Health and Fitness : VGH: Iowa\'s new privatized Medicaid and our patients

We think it is important for our patients, members of our community, and those whose loved ones receive Medicaid support to be aware of recent plans to change Iowa’s Medicaid program.

First, some basic facts. Iowa’s Medicaid program serves approximately 560,000 people in the state, almost 1 in 5 Iowa residents. For area hospitals this group represents nearly 15% of their patient population. For area providers of long term care the Medicaid population is about 65% of their patients.

The program serves the neediest and most vulnerable of the state’s population. Among those groups are the disabled, those with very low incomes, poor children, and those in long term care without the ability to pay for care from their own funds. Changes to the program have already resulted in many doctors dropping Medicaid patients from their practice as reimbursements have diminished.

Management of Iowa’s program has been the responsibility of the Department of Human Services. The Iowa department made payments directly to providers of health services on behalf of patients. Under a directive from Governor Brandstad, management of the program will be outsourced to four private companies. The private companies will receive payment from the state, then make payments to healthcare providers based on what each company’s plan will cover. It will be the responsibility of patients to enroll in the plan best suited to their needs.

While many others have criticized the change for various reasons, it is the hurried nature of the changes and the resulting confusion for patients that we are concerned about. The current plan calls for Iowa’s Medicaid system to be managed by the four private companies starting January 1, 2016.

At a recent meeting in Van Horne sponsored by Representative Pettingill and Iowa Senator Tim Kapucian, health care providers in attendance expressed concern that they are in the dark on the details of how the changes will impact patients. Those in attendance included an area pharmacy, long-term care facilities, both Marengo Memorial and Virginia Gay hospital, and other area agencies providing services reimbursed by Iowa’s Medicaid program.

Though Medicaid recipients were to have received a letter explaining changes to the program, we are concerned that many will be unable to navigate the complex choices they now face. With the details of each company’s plan not yet published and the deadlines for implementation looming, we are worried that patients will unexpectedly be prevented from receiving care they formerly received, routed to facilities far away or that they are unfamiliar with, that they may be unable to receive prescriptions locally, and a host of other issues.

The choices facing Medicaid patients will now be similar to choices for Medicare Part D and health care insurance plans. Each plan will offer different benefits and their own limitations on coverage.

We are very appreciative of Representative Pettengill and Senator Kapucian taking time from their busy schedules to provide us with the best information they had available. If you wish to contact legislators please remember that these changes were instituted by executive order, not by the legislature.

We have no interest in being part of the political dialogue, but we are deeply concerned that Iowa’s most vulnerable and their caregivers may be deprived of the time and information needed to successfully adapt to these changes.

If you or a loved one has received information from the Iowa Department of Human Services concerning Medicaid please read it carefully. That correspondence and additional correspondence concerning your Medicaid coverage needs to be carefully monitored and you may be required to make very important choices about your care in the weeks ahead.

Readers wishing to learn more about the concerns of other eastern Iowa health care providers may also want to review Sunday's article in the Cedar Rapids Gazette by clicking here.