As United Healthcare readies to leave Iowa’s Medicaid market, patients worry Genesis doesn’t have contract with insurer’s replacement

May 17-- May 17--Medicaid patients and their families had plenty of questions and skepticism for Iowa Medicaid Director Michael Randol at a town hall held Thursday at the Davenport Public Library. The meeting was meant to explain what will happen to the state's Medicaid system once provider United Healthcare departs.

A separate forum was held for providers, such as doctors and hospital systems.

Iowa Total Care will replace United Healthcare, which will exit Iowa's Medicaid program no later than June 30. After warnings to improve services and cut costs, Gov. Kim Reynolds cut ties with United Healthcare in March, saying the company's terms for remaining in the system were unreasonable and unsustainable.

At the hour-long town halls, Randol tried to reassure patients that their benefits would not change, and inform providers how the transition would take place. "The MCOs do not determine benefits, the MCOs do not determine Medicaid policy," he said.

Amerigroup, another managed care organization that also provides Medicaid in Iowa, will not change, he said. "It doesn't matter what MCO you have members assigned to, the benefits are the same."

Effective July 1, every member will be assigned to either Iowa Total Care or Amerigroup. Members who enroll by June 18 will be effective July 1, while those who choose July 18 will have their choice be effective Aug. 1 and those who choose by Aug. 18 will have their choice effective by Sept. 1. That open choice period ends Sept. 30.

As part of the transition, the Department of Human Services plans to ensure there is continuity with case managers, Randol said. While case managers will be assigned to one MCO or the other, rosters will be maintained and they will help patients stay with case managers if they desire.

United Healthcare will continue to pay claims for services before July 1 and will also process claims and grievances after July 1, Randol said. Comparing it to when AmeriHealth Caritas dropped out of coverage in 2015, he noted United Healthcare will continue to have a commercial and Medicare presence in Iowa, whereas Caritas did not maintain a presence. "So they have a very good incentive to make sure that when they exit, they do so in a very appropriate manner."

Both providers and patients had questions for Randol and his team, including about the status of Genesis Health System. According to a woman who did not wish to be named at the provider town hall, Genesis will not contract with Iowa Total Care in the area.

"We will expect Iowa Total Care to have network adequacy in provider types in three different regions of the state, and we will make sure that they adhere to that," Randol responded, saying that they are continuing to negotiate with Genesis.

"Right now, we are looking at negotiating a contract with Total Care, seeing where that goes basically," Genesis Health System Government and Community Relations Officer Henry Marquard said in an interview Thursday night, adding that the hospital is "optimistic."

At the member town hall, members had concerns about holding MCOs accountable. Medicaid member Doug Sample was especially concerned about Iowa Total Care, noting a Des Moines Register article finding that Iowa Total Care parent corporation Centene had been sanctioned in a number of states for non-compliance with federal or state Medicaid contracts or rules. In addition, the article noted Iowa Total Care had been awarded a contract in May 2018 despite scoring nearly 14 points lower on an evaluation than when they had applied and been rejected in 2015.

"I can't validate any of that, so I won't comment on the story," Randol responded. "The only comment I will have is that they went through the procurement process. There was an evaluation committee that read the proposals, and they recommended Iowa Total Care, and they were selected to come into this market."

Randol said Iowa Total Care will be held accountable to all contract obligations, and the state will have the capability to implement damages if they don't meet them.

Members pressed Randol on what ability the state has to implement damages and sanctions for not meeting obligations. "Obviously, they're going to be held to their contractual obligations," Randol responded.

"Well, I would suggest that you go on to our website and you can read the contract. You can read the contract if you choose to," Randol told participants when he was asked about specifics. "There's financial leverage to hold them accountable to contractual obligations."

Medicaid member Matt Grillot, who is C 5/6 quadriplegic, was worried about Genesis as well.

Randol, in response, said he was "confident" Iowa Total Care will have a contract with Genesis. "I know one thing is being said publicly, but there are other negotiations that continue to this day with Iowa Total Care and Genesis."

Marquard pushed back against the claim that Genesis would not reach a contract, saying that wasn't so. "It's not a foregone conclusion, but my anticipation and what we are working towards is reaching an agreement with them."

One member was especially upset about a bill allowing Medicaid to deny payment for gender-reassignment surgery. "I'm very angry about people who have no knowledge of medical or psychiatric care making decisions about what's medically necessary," Scott Fieker, a transgender male who is a licensed counselor, told Randol and his staff. "I don't know how you do your job. I don't know how you live with yourself.

"I hope that we can redact what she's done, but the fact that the Affordable Care Act says we are people and we do deserve medical care and it's not cosmetic and we were born this way, it infuriates me that in this time and age that we are killing or causing young people to commit suicide and the governor will not even listen to us."

When the town hall had ended, Medicaid Managed Care Bureau Chief Elizabeth Matney sat with members of the public to help work through their issues.

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