Remaining Iowa Medicaid insurers to have equal shares of population

April 10-- Apr. 10--Iowa Medicaid members will be distributed equally across the two remaining managed-care organizations once UnitedHealthcare of the River Valley exits Iowa's program in the coming months.

State officials say they have been working on a plan to handle distribution of the more than 600,000 Iowans on Medicaid since Edina, Minn.-based UnitedHealthcare announced late last month it would withdraw from the state's managed care program by June 30.

As a managed care organization, UnitedHealthcare handles coverage for more than 425,000 poor and disabled Iowans on Medicaid.

"With respect to UnitedHealthcare's transition, it's our absolute No. 1 priority," said Iowa Medicaid Director Michael Randol in a public meeting in Des Moines Wednesday. "Myself and my team have been working tirelessly over the last couple of weeks with respect to that announcement."

During Wednesday's Council of Human Services meeting, Randol told council members the goal was split the total Medicaid enrollee group 50-50 between the two remaining managed-care organizations, Amerigroup Iowa and Iowa Total Care.

Randol said officials with Iowa Medicaid Enterprise are finalizing the algorithm to distribute members equally between the insurance companies starting July 1.

"Now, the algorithm won't be perfect in that, but right now it's very close to that," Randol said. "Amerigroup has a slight increase in percentage. We're not going to know the final distribution until member choice is concluded."

Their main priority is to "ensure equity of care for members," he said.

"For example, those members who were removed from Amerigroup and assigned to either UnitedHealthcare or Iowa Total Care, we're going to put those members back to Amerigroup," Randol said. "Now, if a member chose to leave Amerigroup to go to Iowa Total Care, we will honor that choice."

Iowa Total Care -- a subsidiary of St. Louis-based Centene -- is on track to join Iowa's program July 1, Randol said.

The insurance company was selected as a managed-care organization after another insurer -- AmeriHealth Caritas -- withdrew from Iowa's program in late 2017.

Iowa Total Care has signed a five-year contract with the state. Amerigroup's contract runs through March 2021.

State officials will send notice to affected Medicaid members the week of May 6 about the transition.

A primary concern for state Medicaid officials are the long-term supports and services members -- those who rely on case managers or care coordination for their list of needed services.

Randol said managed-care organization executives are in ongoing discussions on continuation of care coordination for members to ensure there are no gaps in services between one insurer to the next.

Iowa Total Care is actively hiring staff leading up to their July 1 start date.

Randol said state officials are encouraging the insurer to consider hiring UnitedHealthcare case managers, as well as other support staff. If hired, case managers can continue overseeing their members' services under a new managed-care organization.

Focus on transition

Medicaid officials have not made a decision on whether they will bring another managed-care organization into the program, said Jerry Foxhoven, director of the Iowa Department of Human Services, which oversees Iowa Medicaid Enterprises.

Once the transition from UnitedHealthcare is complete, "then we will sit back and decide if we should do an (request-for-proposal) for a third managed-care organization or not," Foxhoven said. "Right now, our focus needs to be 100 percent on that transition."

Foxhoven added the program is in compliance with the law with two managed-care organizations as the requirement only dictates members must be provided choice.

But state officials did receive some heat about the program during the council meeting.

"The whole idea of oversight and having outcome measures becomes super difficult when we have this much turnover in what's a relatively new program," said Kim Spalding, Council on Human Services member and Coralville pharmacist.

"... I just think our goal at some point has to be some form of stability because we're not going to have long-term outcome measures and have long-term quality measures if we can't keep people in the system longer than this."

Randol responded that he "couldn't agree more."

"When you have this much disruption, you can never establish a base," he said. "We have to get to a point where we can focus not on disruption or membership change, but on population health of those members."

In announcing its withdrawal from the program, UnitedHealthcare cited the loss of millions of dollars since joining the program in April 2016.

However, the state disagreed with the company's reasoning, saying the managed-care organization did not want to be upheld to specific performance metrics they were contractually obliged to meet.

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