As of 12/04 2017:

What is going on with Medicaid Managed Care in Iowa?

There has been a lot of news about Medicaid managed care this month, starting with the announcement on October 31st that AmeriHealth would be ending its contract with the state effective December 1st. In the weeks since that announcement there have been several different statements from DHS about how AmeriHealth members would be transitioned. It has been confusing to keep up with all of the changing information in such a short amount of time, and is surely very stressful for Medicaid members and their families. Because AmeriHealth serves a much higher number of members with disabilities and long-term care needs than the other two MCOs – 74% of Medicaid members with serious disabilities – this is disproportionately impacting individuals with disabilities and their families.

Below is our best attempt to provide an overview of what has happened over the past month, what this means for patients and families, and where to find more information.

The Short Version:

  • AmeriHealth ended services effective December 1, 2017
  • Most members who were with AmeriHealth were enrolled with UnitedHealthcare
  • Members who switched to Amerigroup before the initial November 16th cut-off will have their Medicaid services managed by DHS
  • The ability for members to choose their MCO is temporarily suspended because Amerigroup does not have the capacity to take on new members at this time
  • The state is looking to contract with at least one additional MCO beginning in July 2019

Detailed Overview and Timeline:

  • DHS Announces AmeriHealth Pulling Out of Managed Care: On October 31st DHS announced that AmeriHealth would be ending its work with the Iowa Medicaid program effective December 1, 2017. AmeriHealth is one of the three managed care organizations (MCOs) who began managing Iowa’s Medicaid program in April 2016, along with UnitedHealthcare and Amerigroup. AmeriHealth stated they were leaving the program after months of negotiations about rates and terms, and have openly stated they believed the rates were miscalculated for the managed care program. At the time of the initial announcement DHS said the 215,000 Medicaid members currently enrolled with AmeriHealth would be auto-enrolled with one of the two remaining MCOs but able to switch to the other by November 16th, and after that any reason until March 1st. This is similar to the process people initially went through when managed care was rolled out last year.
  • All AmeriHealth Members to Switch to UnitedHealthcare: On November 7th, contrary to their initial announcement that AmeriHealth members would be auto-enrolled between the two remaining MCOs, DHS announced that all AmeriHealth members would instead be auto-enrolled with UnitedHealthcare but could choose to switch to Amerigroup if they wanted. Two weeks after this announcement the plans changed again. On November 21st DHS announced that Amerigroup did not have the capacity to take any new members, so all AmeriHealth members and any new Medicaid members would be enrolled with UnitedHealthcare without the option to switch until further notice. Federal law requires that members have choice among MCOs, but both state and federal authorities say that because suspending choice is temporary they do not need to get federal approval. It is unclear how long choice will be suspended, but Amerigroup has said they are actively ramping up their capacity in order to be able to serve additional members.
  • DHS to Resume Oversight of Portion of AmeriHealth’s Members: In another change of plans, DHS announced on November 27th that DHS would resume direct oversight of 10,121 AmeriHealth members who tried to switch to Amerigroup by the initial November 16th cut off. These members will be served by Medicaid “fee-for-service” which is how all members were served before managed care.
  • DHS Seeking Additional MCO: At the time of the initial announcement about AmeriHealth, DHS also announced that they would be releasing a request for proposal (RFP) to add at least one additional MCO to the program starting in July 2018. However, in subsequent communications they have pushed that date back to July 2019. The RFP was released the first week of November.

 

Where to Find More Information:

The following resources available on the DHS website for members and providers are updated as additional information is available. The FAQ docs have useful information about the process for changing MCOs for good cause, how long prior authorizations will be honored, and HCBS level of care assessments that are due for reauthorization soon.

  • Member FAQ: AmeriHealth Caritas Iowa, Inc. Withdraw and Suspension of MCO Choice (link): This page has information specifically for members about the transition, including an explanation of the temporary suspension of choice, what to do if existing healthcare providers don’t contract with their new MCO, the process for changing MCOs for good cause, and information for those members who will have their services managed by DHS.
  • Provider FAQ: AmeriHealth Caritas Iowa, Inc. Withdraw and Suspension of MCO Choice (link): This page has information for providers including how to determine which MCO their clients are enrolled with, how long prior authorizations will be honored, the process for expedited contracting with the remaining MCOs, HCBS level of care assessments that are due for reauthorization soon, and much more.
  • DHS Informational Letters (link): DHS publishes bulletins to clarify and explain programs and policies. Letters are posted on their website, and you can also sign up to receive an email when new informational letters are released. Several informational letters have been released over the past few weeks about the transition. The initial letter sent can be found here (link).
  • Sample letter sent to AmeriHealth members explaining the move and what they can expect now (link): This sample letter was sent to AmeriHealth members after an initial letter to explain the most recent changes.