for week ending
November 7, 2015
News from the State Capitol
Rep. Sandy Salmon
We enjoy hosting visitors from District 63
and from around Iowa:
Waverly Rotary Club Oktoberfest Fundraiser
My husband and I are with Marv Walston (center) of Waverly, who enthusiastically spearheaded the Waverly Rotary Club’s effort to raise money for Rotary’s worldwide humanitarian projects in Third World countries, such as eradicating polio and providing clean drinking water.
Medicaid Moving to Managed Care
Iowa’s Medicaid program is currently in the process of transitioning to managed care, called “Iowa Health Link.” Medicaid managed care is set to begin on January 1, 2016. The Medicaid program currently serves nearly 600,000 Iowans each year, which is about 22% of Iowa’s population.
Over the last few years, the Medicaid budget has been a budgetary challenge for the state due to costs increasing and money from the federal government decreasing. The cost of delivering this program has grown by 73 percent since 2003. Medicaid expenditures are currently projected to grow by 21 percent in the next three years. Currently $4.2 billion is spent each year on Medicaid services. With all of these challenges facing the state, in 2015 Governor Branstad decided to transition the Medicaid program to a managed care system.
More from the Waverly Rotary Club
Terry and Sandy Dahlquist (seated) of Waverly are sharing a laugh with Jim Moeller (standing) of Denver. Jim was the tuba player in the German band whose enjoyable music lent to the Oktoberfest atmosphere.
Over 70% of the total Medicaid enrollment in the United States receive Medicaid benefits through managed care. All states except Alaska and Wyoming have all, or a portion of their Medicaid population enrolled in managed care. (In Iowa have had a couple smaller subsets of our Iowa Medicaid population on managed care already.)
In a managed care system, Iowa Medicaid Enterprise will contract with managed care organizations (MCOs) to pay for health care services. These MCOs will then contract with providers across the state to provide care to Medicaid recipients. The goal of the program is to improve coordination of care and access to care, have greater accountability for outcomes, and create a more predictable and sustainable Medicaid budget for the Iowa taxpayer.
Iowa Dept. of Human Services (DHS) is currently working with the Centers for Medicare and Medicaid Services (CMS) to obtain the authority necessary from the federal government to implement this new managed care model. Federal approval has not been given yet.
Wartburg at the Rotary Oktoberfest
Popular Wartburg College’s men’s choral group Vesterburg treated us to a variety of musical selections including the Wartburg College loyalty song.
Contracts have been signed with the following four managed care companies: Amerigroup Iowa, AmeriHealth Caritas Iowa, UnitedHealthcare Plan of the River Valley, and Wellcare of Iowa.
Amerigroup currently serves about 3.5 million members in 12 states nationwide. Together with their affiliated health plans, they serve 5.5 million people in 19 states, making them the nation’s leading provider of health care solutions for public programs.
AmeriHealth Caritas serve 6.6 million people in 15 states and the District of Columbia.
Wellcare serves about 3.8 million members and employs over 6,000 people nationwide.
Tenenbaum’s Jewelry Grand Re-opening
We enjoyed a tour hosted by Waverly’s Tenenbaum’s Jewelry owner Tom Rasmussen and his staff employees in their newly remodeled store. It is much larger to better accommodate more customers and improvements were made to showcase their merchandise.
Member and Provider Information
DHS has worked with the four companies to hold almost 90 public and stakeholder meetings since the transition was announced.
|Overview of Enrollment Process
|Intro Mailings to Members by Population
||MCO Enrollment Begins
||MCO Enrollment Continues
||12/17/15 - Last day to make MCO Choice for 1/1/2016
||1/1/16 - MCO Coverage Begins
||3/19/16 - Member must have “good cause” to change MCO
All Medicaid members will be able to keep their current medical providers, mental health providers, and case manager until at least June 30, 2016 as long as their providers choose to contract with the MCOs. Member enrollment packets will be mailed October through November. Each member will receive a tentative MCO assignment. Members can choose to change their MCO assignment until December 17. After their assignment, they get an additional 90 days to change their MCO for any reason. Iowa Medicaid Member Services will serve as the Enrollment Broker for members and is responsible for providing information and choice counseling for members in their selection of a MCO. Members can utilize the following resources:
“Courage for Drake” Presentation at Waverly-Shell Rock High School
Member benefits will not change. However, members’ providers may change if they choose not to contract with a MCO.
Coach Mark Bigler from Davenport West, whose parents Lloyd and Mavis live in Waverly, shares the riveting story of how his 5-month old grandson Drake was killed by a drunk driver. Students were “pin-dropping” quiet as he exhorted them to not drink and drive and to discourage others from doing it as well.
Providers across the state are encouraged to contract with each of the four MCOs to continue providing care to Medicaid members. Contact information for providers seeking to contract with the MCOs can be found below.
Iowa Health and Wellness Plan (IHAWP) members will also be a part of the managed care company transition. They will still need to engage in healthy behaviors. IHAWP members who complete their healthy behavior requirements each year will not be charged a monthly contribution the following year.
More from “Courage for Drake”
Waverly-Shell Rock students are urged to consider the seriousness of drunk driving as the video of Drake Bigler reveals the tremendous life-changing pain and sorrow that can come from such foolish, self-centered, and thoughtless activity.
Concerns about this Change
On November 3rd, the Health Policy Oversight Committee was held at the Capitol to get an update on the transition to Medicaid managed care in Iowa.
One of the comments from providers and the public was that managed care is happening too fast. They were saying the timeline is too aggressive, and we need to slow the process down. What they may not realize is that there are transition time frames after the January 1st beginning date already built into the changeover in order to serve as a safeguard for Medicaid recipients. For physical and behavioral health services, there will be a 6-month transition period from January 1 to July 1. They have the shortest timeline because behavioral health is the only sector of Iowa Medicaid that was already operating under managed care but through a different company. Home and Community Based Services case managers will have a year to fully transition into managed care, thus they have until December 31, 2016. Finally, nursing facilities will have a two-year transition period and will be fully transitioned by January 1, 2018.
Another complaint was that DHS has not given sufficient notice to Medicaid members about this change. However, informational toolkits were sent to members in September. Enrollment packets with enrollment assistance details are being mailed to members in November. Many of these items could have been completed sooner if not for the federal government making Iowa navigate additional roadblocks in an apparent attempt to slow or upend the process.
“Courage for Drake” Presentation at Denver Schools
Denver High School and Middle School Principal Paul Gebel introduces Coach Mark Bigler to the high school and middle school students. Mark Bigler is a familiar face in Denver as he taught and coached there in the 80’s.
DHS has felt their outreach to members has been significant. The department has held four public hearings, twenty-two provider training sessions, several focus groups, plus twenty-two stakeholder kick-off meetings, not to mention conference calls, workgroups, and presentations at seventy meetings and conferences since June. Members can contact member services at 1-800-338-8366 from 8 a.m. to 5 p.m. Monday through Friday and speak with someone directly. They can also select their managed care company through a voice system available 24/7.
Some committee members wanted to postpone implementation of the Medicaid Managed Care Program by six months. If this were to happen, the 2016 Legislature would need to immediately find an additional $51 million in revenue to support the Medicaid program with no increase to services or rates. In light of the .1% revenue growth to date for the fiscal year, where will that money come from? These same members failed to offer any type of alternative to the managed care effort to meet the critical goals of care coordination, access to care and predictability and sustainability for the state’s Medicaid budget.
The next Health Policy Oversight Committee meeting will be held December 7th.
More from “Courage for Drake” in Denver
Coach Mark Bigler shared his story with the students at Denver. I am working on legislation to strengthen our drunk driving laws by requiring all convicted first-time OWI offenders to have an ignition interlock device just as 2nd-time or more convicted OWI offenders must do.
Feel free to contact me with ideas, thoughts, and concerns. My phone is 319-987-3021 or you can email me at firstname.lastname@example.org. I want to hear what you are thinking and will listen to your input. Together we will work to make a difference for the future of Iowa. Thank you very much for the honor of representing you!