‘Good riddance’

YSS director, legislators react to AmeriHealth exit from managed care market

Hundreds of thousands of Iowans will be moving to a different managed care organization (MCO) after AmeriHealth Caritas announced it’s exit from the state’s private Medicaid program on Tuesday.

The two remaining MCOs in the Iowa Health Link program, Amerigroup Iowa Inc. and UnitedHealthcare Plan of the River Valley Inc., will absorb the more than 213,000 Iowans currently under AmeriHealth.

“Good riddance, I’ve had nothing but complaints about them, and I’m not the least bit surprised,” said state Rep. Dean Fisher, R-Montour, of the move.

He said complaints he’s heard about AmeriHealth’s services include issues with payments, adding the switch from the state-run Medicaid program in 2016 may have caused some of the payment delay issues by taking time to check for fraud or errors in paperwork.

“Now, the system checks for that, and of course it’s a little bit slower,” Fisher said. “Some of it may have to do with these insurers taking a little longer than they should as well; it’s a mixed bag.”

State Rep. Mark Smith, D-Marshalltown, said AmeriHealth’s exit is an example of the ineffectiveness of the state’s managed care system.

“I think that this is very concerning to a number of Iowans who had signed up for that plan, and I think it speaks, again, to the problems that we’ve had with the (Gov.) Reynolds administration and managed care,” he said. “It has not worked, and it affects not only the Iowans who are covered by Medicaid, but it affects all of us because it affects a number of services we have available in our community.”

State Sen. Jeff Edler, R-State Center, said he’s not ready to give up on the private Medicaid system yet, but would be open to adjustments.

“Being that we’re just into year No. 2, it’s obvious when you make that big of a change, there are going to be issues,” he said. “I have some questions about it … I’m working with different associations and patients, getting input to see what we can do to help create a better system.”

One area organization that receives some funding from AmeriHealth is Youth and Shelter Services of Marshall County, and director David Hicks said the state’s Medicaid system is inconsistent.

“We don’t receive a lot of funding, but we do receive funding from AmeriHealth … I do know that, within the three MCOs, there’s just three different sorts of rules and billings and procedures with all three, so it’s very inconsistent,” he said.

Hicks said some issues the non-profit has had with AmeriHealth are inconsistency with service and delayed payments.

“A lot of times we’ll submit billings, but they would see an error or an issue, and then they would shoot it back to us for correction or clarification, then we shoot it back to them,” he said. “By the time that happens, we’re looking at a month, month-and-a-half, maybe two months down the road [from] when we provided the service, but we haven’t received the fee.”

Fisher said Medicaid has expanded since the three private, for-profit companies came online last year.

“It’s very difficult to control the growth in the costs,” he said. “Switching to the private health care managers was an attempt to control those costs; I think it has, to some extent, but still the shear size of Medicaid continues to grow.”

Smith said the system has not worked.

“It was proposed to be a cost-saving measure, and what we’ve seen are requests for additional money to operate the program,” he said. “We didn’t seem to be having that problem before the decision was made to go to managed care.”

Smith and Edler joined Fisher in saying they had heard complaints from Medicaid beneficiaries working with AmeriHealth.

“I’ve actually helped several different providers get in touch with the MCOs to get their reimbursement,” Edler said. “I’ve always been able, once I’ve got that contact, to get the payment.”

Upon hearing the news of the move Tuesday, Hicks said he felt for the people who would have to be re-assigned to a different MCO within a few weeks. He said YSS clients in and outside of Marshalltown may be impacted by the change.

“Probably not so much here in our branch in Marshalltown, but in Ames, where they do a lot more behavioral health with Medicaid, there may be some issues, there,” Hicks said. “I think our fiscal department is nimble enough that we’ll work through this, just like we did when all three [MCOs] came on at the same time; we’ll navigate this.”

He also said he’s concerned for AmeriHealth employees.

“I think there’s a lot of great people that work for that company that are going to be out of work right before the holidays,” Hicks said. “We’ll see how it affects us as a nonprofit, but, maybe most importantly, how we advocate for those that we serve.”

A request for proposal has been released for a new MCO, according to the Iowa Department of Human Services, and the new option is expected to be brought into the market by July 1, 2018.

“Just from my vantage point, it hasn’t been effective because we don’t have consistency across the three MCOs, because they do such different styles and cover different things,” Hicks said of the private Medicaid system. “Before, there was one state-paid, managed and all funneled through one area; Everyone was on the same page, I felt that there was some equity with that; maybe not so much now.”


Contact Adam Sodders at (641) 753-6611 or asodders@timesrepublican.com