DES MOINES — Iowa’s Medicaid program, and the people dependent on it, were thrown for a loop last week.
While details are in flux, state officials reassured Iowans the departure of a managed-care organization from the privatized program will be a seamless process.
Officials announced March 29 UnitedHealthcare of the River Valley will withdraw from Iowa’s program.
A managed-care organization — a private insurance company contracted by the state to administer Medicaid coverage — UnitedHealthcare has more than 427,000 members. That’s more than two-thirds of the total number of Iowans on Medicaid.
Members will receive notices they will be reassigned to one of two other insurers, and then have 90 days to switch if they wish to change to a different managed-care organization.
Because of the sudden change, details of the switch to other insurers are still being finalized.
And despite reassurances the transition will be smooth, many Iowans say are frustrated with the lack of consistency in the managed-care program since it privatized three years ago.
“I feel like we’re in limbo,” said Delaine Petersen of Cedar Rapids, caretaker of a disabled daughter on Medicaid. “Do you turn right or do you turn left? Are you making a mistake in either of those choices?
“This is not the way to take care of Iowans.”
According to state officials, UnitedHealthcare is withdrawing because the state would not give into “unreasonable” demands from the insurer during recent contract negotiations.
UnitedHealthcare, however, maintains the state of Iowa has underfunded the program, causing the insurance company to lose hundreds of millions of dollars since it joined in April 2016.
UnitedHealthcare plans to withdraw on June 30 — the day before Iowa Total Care is set to join Iowa’s program.
Petersen said the reason for upheaval doesn’t concern her. Her worry is for her daughter.
Leslie Petersen, 46, is a UnitedHealthcare member and a nonverbal quadriplegic. She lives with her parents — Delaine and Duane — and is reliant on others to help her eat, use the bathroom and otherwise function or move on her own.
Delaine said she and her husband have a list of questions. Among them: Will Leslie have to go without addressing her mobility issues if another managed-care organization denies services? Is going from UnitedHealthcare to another insurer “jumping from the pan and into the fire?”
“Families have spent tons of time getting prior authorizations and special medicine,” Petersen said. “Are they going to have to go through that again? Are they going to get providers the right information so that they can set up their systems to support people?”
Craig Harwood, 62, of Cedar Rapids is the father and caretaker, along with his wife, of their son, Dan, 38, who has been diagnosed with Down syndrome. Craig said the managed-care system can feel like it’s “constantly being changed.”
“It has not been horrible for him, but he’s also got the two of us who advocate for him at every stage,” he said. “There’s people out there that don’t have their own voices and need someone else to advocate for them.”
You have free articles remaining.
However, Craig said he is fearful of what the switch could mean for providers and the services they offer. Dan has been with Options of Linn County for about 17 years, and goes every weekday for habilitation services.
“We’re not worried about him specifically because we’re both going to be in there fighting for him,” Harwood said. “What we’re worried about in this transition is what it does to service programs like Options ... . If Options closed, that would be devastating to Dan. That’s the reason why he gets up and leaves the house every morning.”
For many members and health care providers, UnitedHealthcare’s announcement felt all too familiar.
“The effect on Options will probably be déjà vu all over again,” said Jim Fox, director of Options of Linn County.
Managed-care organization AmeriHealth Caritas announced in October 2017 it planned to pull out of the state’s program by the end of that year. The majority of AmeriHealth members was assigned to UnitedHealthcare.
“The rates are set, but history shows that with a new (managed-care organization) receiving a sudden influx of new members, billing is a nightmare for six to nine months while they sort their systems,” Fox said.
“For small agencies and providers that rely on accurate monthly income for cash flow and meeting payroll, it can be devastating.”
For one small provider, the billing took longer than a few months to sort out.
Ann Brownsberger, co-founder of the Village Community in West Branch, said her organization was paid accurately and on-time in December for the first time in 33 months.
The Village Community offers services to 15 disabled individuals who are on UnitedHealthcare or the state-run fee-for-service program.
“Are we going to start this again?” Brownsberger said. “We hope things worked out with Amerigroup (Iowa), and we hope that won’t be a concern with Iowa Total Care. But if history tells us anything, that’s probably not going to be the case.
“It feels like we’re starting all over again,” she said.
Iowa Department of Human Service officials and UnitedHealthcare executives say they are committed to working together to ensure a smooth transition for Medicaid members.
Gov. Kim Reynolds said the two remaining managed-care organizations are still “committed to Iowa.”
“Amerigroup Iowa remains committed and focused on ensuring access to quality care for the Iowans we serve,” Amerigroup Iowa officials said in a statement.
Iowa Total Care officials say it is “prepared and ready to go live July 1.” It is owned by Centene, based in St. Louis.
Gazette Des Moines Bureau reporter Rod Boshart contributed to this article.