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Insurer with biggest special-needs population exiting Iowa Medicaid program

AmeriHealth Caritas Iowa — the Medicaid insurer with the largest concentration of the state’s special-needs population — will withdraw from the Medicaid program at the end of November, officials announced Tuesday. 

The company covers one in four Iowans. 

The Department of Human Services already is searching for a replacement, DHS Director Jerry Foxhoven said during a news conference in Des Moines. A request-for-proposal is now online, and the new insurer will be available July 1, 2018.

“It isn’t a shock that we would lose one. Other states have lost (managed care organizations) as well,” Foxhoven said. “This has happened elsewhere. We’re not the first state to have MCOs decide they didn’t want to move forward with it and we won’t be the last, I’m sure.

“I don’t think we’ll have any problem finding another company to replace” AmeriHealth, he said. 

Foxhoven said the state is working with the insurers to achieve high-quality, cost-effective health care while ensuring sustainability to the program and state budget. To do that, the state has produced strong oversight expectations, he said.

“I think it’s indicative of we’re doing really continuous improvement,” Foxhoven said. “We’re trying to make this program as strong and robust as we can possibly make it. From time to time, that will mean a company may leave or enter. I don’t think that’s a challenge to the program.

“If anything, I think it’s a good thing because I think if you didn’t see any changes it would mean that we’re not holding anybody accountable or we’re not expecting any improvements.”

The more than 213,000 Iowans enrolled with AmeriHealth will be reassigned to the remaining two Medicaid insurers — Amerigroup Iowa and UnitedHealthcare of the River Valley — both of which re-signed contracts with the state. 

The state has agreed to raise the managed-care organization’s capitation rates — the per-member per-month fees — by 3.3 percent. Foxhoven said the state agency will not need to ask the Legislature for additional appropriations, noting the current budget will cover the increase.

“This is a very small increase when compared to other national trends and insurance carriers who are seeking a 57 percent increase,” he said, referring to Minnesota-based Medica.

Medica is the only insurer selling individual plans statewide on the Affordable Care Act marketplace.

DHS has developed a comprehensive transition plan and will closely monitor patients as they transition from one insurer to another. AmeriHealth enrollees will start coverage with their new insurer on Dec. 1, however, families have until March 1 to change insurers.

DHS officials said this is to ensure there is no gap in coverage or access to care.

“Members can see a doctor as they normally would, and they should watch their mail and our website for more details as it becomes available,” said DHS Deputy Director and Acting Medicaid Director Mikki Stier in a news release.

‘My heart is sinking’

But it may not be as simple as that for all AmeriHealth enrollees.

“We are at 99.5 percent of clients and business being with AmeriHealth,” said Marilyn Althoff, executive director of Hills and Dales, a Dubuque-based intermediate care facility. “We are really in a lurch on transitioning.”

Hills and Dales provides 24-hour care to nearly 50 medically fragile children and young adults who live there. The children have intellectual disabilities, physical disabilities or autism.

“It’s not as simple as changing a family doctor,” she said. “It’s very complex — they have complex pharmaceutical needs, therapy needs, durable medical equipment needs.”

And because the doctors group in Dubuque chose to sign only with AmeriHealth Caritas, Hills and Dales had to work with each of the 50 families to get the children switched over to that insurer.

“My heart is sinking right now thinking what we’re going to have to go through again,” she said.

AmeriHealth said it chose to withdraw from the state Medicaid program “after months of negotiations yielded no agreement on contract rates and terms,” adding it will now focus on working collaboratively with Iowa to provide a seamless transition.

“We wish the state of Iowa well as it continues this important program,” said Regional President of AmeriHealth Caritas Russell Gianforcaro in a statement.

Financial challenges

All three private insurers saw large financial losses — more than $500 million collectively — during their first year of operation in Iowa, but AmeriHealth by far saw the largest. The company lost nearly $300 million, while Amerigroup reported a loss of $133 million and UnitedHealthcare said it lost more than $100 million.

AmeriHealth lost another $65 million as of June 2017, according to Iowa Insurance Division financial disclosures.

To help deal with the losses, AmeriHealth announced a series of changes in early 2017 to better control costs, including moving case management services in-house and cutting reimbursement rates to home and community-based services providers.

AmeriHealth has the highest number of Medicaid enrollees, with more than 213,000 beneficiaries compared with Amerigroup Iowa’s 187,000 and UnitedHealthcare’s 167,000, according to the most recent DHS quarterly report.

The insurer also has the biggest share of the state’s special-needs population — with more than 23,300 beneficiaries receiving long-term services and supports, compared with Amerigroup’s 7,700 and UnitedHealthcare’s 6,500.

Long-term enrollees include elderly Medicaid beneficiaries as well as those with disabilities receiving waiver services.

Iowa Democrats said Tuesday’s announcement proves the decision to move to Medicaid managed care in 2016 was a mistake. A chorus of state senators, representatives and candidates for governor said the move has been a bad one for patients and providers, adding it’s time to reevaluate the system.

“For too long, Gov. (Kim) Reynolds and Republican legislators have been telling Iowans that the privatized Medicaid experiment was a huge success. That’s nonsense,” said Sen. Janet Petersen, D-Des Moines, the Senate Democratic Leader. “The best advice for Gov. Reynolds and legislative Republicans is this: ‘You’ve dug yourself into a hole. You need to stop digging.’”

Frosty Halloween fun (with photos)

MASON CITY | A chilly night and a little frost on the pumpkin did not stop scores of North Iowa children to hit the streets for trick-or-treat fun Tuesday night.

Expect a small warm-up the rest of the week with highs in the mid-40s through Saturday. Highs in the mid-50s — and rain — are forecast for Sunday. 

Reports: Iowan urged Trump campaign adviser to meet with Russians

ALEXANDRIA, Va. | As national co-chairman of Donald Trump's presidential campaign, Northwest Iowa's Sam Clovis encouraged a low-level foreign policy adviser to meet with Russian officials to build relations with the Kremlin, according to media reports Monday.

"Make the trip, if it is feasible," Clovis wrote in an August 2016 email to George Papadopoulos.

Papadopoulos, 30, a former researcher at the conservative Hudson Institute, was thrust Monday into the center of special counsel Robert Mueller's investigation into possible Russian meddling in the 2016 campaign. Papadopoulos, who was secretly arrested in July for lying to federal authorities, has pleaded guilty and is cooperating with Mueller's investigation, according to court papers unsealed Monday.

The campaign supervisor who sent the email to Papadopoulos was not identified in court documents, but the Washington Post and Yahoo News identified the supervisor as Clovis, who now serves as senior White House adviser to the U.S. Department of Agriculture.

In his plea filing, Papadopolous admitted that he told Trump and other top campaign national security officials during a March 31, 2016, meeting that he had contact with intermediaries for Russia who said they could set up a meeting between Trump and Russian President Vladimir Putin.

The statement does not describe Trump's reaction at the time but Papadopoulos continued to email campaign officials about a possible meeting with individuals claiming to work for the Russian government who were offering "dirt" in the form of emails from Democratic nominee Hillary Clinton.

Papadopoulos, who had no formal responsibilities, communicated most with Clovis and campaign chairman Paul Manafort, an official involved with the group told the Associated Press.

A separate raft of charges Mueller announced Monday against Manafort and his longtime aide Rick Gates do not appear to be directly related to their work for Trump.

White House press secretary Sarah Huckabee Sanders termed Papadopoulos' role with the campaign as "extremely limited."

Clovis "always vigorously opposed any Russian trip for Donald Trump and/or the campaign," Clovis' attorney, Victoria Toensing, said in a statement Monday to the Washington Post.

Toensing said Clovis was "being polite" when he encouraged Papadopoulos to meet with Russian officials in August, adding that the campaign had a "strict rule that no person could travel abroad as a representative of the campaign," the Washington Post reported. Clovis could not stop an American citizen from traveling abroad “in his personal capacity,” she added.

Clovis, a conservative Republican who joined Trump's campaign months before Iowa's first-in-the-nation presidential caucuses in February 2016, has been nominated by the president to be the top scientist at the U.S. Department of Agriculture. The nomination, which has sparked strong objections from environmental groups and some ag organizations, is scheduled for a confirmation hearing before the Senate Agriculture Committee on Nov. 9.

Clovis ran unsuccessfully for U.S. Senate in the Republican primary in June 2014 and lost to Democratic incumbent state Treasurer Michael Fitzgerald that fall. A former Morningside College economics professor, he took an extended leave of absence from the Sioux City school when he joined the Trump campaign as national co-chairman and chief policy adviser in August 2015. He also formerly hosted a Sioux City radio talk show.

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'Mason City is open for business': Former mayors support downtown project


MASON CITY | Two former Mason City mayors say they strongly support the River City Renaissance project and are urging voters to approve related ballot proposals Nov. 7. 

Roger Bang, who served one term as mayor and four terms as councilman, said Mason City residents need to see "the big picture" the project represents.

Jean Marinos, who also served as mayor and council member, said the project has far more positive aspects than negative ones.

Both point to recent successes in Mason City when residents have approved public projects. 

One of the ballot issues is to approve a lease agreement with Southbridge Mall for the ice arena/multipurpose center. The second is to issue $14 million in bonds for costs related to Gatehouse's hotel project in the mall's south parking lot. 

"We need to send a message that we're open for business," said Bang, who served on the council from 1987 to 2003 and as mayor from 2005 to 2009.

"As a city, we've gone through a rough patch," he said, referring to the Prestage controversy in 2016 and related events. "We've had some tough times. People have accused us of being bullies and racists, which of course is not true," he said.

Bang said the downtown project is an opportunity to turn things around. "We're at a crossroads," he said. "This project isn't perfect. No project is ever perfect. There's risk to it, but there's always a risk. The question is whether we can manage the risk, and I think we can," he said.

Marinos said:

• The project will cause no tax increase. 

• The arena — which will be an improved hockey venue — will pay taxes to the city, which would not occur if the city owned it. 

• The state will invest $7 million to $10 million in Mason City, money some other city will get if residents reject the plan. 

• The city will have a new conference center, multipurpose center and performing arts pavilion.

"I cannot think of any valid reason to vote 'no' on the two proposals," said Marinos, who served as mayor from 2003 to 2005 and council member from 2011 to 2015. "With a favorable vote, Mason City can move forward to a better economic future."  

Marinos and Bang's comments come in contrast to those of Mason City native Pat McGarvey, a retired Austin, Minnesota, city administrator and former interim administrator in Mason City, who opposes the project because of its risks.

McGarvey says he thinks the city is giving too much away. He believes the city should own the arena and should ask for more financial commitment from Gatehouse. 

Bang said Mason City voters have approved bond issues to support the Curries plant, to build the aquatic center, and to renovate the library, which was a stepping stone to the Vision Iowa project.

"All of those were risks the voters were willing to take on and all were managed successfully," he said. "It's time to move on."

Marinos said, "It was just 10 years ago when Mason City citizens approved a $7.6 million bond issue to renovate the library and to ensure the funding from Vision Iowa.

"Take a look around the downtown area and you will see what the positive vote has meant for our community — a renovated library, the Historic Park Inn Hotel, the Architectural Interpretive Center and the dynamic streetscape.

"Let's continue to invest in Mason City," Marinos said. 

barrd / msc