Iowa Home Healthcare Providers Report Delays in Medicaid Payment

Reports of missing or incorrect payments sound similar to those that occurred in Ohio, Kentucky, and other states that made a rapid transition to Medicaid managed care.

Published reports from Iowa say some managed care companies that took over care for 560,000 Medicaid clients in April are slow to make payment, including to home healthcare aides making as a little as $9 an hour.

Reports in the Des Moines Register, The Gazette, and others spell out union complaints on behalf of aides in the Consumer Directed Attendant Care (CDAC) program, which pays for aides to bathe, feed, or provide medication for those with disabilities or long-term illnesses, who remain at home. In some cases, the attendant is a family member, because the program’s mission is to keep fragile clients out of institutions.

Officials with AFSCME Iowa Council 61 reported a jump in the number of calls from CDAC providers saying they’ve gone weeks without payment, despite resubmitting forms. Individual aides have reported missing home and car payments or skipping their own medication for lack of a paycheck, according to the reports, which list the number of aides at about 6700.

Iowa’s experience comes less than 2 years after similar complaints surrounded Ohio’s rollout of Medicaid managed care. Patients who were “dual eligibles,” qualifying for Medicaid and Medicare, reported having long-time aides leave for other jobs because they couldn’t keep going without a paycheck.

States including Kentucky, Kansas, and Illinois have reported problems in their own transitions. In 2013, The American Journal of Managed Care spoke with Kentucky’s Medicaid Commissioner Lawrence Kissner, who came in after the commonwealth had a difficult changeover in 2011. Kissner said at the time that payment delays were common in the early months but things improved over time.

He also said that problems are common when the move to managed care in Medicaid is motivated by a budget crisis, as was the case in Kentucky.

In Iowa, Governor Terry Branstad unveiled his managed care plan in early 2015, saying it would save $60 million in the $5 billion program first 6 months of 2016. After a year of debate with the legislature, and some legal issues with the awarding of bids, CMS twice delayed the launch until April 1, 2016.

CMS put a number of conditions on Iowa’s changeover, including state monitoring requirements, grievance procedures, and requirements that clients be allowed to keep case managers and current medications during a transition period. However, at least one case outlined in news reports involved a 23-year-old disabled woman, whose mother was asked to change to less expensive medications that had not worked in the past.

Iowa Department of Human Services spokeswoman Amy McCoy told news outlets that the new managed care organizations (MCOs) have offered training for individual CDAC providers who are not familiar with new billing systems. Missing signatures were a common problem, McCoy said.

CMS' Kansas City Regional Office responded to an inquiry about what it was doing to resolve the complaints. Through spokeswoman Julie Brookhart, the agency replied, "CMS has worked with the State of Iowa on recent reports of provider billing issues. The State of Iowa continues to monitor claims at the systemic and individual provider level and is working closely with the Managed Care Organizations, and provider associations to resolve any billing concerns."

The 3 Medicaid MCOs in Iowa are: Amerigroup Iowa, Inc.; Amerihealth Caritas Iowa, Inc.; and UnitedHealthcare Plan of the River Valley, Inc.