In a reversal of an earlier decision by the state, Medicaid beneficiaries who had chosen Amerigroup Iowa as their 2018 managed-care organization instead will be covered by a state program, according to a post on the Department of Human Service’s website Monday.

AmeriHealth Caritas members who had chosen Amerigroup Iowa as their managed-care organization by a Nov. 16 deadline “will have coverage through Iowa Medicaid Fee-for-Service” as Amerigroup has said it currently does not have the capacity to accept new members, the department’s post said.

The information was posted without any additional public statement from the department. A department spokesman could not immediately be reached for comment.

Fee-for-service and managed care are two different ways to pay the bills, Rep. Liz Mathis, D-Hiawatha, said. Under fee-for-service, a Medicaid member would be charged per doctor appoint or service, she noted.

However, the two approaches also differ philosophically. Managed care, she said, would take a more wholistic look to help ensure a patient’s long-term health.

Iowa transitioned the majority of its Medicaid program from Iowa Medicaid Fee-for-Service program to its current managed-care system in April 2016.

The state ultimately contracted with three insurers to administer its Medicaid program — including AmeriHealth, which announced at the end of October it was exiting the state program for 2018.

The two remaining managed-care organizations, Amerigroup and UnitedHealthcare of the River Valley, both re-signed contracts with the state for 2018.

However, early last week a department notice was sent to state lawmakers stating Amerigroup did not “have capacity to take any new members, including those who have actively chosen Amerigroup Iowa as their (managed-care organization).”

The department officials has said they are closely monitoring Amerigroup as it continues “ramping up their capacity.”

“Until that time, (Medicaid members) will have coverage through Iowa Medicaid Fee-for-Service,” the Monday website post continued.

UnitedHealthcare is the only managed-care organization available to some 213,000 members following Amerigroup’s announcement, as was noted in the post Monday.

“There’s really no choice there,” Mathis said. “I think that’s a problem, especially if you don’t want to go with (UnitedHealthcare) and you want to go with Amerigroup and you can’t.

“That’s not really what managed care is or what was promised to the state of Iowa.”

Some beneficiaries who switched to Amerigroup before the Nov. 16 deadline received letters tentatively confirming their assignment.

However, the department’s post said those letters were sent before the DHS was notified Amerigroup would not be taking new members, so they, too, will be moved to the state program.

Federal law dictates that states’ private Medicaid programs are required to provide a choice for its members. The notice from the Department of Human Services initially stated that the Centers for Medicaid and Medicare Services had approved a temporary suspension of the provision.

However, state and federal officials later said a federal approval wasn’t necessary for a temporary wave of choice.

Mathis said state lawmakers have been given assurance that the department and Iowa Medicaid Enterprises will ensure a smooth transition so Medicaid members are covered adequately.

“I think we just need to pay close attention over the next 30 days to make sure people are getting the services that they need and that UnitedHealthcare is working very hard to build up their case management,” Mathis said. “After all, they have to go from zero to 65 in a certain amount of days.”


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