Health care providers brace for new disruption to Medicaid marketplace

April 07-- Apr. 7--Iowa health care providers already were concerned about the entrance of a new Managed Care Organization to the Medicaid market, then came more unsettling news: UnitedHealthcare would not renew its contract with the state.

Iowa began 2019 with two private insurance companies caring for the state's Medicaid population: UnitedHealthcare and Amerigroup. Iowa Total Care, a subsidiary of the nationwide company Centene Corp., is set to accept new patients beginning July 1.

UnitedHealthcare's departure is not a first for Iowa since Medicaid managed care was implemented in the state in April 2016. In October 2017, AmeriHealth Caritas pulled out of the marketplace with millions of unpaid claims owed to Iowa health care providers.

On March 29, Gov. Kim Reynolds said she "ended negotiations between the state of Iowa and UnitedHealthcare because of terms that I believed to be unreasonable and unsustainable."

The group's exit will affect about 425,000 poor or disabled Iowans who currently receive their Medicaid benefits through the out-of-state insurance company. They now will be reassigned to the remaining MCOs, one of which has yet to establish itself in the state.

"I question whether the resources will be there," said Dave Weiss, administrator at Family Medicine of Mount Pleasant. "And what will end up happening is the patients and providers will bear the brunt of any unfinished details that should be in place."

In February, Weiss raised concerns with lawmakers about Iowa Total Care, which at the time, he said, had yet to hire sufficient staff in Iowa and did not have its provider manual approved by the Iowa Medicaid Enterprise.

"We have a new MCO coming in and I have no clue what their readiness and resources will be to take on approximately one half of the patients," Weiss said, of those dropped by UnitedHealthcare. "How ready are they going to be come July 1?"

At Family Medicine of Mount Pleasant, about half of the Medicaid population was insured by UnitedHealthcare, he said, and now will be moved to a new company.

Auditor Rob Sand held a press conference Monday at the Capitol in Des Moines to inform health care providers and patients about their contractual rights during the state's split with UnitedHealthcare.

"I think it's important for everyone to keep in mind that on the receiving end of this split are the most vulnerable people in Iowa," said Sand, elected in 2018.

Since he took office in January, Sand said his office has held weekly meetings on Medicaid and reviewed the 287-page contract with UnitedHealthcare to determine the steps it must take before its ties are severed with the state.

"I think it's important for Iowans all over the state to know about their rights and the obligation that the state of Iowa and that United owe them as taxpayers, patients and providers related to this departure," he said.

In 2019 alone, local health care providers from Great River Health System, Optimae Life Services, Hope Haven and Henry County Health Center have told state legislators about the issues they continue to have, three years later, with Medicaid managed care.

Though lawmakers of both political parties agree the privatized system is flawed, there is no appetite in the Republican caucus at-large to revert back to the state-run system.

"Going back to the old system is not possible," said newly elected Rep. Joe Mitchell, R-Mount Pleasant, Thursday in a statement. "The old system was completely unsustainable, unaccountable, and the growth of the program threatened the state's ability to fund key priorities like K-12 schools, public safety, and other core functions of government."

Rep. Jeff Kurtz, D-Fort Madison, said Friday members of his party offered two amendments this session to Medicaid legislation "to try and fix this problem." One amendment proposed moving Iowans with long-term assistance needs back to the fee-for-service system, while the other would end Medicaid privatization at the end of Fiscal Year 2019 and "force the governor and lawmakers to develop a system that improves access to health care."

Neither amendment moved forward this year.

"If the majority party wants to put forth a plan on how we proceed from here, they should do so immediately," said Kurtz, Friday in a statement. "It's obvious to everyone that all the promises made about the wonders of privatization have not materialized, and no matter what the governor and her enablers are telling us, they will never materialize."

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