Medicaid providers, patients testify about issues in Iowa

Aug. 30--DES MOINES -- Powerful testimony and more statistics were some of the present aspects of Monday morning's listening post portion of the Iowa Legislature's Joint Senate Co-Chair of the Health Policy Oversight Committee at the Iowa Capitol.

The listening post, along with a more formal Oversight Committee meeting held Monday afternoon, were part of an ongoing Democrat-led push to bring issues with the state's Medicaid privatization and its three managed-care organizations to light and to help iron out both eligibility and pre-authorization snags as well as tracking and improving claim and payment efficiency.

Sandy Ham, CEO of Progress Industries, was among those who attended the listening post, but she couldn't be reached for comment by presstime Tuesday.

There had been involvement from Jasper County officials at previous Medicaid hearings and listening posts, including one held Aug. 2 in Baxter. A July 26 hearing at the State Capitol was attended by Sen. Chaz Allen (D-Newton) and Julie Smith, director of Capstone Behavioral Healthcare, which has Jasper, Marion and Poweshiek county clients.

Rep. Mark Smith (D-Marshalltown), who hosted the Aug. 2 meeting in Baxter, recently said there might be more meetings in the weeks or months ahead in the Marshalltown area where those affected by Medicaid issues can meet with state legislators and/or state Medicaid officials.

Monday's hearing happened three days after The Iowa Department of Human Services released its first quarterly report since the state handed over its $5 billion Medicaid program with more than 560,000 recipients to the private insurers on April 1. The report detailed claims payments, enrollment figures and capitation rates for Amerigroup Iowa, AmeriHealth Caritas Iowa and UnitedHealthcare of the River Valley.

Monday's testimony included some detailed issues from providers, especially about available and covered services. One provider said the added stress of either finding out certain services might not be covered has been enough to upset clients in chartable, documented ways.

Michelle Meadors, a Des Moines-area Medicaid consumer, testified before the committee, urging them and other lawmakers to help provide a health care environment they'd want to have if they had a life-changing accident or illness. The quadriplegic said she was injured in a car accident about five years ago, and now requires directly attended care.

"I was optimistic about managed care organizations," Meadors said. "That's what I wanted -- to manage my health care. Everyone talks about pre-authorization. Well, every other day I have what I call a (expletive), shower and shave day. I have to schedule my (expletive), I have to schedule my shower, and I have to schedule my shave. I couldn't get supplies. You would think these supplies, along with catheter tubes, would be essential."

Last Friday's quarterly report says the state is projecting the move to managed care saved it more than $22.2 million in spending during its first three months, adding it is on track to save more than $110 million in the first year. While all three MCOs resolved beneficiary grievances within 30 days of receipt, according to the report, one MCO, Amerigroup, received 145 grievances during the quarter, while AmeriHealth received 42 and UnitedHealthcare received 39.

All three MCOs have reported financial losses in the initial months of the new arrangement.

Capitation rates -- or the per-member, per-month fees paid to the MCOs by the state -- equal more than $850 million.

Contact Jason W. Brooks at 641-792-3121 ext. 6532 or [email protected]

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