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MCOs Say Thousands of Contracts Signed

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Managed care organizations (MCOs) and state Medicaid staff presented to the Legislative Health Policy Oversight Committee on December 7.  Here is what they talked about:

Mikki Stier, the state's Medicaid director, discussed problems with the state's Medicaid help line, and tech proglems that caused some family members to be split up among MCOs.

  1. Auto-Assignment Glitches: Over 100,000 Iowans were assigned to each MCO.  These assignments were to consider existing provider relationships in that assignment, and keep famillies in the same MCO. As sometimes happens with techonology, there was a glitch that caused at least two families to be split up.  According to Stier, the problem was not wide-spread and the situation has been fixed.

  2. Call Center Wait Times:  Iowans concerned about the change to managed care, or having questions about how the transition will impact them, were told to call the Medicaid Help Line.  Many people have complained that they were put on hold for hours, their calls were dropped, and questions went unanswered.  Stier reported that they had investigated these complaints and found that their vendor had never increased call capacity and had not added more lines as requested.  Those changes have now been made, and they have hired 24 more staff to take these calls. Stier added that they are now actively monitoring the lines to make sure calls are answered quickly.

The managed care organizations (MCOs) also updated committee members on their progress to date in signing up providers, and hiring staff.  Currently, there are 29,961 Medicaid providers in the state.*

  • Amerigroup reports that they have more than 8,000 providers signed up, including 11 hospitals. They have hired about 80% of their staff.
  • AmeriHealth Caritas has signed contracts with 2 major hospitals, and is very close to having contracts signed with 2 more.  They are just under 100% "critical position" staffing.
  • United Healthcare reports that it has hired 85% of its staff and has signed contracts with 4 large health systems (University of Iowa, UnityPoint, Genesis, Covenant). They also report having signed contracts with 50% of Medicaid’s current fee for service providers, 90% of the long-term HCBS providers signed up, and 80% of the Behavioral Health providers.  United Healthcare has been an insurance provider in Iowa for some time, so it has many existing relationships with providers (although these providers must sign separate agreements for the Medicaid population).
  • WellCare has signed a contract with one hospital system, with two others very close to being signed. They now have 5,300 providers under contract and are at 76% staff capacity. 

Medicaid staff and MCO representatives fielded many questions from legislators. Some wanted to know impacts on their providers, others wanted to know details about rates, but most wanted to know where the breakdown in communications was occuring, and how it can be fixed.  To sum it up - most legislators just wanted to know what to tell their constituents.  The biggest question was about providers - and how Iowans were to find out which providers had signed up with each MCO.  The MCOs responded that people should call them directly, and that the information is updated daily on their websites. You can find links to these websites here.

Rep. John Forbes, a pharmacist by trade, expressed disappointment in the numbers of providers signed to date.  "I'm disappointed with the numbers you are giving me - 8,000 out of 29,000 providers under contract? We are just 25 days away from the live date."  Rep. Lisa Heddens, who has a son that receives Medicaid services, expressed similar disappointment, saying the numbers presented were only 17-26% of the current Mediciad provider network.  That's one in four Medicaid providers - with less than a month to go before the system switches to managed care, and just days before people must choose an MCO (by December 17).

Legislators were pleased to find out all four MCOs planned to adopt the current Integrated Health Home model that has been operating in the state under the Magellan behavioral health managed care plan.  Providers who participated in this program were concerned that they would have to replace the current model that has been working for Iowans with mental illness with potentially four new models.

Medicaid staff reminded legislators that contracts are being signed every day, and that the numbers are continuing to grow dramatically each day.  After the meeting, Medicaid sent out this update on signed MCO provider contracts (click here).

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*You may have heard that there are about 40,000 Medicaid providers in the state. That is true - there are about 40,000 individual providers of Medicaid services.  However, many of them work for large health systems or work at the same clinic.  Iowa Medicaid tracks provider contracts by tax ID number, so those that bill together are counted as one contract (because they contract together).  By that standard, there are 29,961 Medicaid providers.  This is the number that Medicaid is using to track contracting.