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State's Managed Care Readiness at Second Oversight Committee

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During the 2015 legislative session, legislators knew there would be issues that needed to be addressed as the state moved its Medicaid system into managed care.  That's why they created the Legislative Health Policy Oversight Committee - so key legislators could get updates on the transition, look at data once managed care begins, get public input and hear concerns, and make recommendations that will improve the Medicaid managed care system.  

Ten legislators serve on this group - evenly split between House/Senate, and Republican/Democrat.  So any decisions made by this committee must be supported by both parties, and acceptable to both the House and Senate. The co-chairs of the Health & Human Services Budget Subcommittee are also the co-chairs of this committee (Rep. Dave Heaton of Mt. Pleasant and Sen. Amanda Ragan of Mason City).  You can see who serves on this committee here.

The committee met for the first time in early November, before many managed care organizations (MCOs) had contracts with providers and before rates were available.  At that meeting, there were definitely more questions than answers, and some legislators were frustrated that the state was not further along. Some on the committee called for a vote to slow the process down and delay the January 1 start date. That vote failed (5-5).  Other committee members said the state needs to keep moving in order to meet its goals, and argued that managed care will eventually not only save the state money, but provide people with more flexible options.  It was clear members of the public attending the meeting were frustrated too. Dozens asked to stop or slow the start of managed care, and  more than 40 people submitted public comment.  You can read a staff summary of this meeting here.

The committee met again on Monday, December 7, and devoted even more time (nearly two hours) to public comment. More than 200 people came to the Capitol for the meeting, most had to sit in the hall and watch the meeting on TVs.  While many of these advocates took the opportunity to speak to members of the committee, others said they were there for emotional support.  To date, the committee has accepted more than 159 written comments, and heard testimony from many more.  The same themes came up once again during these comments:

  • Slow this down so we can do it right.
  • People still do not have the information they need to make an informed decision in choosing an MCO.
  • There is a lack of coordination and a breakdown in communication.
  • Information that is provided is often conflicting, leaving people confused and frustrated and fearful.
  • Providers aren't signing up, contracts are complicated, and rates are not available to all.
  • Difficult to look up providers that have signed onto an MCO, particularly if you don't have the Internet.
  • Concern providers haven't been trained on new administrative practices but must be in compliance on January 1.
  • People don't see the benefit to managed care because of the confusion and chaos and lack of communication, and they are afraid that what is working for them will be taken away.

Legislators sat through nearly two hours of emotional testimony, as families pleaded for their children and people needing services expressed their frustration with the communications.  Public demonstrations are not allowed in legislative committee rooms, but those in the hallway were not shy with their applause as they watched the live-streamed meeting.  Several people receiving services from managed care companies in other states came to talk about the benefits they see in managed care.

We do not have the space to list all comments, but here are a few examples of what was said:

  • People keep saying that we fear change; it’s not change we fear, it’s the failure to answer our questions, to get basic answers about the care my daughter will receive, and where she’ll get that care. My daughter still has not received her enrollment packet, yet she must make a decision by December 17.  This is a fast track to disaster.
  • As a WellCare member from out of state, managed care was life-changing.  My advice to you: It has been a positive experience…don’t give up and find what works for you.
  • Let’s delay this process, take a little more time on implementation, and do it right by Iowans.  People are caught in a communication loop with no resolution – people call Medicaid through the Help Line; they are told to call the MCOs; they call the MCOs and are told to call each of their providers to see which networks they plan to participate in; they call their providers who say they are still working through that process.  It’s an unending loop, with no answers.

  • I am a parent of three kids that receive Medicaid services. We received their enrollment packages on November 27, and all three kids were assigned to different MCOs. This is just not something that should be done quickly and without proper preparation.
  • My son receives services through the HCBS waiver.  Medicaid is a one-stop shop for the most needy Iowans – this should not be rushed.
  • As a parent of a son with cerebral palsy, there are two things I want to say: 1) we do not have a list of providers that have signed contracts with MCOs, so we do not know where to go and how far we will have to travel for medical care; and 2) information has been hard to find and impossible to grasp, and most times we have gotten conflicting information from Medicaid and MCOs.
  • I am the parent of a daughter with mental illness and other disabilities; she is successfully and happily employed as cashier at local grocery store on a part-time basis. She is a loyal and dependable worker, but makes minimum wage and has no benefits, so depends upon Medicaid to help pay for the services she needs.  Her hope and mine is that she can find a full-time position with benefits that allow her to be self-sufficient and independent. 
  • There are no primary care physicians signed up with MCOs as of today in Dubuque County, and none of the MCOs have contracted with psychiatrists anywhere in the state.
  • Our son spent 4 months in NICU after he was born, and at the age of four has already had 11 surgeries.  They have had great difficulty with this transition, and the lack of information about their child’s care is causing huge strain on the family.  I keep asking myself, Will my son survive this change to managed care?  And I ask you - are you willing to risk my son’s life? Because that is what you are asking us to do, risk his life.  This is not right, taking the most fragile population and risking their lives.  The right decision is to slow down.

After a long day of status updates and testimony, the committee again took a vote on whether to slow down managed care, but it failed 5-5 (Republicans against, Democrats for).  Republicans said the motion was outside the charge of the committee.  Rep. Joel Fry reminded his colleagues that they had not passed legislation that started us down the path to managed care.  "This was the Governor's call," said Rep. Fry.  He said that the committee’s charge was not to recommend legislation or weigh in on managed care, but to provide a venue for people to have their issues addressed. 

Want more?

  • Watch as much (or little) of the five-hour December 7 meeting on YouTube hereFor those of you nervous about telling your story, there are some great examples on this video stream! 

  • You can read all of the comments submitted so far to the committee here Again, if you want to write your legislator and want some examples, this is the place to find them.  But remember not to copy - your story is best told by you.

  • If you want to submit comments, its not too late!  You can send your comments to patty.funaro@legis.iowa.gov.  Put "Health Policy Oversight Committee - Public Comment" in the subject line of your email.  You can also mail your comments to Health Policy Oversight Committee, c/o Patty Funaro, State Capitol, Des Moines, Iowa 50309.

  • Finally, you can send the members of the Health Policy Oversight Committee your comments directly using our online Grassroots Action Center here.