SIOUX CITY | After lawsuits, protests and two delays, Gov. Terry Branstad's plan to shift management of Iowa's Medicaid program to private, out-of-state, for-profit health care companies goes into effect Friday, three months later than it was supposed to.
Don Dew, a Medicaid beneficiary and director of the Disabilities Resource Center of Siouxland, said Tuesday two of his providers hadn't signed contracts with Amerigroup Iowa, the managed care organization (MCO) he was assigned. One of those providers is affiliated with CNOS in Dakota Dunes.
Spokeswoman Ashley Mozak said Wednesday CNOS has signed contracts with all three MCOs and is ready for the transition.
Dew, who has epilepsy, is hopeful he won't have to travel nearly five hours to Iowa City to see a neurologist.
"It's really a wait-and-see. But I think what we'll end up seeing is a lot of problems come April 1," he said.
Medicaid, a federal-state insurance program for the poor and disabled, was supposed to be privatized Jan. 1, but the Centers for Medicare & Medicaid Services said Iowa wasn't ready to make the transition by Branstad's deadline and delayed it.
The Branstad administration projects that moving Iowa's 560,000 Medicaid beneficiaries to its new managed care program, IA Health Link, will save the state $47 million in the first six months, down about $4 million from original estimates.
Siouxland Community Health Center and UnityPoint Health -- UnityPoint Health-St. Luke's parent company -- have signed contracts with all three MCOs hired by the state of Iowa to help run its $4 billion Medicaid program. The MCOs must offer the same benefits as the previous Medicaid program.
"We are continuing to help prepare our staff and patients for the transition by providing them facts Iowa Medicaid members should know about the new program," said Sabra Rosener, vice president of government relations for UnityPoint Health.
"UnityPoint Health is contracted with all three MCOs in the new Medicaid program – Amerigroup Iowa, AmeriHealth Caritas and UnitedHealthcare. This means if members already receive care from UnityPoint Health, they can continue their care as usual no matter which MCO or plan they choose."
Executive director Karen Van De Steeg said the June E. Nylen Cancer Center is also working with all three approved MCOs.
"The cancer center is ready, but we have some concerns as to whether the MCOs are ready based upon their additional requests for information," she said.
Mari Kaptain-Dahlen, Siouxland Community Health Center's CEO, said outstanding questions remain about how the processes will work for each of the three MCOs, but she said the health center's goal is to make the implementation a "seamless, smooth transition" for patients.
She said staff are contacting patients who have appointments next week to pre-register them and ask which plan they are enrolled in.
"We are reminding patients that the most important item to bring to their appointment is their card from the MCO that has their Medicaid number," she said. "Once patients are registered in our system with their new health plan, we will be able to work with the plan to make sure that patients receive the care they need."
Dave Smetter, Mercy Medical Center's vice president of communications and community development, said the Sioux City hospital has signed contracts with AmeriHealth Caritas and Amerigroup Iowa. Negotiations are ongoing with UnitedHealthcare Plan of the River Valley, but he said Monday Mercy won't have a signed agreement with the MCO by Friday.
"Mercy staff is working with AmeriHealth Caritas and Amerigroup to understand their policies and procedures for providing patient care to their customers," he said. "We are prepared to educate patients as they present themselves at Mercy."
None of the MCOs have been able to negotiate contracts with the Mayo Clinic in Rochester, Minnesota. In the meantime, the medical center, which is a world leader in cancer care and research, has agreed to accept Iowa Medicaid patients who can't get the same treatment elsewhere on a case-by-case basis after April 1.
Dew said he knows local residents covered by Medicaid who receive care at the Mayo Clinic.
"That's risking life right there. That's one reason why people have been going to the Mayo Clinic," he said. "To then say, 'Well, you can go to Iowa City.' If they could have, then they would have."
Smetter said patients should know which MCO they are covered by. However, he said, all patients who come to Mercy's emergency department will be seen by a physician and stabilized.
Rosener said UnityPoint Health is advising Medicaid beneficiaries to make sure that their primary care physician's name is listed on their new identification cards. According to information posted on the Iowa Department of Human Services' website, patients should have received cards from their MCO by Friday.
If beneficiaries' cards don't list a primary care physician or have the incorrect doctor listed, Rosener said they will need to call their MCO to get a new card. Those who need to select a primary care doctor in their new plan must also call their MCO. The MCO will help find a doctor who is taking new patients. The deadline to change MCOs is June 16.
Dew said Medicaid beneficiaries will also have to take steps to ensure they have non-emergency medical transportation. Each MCO has a contract with a different transportation provider.
"Once you find out who your MCO is, then you have to find out who your transportation person is going to be. Then you have to get signed up with them," he said. "You need to actually be doing that this week if you have an appointment in April."