Medicaid Transition to Privatization Underway

Medicaid Transition to Privatization Underway

Area healthcare and health service providers who care for Iowa’s low-income residents through Medicaid began the transition to privatized care effective April 1.  Traditional Iowa Medicaid patients will now be under the supervision of three state contracted health plans or Managed Care Organizations (MCOs): Amerigroup Iowa, Inc., AmeriHealth Caritas Iowa, Inc., and UnitedHealthcare Plan of the River Valley, Inc. Together these three MCOs will oversee the care of approximately 608,000 Medicaid patients across the state.

Locally, each primary care medical provider, mental health provider, and long-term care facility contracted with MCOs with which it wanted to do business. For example, Grinnell Regional Medical Center and the GRMC affiliated clinics currently have contracts with Amerigroup Iowa, Inc., and AmeriHealth Caritas Iowa, Inc. Mayflower, St. Francis Manor, and Grinnell Health Center have contracted with all three MCO providers. Physicians’ clinics and mental health clinics have contracted with at least one provider, with the option to add an MCO in the future.

The MCO transition is complicated because Hawk-I plans are considered separate from the adult plans, and both patients and providers have the opportunity to make changes. Medicaid patients have been auto-enrolled into one of the three MCOs and should receive a member ID cards via the mail. The patient’s primary care doctor’s name should be listed on the member ID insurance card. If a member missed receiving a card in the mail, he or she may contact the member service number to get in contact with their assigned MCO. Important to note, if a patient’s local provider is not contracted as an in-network provider, patients will have the option to switch MCO carriers until June 16, 2016.Medicaid members with questions about the primary care doctor listed on the card or do not know which MCO has been assigned should call Iowa Medicaid Member Services at 1-800-338-8366.

“We were changing signage and flyers almost daily in the past month as the rules and implementation plans were unrolled,” says Joann Salsman, GRMC’s patient billing manager. “Big transitions that affect a large population have so many adjustments as the state and MCOs solidified the nuts and bolts of each plan and process. We continue to work on the process here at the hospital to ensure, to the best of our ability, our patient’s experience with this transition is a positive one.”

“On Friday, April 1, we experienced a large volume of calls and meetings with patients as they tried to set up their provider relationships to coincide with MCO at Grinnell Regional Medical Center,” Salsman says. “Overall, the transition is going as expected considering the magnitude of the change and the nuances of the program.”

“Grinnell Regional remains committed to serving all community members, regardless of insurance status,” says Kyle Wilcox, GRMC vice president of finance. “With that, we also remain committed to providing the highest quality experience through amazing team members, excellent facilities, and the best technology. To accommodate both commitments, we believe AmeriGroup and AmeriHealth have provided GRMC a fair contract to serve our community members who use Medicaid health benefits. We will continue to work with the third Medicaid Managed Care contractor to find a mutually beneficial arrangement but do not have a sense of when that arrangement will be accomplished.”

Anyone needing help with enrolling or switching plans may call Iowa Medicaid Member Services at 1-800-338-8366. Medicaid representatives are available Monday through Friday, 8 a.m. to 5p.m.

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