Iowa: Providers fear managed care lock out

Tuesday, December 22, 2015

DES MOINES, Iowa – Stakeholders in Iowa say they have a number of concerns about the upcoming transition to IA Health Link, a new Medicaid managed care program, slated for Jan. 1, 2016.  

Iowa’s Department of Human Services in October finalized contracts to administer the plan with four managed care organizations (MCOs): Amerigroup Iowa, AmeriHealth Caritas Iowa, WellCare of Iowa, and UnitedHealthcare Plan of the River Valley.

While the MCOs are required to work with existing Medicaid providers, whether they are in-network with them or not, Rose Schafhauser says providers are still worried about getting locked out.

“Obviously, everybody’s nervous,” said Schafhauser, executive director of MAMES. “We’ve heard stories in other states where contracts weren’t being offered to everyone.”

There’s also concern among providers who have received contracts. Although the fee schedule is locked in at the current Medicaid reimbursement rate, the rates are only guaranteed until June 30, 2016.

“They’re sending us contracts that are a minimum of one year with renewal access, but we don’t have the fee schedule after July 1,” said Leila Wilkerson, director of Heritage Medical Equipment and Supply in Burlington. “We only know what we’re getting paid the first six months.”

Also at the forefront of providers’ minds: Univita, which in August filed for Chapter 7 bankruptcy a year after 10 of the 14 MCOs charged with running managed care plans in Florida contracted with the provider to administer DME, leaving providers scrambling to get paid.

“The (four MCOs) have done business with other state Medicaid programs in the past, so I feel like they have more experience than others,” said Wilkerson. “But there’s always a concern (that it could happen here).”



MCO's in Texas have pretty much been a disaster for us providers, unfortunately that has quickly become a disaster for the chilren that require services. Providers can only take it on the chin for a short while...... Then it's cash if you want it!