Managed Care | Year One The Iowa Medicaid program sees successes, and continued challenges

It’s been one year since the state handed over its Medicaid program with nearly 600,000 poor and disabled Iowans to three private insurance companies.

What a year it’s been.

Providers ran into billing issues, complaining that the insurers were not paying them properly or on time. AmeriHealth Caritas Iowa, Amerigroup Iowa and UnitedHealthcare of the River Valley all lost more than $100 million during their first year of operation.

And most recently, the state of Iowa has opted to enter into a risk corridor agreement — in which the government steps in to help protect insurers from unexpectedly high losses by paying the difference if an insurer spends more in medical care than it collects in revenue. The price tag for the state is $10 million, with another $225 million from the federal government.

“The first year has been spent trying to resolve mechanical issues — prior authorizations, payment and contract issues. We could do well to spend more time next year helping the MCOs understand the services we provide in the community.”

– Dan Strellner

President, Abbe Inc.

It hasn’t been all negative — 238,000 Medicaid beneficiaries have received a health risk assessment, which gets them targeted care coordination earlier; the state has worked to put out quarterly reports showing if MCOs are meeting previously agreed upon benchmarks; and the state reports that hospital admissions and readmissions are down for the Medicaid population.

The Gazette spoke with a number of different stakeholders about the first year of Medicaid managed care as well as their hopes for year No. 2.

The three managed-care organizations either declined request for an interview or did not respond to The Gazette’s request.