Under the Golden Dome, Too

Time to question the status quo
     Happy holidays! With Thanksgiving in the rearview mirror and Christmas and New Year’s just around the corner, the 2016 legislative session is nearly upon us. Before I head back to serve in Des Moines, I’m really looking forward to spending some quality time with family and friends over the holiday season. I hope that you are also able to be with your loved ones as the year winds down.
     I have been receiving emails and calls since the end of last session regarding the state’s upcoming transition to Medicaid managed care. As your state representative, it is my duty to represent you in Des Moines and ensure that you are kept in the loop about your state government. This column will provide an update on the transition and hopefully answer any questions you may have about the status of Iowa Medicaid.
     Medicaid spending has increased rapidly over the last several years, which is limiting the Legislature’s ability to make meaningful investments in Iowans’ priorities.  Funding for things like education, public safety and courts are being put at risk because of the unsustainable growth in this inflexible federal program. This problem is not confined to Iowa, as every state is working to slow down the costs of Medicaid. 
     Protecting the status quo is no longer an option and we must be open to finding solutions to contain the ever-growing costs of Medicaid, while also improving patients outcomes
     In response to the increasing unpredictability, Gov. Terry Branstad in January proposed transitioning Iowa’s Medicaid program to a managed care model. What that means is that rather than state employees administering the program, private insurance companies will do so.
     Managed care is not a new concept nationally, or even in Iowa. Iowa has used a form of managed care since 1990 for a portion of the state’s Medicaid population. Across the country, nearly 40 states use some sort of managed care model for services, and more than half of Americans covered by Medicaid have their health care delivered through this system.
     One of the biggest concerns during this transition has been that the timeline is too aggressive and it’s moving too quickly. However, safeguards have been put in place to ensure that Medicaid recipients experience minimal disruption of services. For physical and mental health services, there will be a six-month transition period from Jan. 1 to July 1.  Those services have the shortest timeline because mental health is the only sector of Iowa Medicaid that was previously in managed care. Additionally, nursing homes will have a two-year transition period and will be fully phased in by Jan. 1, 2018.
     Last week, Gov. Branstad announced an extension of the provider safe harbor period by an additional three months to April 1, 2016. This gives patients peace of mind and allows providers to be fully reimbursed while they have additional time to review contracts.
     Another concern has been a lack of communication from the Department of Human Services.  Informational toolkits were sent to Medicaid recipients in September and enrollment packets with enrollment assistance details should already be out to members. The delay in providing information to Iowans was due to the fact that the federal government had to approve what material was being sent out, and they prevented DHS from sending it out sooner. 
     Currently, Medicaid members have until Dec. 17 to choose which MCO they would like to manage their care that begins on Jan. 1. While provider networks are not fully complete, I have been assured that new contracts adding more providers are being signed with MCOs on a daily basis. Members then have until March 18 – when provider networks are more complete and robust – to make a final decision on which MCO they would like to manage their health care.  
     With any big change comes some fear of the unknown. However, I am optimistic that as long as both the state, health care providers and consumers engage in constructive dialogue, Iowa’s Medicaid program will be better in future years. As this process moves forward, the Legislature will keep a close eye on the changes and assist our constituents to ensure they receive the care and services they need.
     Additionally, the Department of Human Services has established two toll-free hotlines to troubleshoot any problems that providers or consumers experience during the transition. If a consumer has questions, they should contact Iowa Medicaid Member Services at 800-338-8366. If a provider has questions, they should contact Iowa Medicaid Provider Services at 800-338-7909.
     If you have any questions at all about the state’s transition to managed care, please don’t hesitate to contact me. You can reach me at linda.upmeyer@legis.iowa.gov or (515) 281-3521.