Horizons working through Medicaid Meals on Wheels mishap

June 05--CEDAR RAPIDS -- A Cedar Rapids-based not-for-profit is working through April billing issues after the Medicaid transition has left its Meals on Wheels program on uneven ground.

The state handed over its $5 billion Medicaid program with more than 560,000 enrollees and 29,000 providers to three private insurance companies April 1.

Horizons offers transportation, nutritional and mental health services to underserved populations. It delivers about 1,100 meals a day, said Sofia Mehaffey, director of community health and nutrition programs. Those meals help senior adults and those with disabilities meet their daily nutritional needs and live independently.

But since the April 1 switch, one managed-care organization (MCO) has denied all Meals on Wheels claims, one has not yet responded to the claims and one has approved only a small percentage of meals -- 14 of 58 meals requested for one client, for example -- Mehaffey said.

Horizons has not yet submitted May claims.

"We anticipated growing pains with a change in the model," she said. "We're hoping (the issue) won't be continuous."

Horizons receives funding for its Meals on Wheels -- ready-to-eat meals delivered daily -- from three sources, Mehaffey said -- the Heritage Area Agency on Aging, through the Older Americans Act; Medicaid, through the elderly waiver; and fundraising.

Mehaffey first brought up the issue at Tuesday's Medicaid listening post hosted by State Sen. Liz Mathis, D-Cedar Rapids. More than 65 Medicaid beneficiaries and providers attended the forum, which had representatives from the state and all MCOs.

The MCOs told her the meals could be reimbursed retroactively once the issue is worked out.

Mehaffey later told The Gazette that Horizons, which is the primary provider of Meals on Wheels services to Cedar Rapids residents, will continue delivering food without reimbursement. However, the funding is "absolutely necessary," she said, as Medicaid makes up 18 percent of the organization's revenue.

Horizons is working directly with the three MCOs to get the issue sorted out, she added.

"It's really important that we work through this," she said. "We want to see the positive side of" the privatization. "But our services are also vital to the community."

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