Caritas, one of the managed care organizations, is leaving the program.

December 2017 – Michael Randol becomes director of Iowa Medicaid Enterprises.

May 2018 – Iowa Total Care is selected as the new managed care organization.

March 2019 – UnitedHealthcare of the River Valley resigns as a managed care organization.

August 2020 – Randol is leaving his position in Iowa.

April 2021 – Elizabeth Matney named Medicaid’s new director.

Now, five years later, some Iowans are saying they are unable to get the services they need from the managed care organizations.

Getting home care to meet his personal care needs has been a challenge for Garrett Frey, a quadriplegic who relies on a ventilator to breathe. As a result, he had to rely more on his mother to fill in the loopholes that he said weighed heavily on his family.

“I have a great support system, but I don’t know where I would be without them,” said Frey, who is also on the ADA advisory board for the city of Cedar Rapids. “But I don’t think my mother should feel compelled to be my primary caregiver or one of my family members.”

# Wolff at UpgradeMedicaid said Frey isn’t the only member who believes they are constantly committed to the services they need. Reducing services for disabled iowans and others who need 24-hour care won’t improve their health, she said, but it will increase costs for managed care organizations.

“People get sick, they have more physical symptoms and more psychological problems because of their stress levels,” said Wolff.

To continue handling these complaints, Garcia, of the Department of Human Services, said the department is adding staff to focus on issues that are occurring with both members and vendors.

“Every big system will have some challenges. It’s really important that we hear this and then determine if it’s a one-time problem or a systemic problem, “she said.

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