Health and Fitness : Health care professionals share Medicaid MCO concerns with legislators

Nearly 20 area health care providers gathered last Thursday at the Van Horne Community Center to discuss with State Rep. Dawn Pettengill and State Sen. Tim Kapucian the impending changes to the Medicaid system in Iowa.

In August, Gov. Terry Branstad announced that four companies had been selected to provide services under a “Medicaid Modernization” plan set to begin Jan. 1.

Approximately 12-14 percent of patients at Virginia Gay Hospital and the Marengo Memorial Hospital in Iowa County rely on Medicaid. And at care centers, including the VGH Nursing and Rehab Center, Medicaid members represent 50 to 65 percent of all residents. Approximately 560,000 Iowans – one fifth of the state’s population, are Medicaid members.

Although the decision to make this change came from Branstad and not the legislature, Pettengill and Kapucian organized the meeting to help answer questions.

But along with many questions, those in attendance – representing hospitals, care centers, clinics and pharmacies in Benton and Iowa counties – expressed anger and fear about how much and how quickly the change is taking place.

VGH Administrator Mike Riege reminded the legislators that the Iowa Wellness Program, instituted to comply with the Affordable Care Act, has only been operating about a year and a half.

"This thing has never got off ground and now we are jumping into Medicaid managed care,” he said. “It doesn’t give any comfort to hospitals that we would be able to make people healthier.”

Along with the legislators, the other representative of state government who was there was Donna Harvey, the director of the Iowa Commission on Aging. She told the audience she was there to answer questions and serve as liaison between them and government officials.

The four companies chosen to serve as Managed Care Organizations (MCOs) are Amerigroup Iowa, Inc., AmeriHealth Caritas Iowa, Inc., United Healthcare Plan of the River Valley, Inc., and Well Care of Iowa, Inc.

Harvey told the group that while many other states have chosen to use MCOs for some Medicaid patients, Iowa is the only state preparing to transfer virtually all of its Medicaid members to MCOs.

The speed and universal nature of the change is causing concern among health care providers across Iowa.

Heidi Van Buren, a Certified Pharmacy Tech at Cornerston Apothecary, expressed many of the frustrations and concerns shared by those in the room.

“Why are we turning this on our head? Why are we doing this?” Van Buren asked.

Pettengill recited the three goals Branstad listed when he announced the change.

· Improve quality and access

· Promote accountability for outcomes

· Create a more predictable and sustainable Medicaid budget

The health care professionals, however, questioned how successful the MCO program would be in achieving any of those goals. They questioned how well the state is communicating with those Medicaid members about the changes. They asked about provider payment schedules. They pointed out that although the program is set to begin Jan. 1, virtually no health care providers in the state have yet signed contracts with the MCOs.

“Not to many patients or providers are happy with this,” said Riege. “It sounds like the MCOs would have power to ration care.”

“They have everyone scared,” said Van Buren.

Pettengill replied that there would be strict government oversight over the four MCOs. And although there is a December deadline for enrolling in an MCO, patients will be able to switch MCOs before March 16, if they find the one they originally chose does not meet their needs.

Medicare members were sent a letter in September announcing the upcoming changes, and should receive another letter in the very near future about choosing an MCO.

Some providers, however, are concerned that Medicaid members may not understand the letters.

Pettengill left the meeting with several unanswered questions from the audience; she promised to obtain answers from officials in Des Moines and respond within a week.

While one participant told Pettengill she was being a “good soldier” in presenting Brandstad’s case, she replied that the decision was his, not the legislature’s, and that she was holding that meeting and others to help make the transition smoother for both patients and health care providers. She also said that while some in the legislature may try to reverse Brandstad’s MCO plan, she doubted they would be successful. As a member of the House Rules Committee, the information she was given only applied to rules about administering Brandstad’s proposal, not changing it.

Shortly after the meeting, Pettengill sent an email to all participants, informing them of an information hotline for providers.

See more information about Medicaid Modernization HERE: