Winning bids reflect the trend of national insurers securing a large share of Medicaid managed care business as states seek savings and the Affordable Care Act allows for expansion.
Two of the top 5 national insurers—which could be 3 if planned mergers succeed—are among the victors in Iowa’s bidding to oversee Medicaid services, as the state becomes the 40th to use managed care in its healthcare program for the poor.
Anthem, UnitedHealthcare, AmeriHealth Caritas, and WellCare Health Plans received notices that Iowa’s Department of Human Services (DHS) intends to award them contracts, under a process that began back in February. The presence of large national insurers continues a trend seen in other states, due to both the expansion of managed care in Medicaid generally and especially since the inclusion of the group of beneficiaries making up to 138% of the federal poverty line. In most states that opted for Medicaid expansion, new enrollees were all required to go into managed care.
Governor Terry Branstad, a Republican who oversaw one of the earlier CMS waivers for Medicaid expansion under the Affordable Care Act, called for putting Iowa’s $4.2 billion program under private management at the start of this year, to take effect January 1, 2016. The change will affect 560,000 beneficiaries. Iowa hopes to save $51 million in the first 6 months of 2016 after seeing costs climb 73% since 2003.
There has been skepticism from Democrats in the legislature whether these amounts will be realized, as well as fears that fees paid to private vendors will cause Medicaid clients to be shortchanged, especially those with disabilities or long-term illnesses.
Initially, Democrats’ unhappiness caused a Senate committee to refuse to give DHS Secretary Charles Palmer a formal endorsement for his renomination, despite many years of service. He was later confirmed. Hospital groups also expressed concern about the plan. In response, Branstad’s administration held a series of meetings around the state on the proposal this spring.
The final 4 vendors emerged from an original group of 11 bidders, although 1 withdrew. Under a policy called the Iowa High Quality Health Care Initiative, the conversion seeks not only savings but also movement to value-based, patient-centered care that is better coordinated and more in step with principles outlined by CMS, which is moving away from fee-for-service payment models.
Consumers will see a program called the IA Health Link, which will be promoted through a communications campaign that targets both Medicaid beneficiaries and various stakeholders, including providers.
Early Involvement Critical in Treating Immunotherapy-Induced Overlap Syndrome
April 19th 2024A series of case studies reveals the importance of early diagnosis and involvement of special teams of clinicians when dealing with potential cases of overlap syndrome, which encompasses myocarditis, myasthenia gravis, and immune checkpoint inhibitor–related myositis.
Read More
Overcoming Employment Barriers for Lasting Social Impact: Freedom House 2.0 and Pathways to Work
April 16th 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our second episode, in which we learn all about Freedom House 2.0 and the Pathways to Work program.
Listen
Making Giant Strides in Maternity Health Through Baby Steps
April 9th 2024To help celebrate and recognize National Minority Health Month, we are kicking off a special month-long podcast series with our strategic alliance partner, UPMC Health Plan. Welcome to our first episode, which is all about the Baby Steps Maternity Program and its mission to support women throughout every step of their pregnancy journey.
Listen
Government agencies have created an online portal for the public to report potential anticompetitive practices in health care; there are changes coming to the “boxed warning” section for chimeric antigen receptor T-cell therapies (CAR T) to highlight T-cell blood cancer risk; questions about the safety of obesity medications during pregnancy have arisen in women on them who previously struggled with fertility issues.
Read More
Real-World Study Reveals Key Insights Into DLBCL Treatment Patterns, Outcomes
April 18th 2024A recent study offers valuable insights into the characteristics, treatment patterns, and outcomes of diffuse large B-cell lymphoma (DLBCL) in patients across different lines of therapy, providing a look into the landscape of DLBCL management.
Read More