Ready or Not, Medicaid Managed Care to Start in Iowa

Mayo Clinic's refusal to sign contracts with the 3 new Medicaid providers, and a 9-year-old with a brain tumor, have added drama in the days before the transition.

Governor Terry Branstad didn’t purposely select April Fools Day to transfer 560,000 Medicaid enrollees from a state-run Medicaid system to managed care. But after more than a year of debate, lawsuits, and delays from CMS, Iowa will hand off their care to a private system on Friday.

Critics of the changeover have grilled Iowa Human Services staff into the final days before the switch, with a Senate panel spending 90 minutes going over details earlier this week. Meanwhile, Medicare contractors and providers alike spent this week unveiling deals to bring coverage to group of seniors. Among them:

· Amerigroup Iowa announced it had contracted with McFarland Clinic, which was described as “Iowa’s largest physician-owned multi-specialty clinic,” located in the central part of the state.

· Clarinda Regional Health Center announced it had signed contracts with all 3 Medicare providers doing business with the state.

But it’s not clear whether these announcements will offset last week’s blow. The famed Mayo Clinic in Rochester, Minnesota, which historically has treated cancer patients in northern Iowa, announced it could not come to agreements with any of the 3 companies that will handling Medicaid for the state. Nor it did reach contracts for its primary care clinics that are physically in Iowa. A 9-year-old boy with brain cancer, whose treatment at Mayo was stalled, became a poster child for what can go wrong.

A Mayo spokeswoman told the Des Moines Register the clinic would accept some patients under special circumstances, if they need care that cannot be found elsewhere. But other patients in need of cancer care may have to travel to Iowa City, which could mean a much longer drive for patients who had been accustomed to traveling just over the border.

Branstad first unveiled the plan for Medicaid managed care in early 2015, saving he could save $60 million in the first 6 months of this year if the transition happened January 1, 2016. The plan encountered fierce opposition in the legislature, and CMS ordered 2 separate delays to ensure adequate networks and customer service support.

Besides Amerigroup Iowa, the other health plans handling managed care will be AmeriHealth Caritas Iowa and UnitedHealthcare Plan of River Valley.

Meanwhile, the political back-and-forth over the change continues. State Sen. Amanda Ragan, a Democrat who has opposed privatization from the start, told the Register that other border hospitals in Wisconsin and South Dakota have similar issues, which will mean some Medicaid patients will have to travel farther for care.

Access to care is also a concern of Democratic State Representative John Forbes, who wrote in an op-ed that his office has heard from many frustrated constituents—even as he waits for a revised figure on how much Iowa will save. He urged Iowa lawmakers to “establish some oversight to ensure your tax dollars are being spent wisely and that Iowans are receiving the care they need.”

But another lawmaker, Republican State Representative Kevin Koester, urged patience during the transition, including the inevitable glitches that will occur with a change so large. “I wish to emphasize a primary promise of the program,” he wrote in an op-ed. “Medicaid members will be able to keep their current case manager for at least 6 months and to continue service plans until a new plan is created and agreed upon.”