Iowa organization worries about payments to providers amid Medicaid woes

Iowa Community Providers office in Urbandale. (Caroline Cummings.)

With AmeriHealth pulling out of Iowa's Medicaid program, one organization that represents providers has concerns about future payments to its members.

Earlier this month, the Iowa Department of Human Services announced that one of the three Managed Care Organizations that run Iowa's Medicaid program would be leaving November 30, leaving some 200,000 Iowans on AmeriHealth Caritas hanging in the balance.

Iowa Department of Human Services Director Jerry Foxhoven told a medical council that all of AmeriHealth's patients would be switched to United by December 1, so there would be no gap in coverage.

“We have sent out notices to all of the patients and we’re making this as seamless as it can be made,” Foxhoven told the group at the capitol on November 7.

Shelly Chandler is CEO of the Iowa Association for Community Providers, representing 140 organizations and 30,000 employees that help disabled Iowans. She has some concerns with how the transition of AmeriHealth patients to United will affect the providers she works with.

"When a single client moves from one MCO to another, there is a problem with providers getting paid," she said. "So to move over 200,000 people with now 17 days notice, I am very, very concerned about the 'seamless' transition for our members.”

The community providers she represents can be described as the "other side of healthcare," like psychiatrists, social workers and people providing residential, employment and therapy services. She says healthcare providers—like doctors—could face similar problems with outstanding payments, but not to the same degree community providers will.

"[Healthcare providers] receive third party insurance like blue cross blue shield, for example, private pay, then Medicaid," she said. “It’s not their whole revenue stream that’s going to be affected."

But for community providers, that's a different story.

“For the providers we represent, we are only Medicaid providers so it's all or nothing."

Chandler is pushing for a grace period of 90 days as over 200,000 patients make the switch and United writes up contracts with those providers who currently aren't in United's network. She said that starting December 1, when AmeriHealth patients are due to switch to United, some providers could start losing money if they don't already have contracts with United.

“Right now if you’re out of network, it’s an 80% payment. We want to make sure the provider is paid 100% as opposed to a 20% cut.”

She said she is trying to work out a deal with DHS, United and Amerigroup to enact this grace period, but she said none has committed to that yet.

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