CMS Says Iowa Can Start Medicaid Managed Care April 1

CMS said Iowa had made substantial progress since December 2015, but its approval letter laid out several conditions to protect beneficiaries.

After more than a year of debate, Iowa’s 560,000 Medicaid clients will transition to managed care effective April 1, 2016, based on an approval from CMS announced last week.

Governor Terry Branstad, a Republican, said Friday in a television interview that it was “unfortunate” the process had become politicized in Iowa, even though Medicaid managed care is the norm in more than 30 states.

“Many of the hospitals and providers have tried to scare their patients, and this has been unfortunate,” said Branstad, during an appearance on a roundtable on Iowa public television.

He first unveiled a plan to privatize the $5 billion program in early 2015, with a goal of finalizing the shift on January 1, 2016. CMS said late last year that Iowa was not ready and initially delayed the start date to March 1, 2016, before adding another month to the transition.

CMS’ delays were designed to ensure adequate provider networks, which have been an issue in some states that made large-scale transfers to Medicaid managed care. Federal officials were also concerned about the adequacy of call centers to help clients.

Democrats in the Iowa legislature opposed the transition for a full year, questioning both the anticipated savings and the merits of the plan itself. Hospitals and many providers opposed the transition as well.

Branstad said during the interview that many large states, including New York and California, have adopted Medicaid managed care, and, “It’s not a partisan issue.” However, in California, there have been complaints about network adequacy and the state’s ability of to find enough primary care physicians to meet demand, given the enrollment surge in Medi-Cal, which is the name of the program.

On Tuesday, CMS released a statement saying Iowa had made progress since December, leading the agency to move forward with an April 1, 2016, start date. “CMS’ primary focus is on protecting the quality of care delivered to beneficiaries, and we will continue to closely monitor the state’s progress,” a letter to Iowa’s Medicaid director said.

In his television appearance, Branstad said he understood that some providers were not happy about moving away from fee-for-service and into the oversight that managed care offers, but they would have to adapt. “This is the modern way to deliver healthcare,” he said.

He also said managed care was not entirely new in Iowa; its previous transition with mental health services had actually received some positive reviews.

CMS’ letter outlined several conditions:

· Iowa must monitor managed care organizations, including staffing levels, the quality of enrollee-provider communication, and grievance procedures.

· Communication and customer service must be closely monitored, including call centers.

· CMS has signed off on provider network adequacy for now, but expects Iowa to monitor this going forward.

· CMS wants weekly reports on case management services.

· Iowa must allow beneficiaries to keep current case managers through September 30, 2016, keep existing prescription drugs during the transition and honor existing service organizations for acute and specialty care during the first year.