On Eve of Medicaid Switchover, Transparency and Access Among Recipients' Chief Concerns

Mar 31, 2016

From tomorrow on, the previously state-run Medicaid system will be managed by private companies called "managed care organizations," or MCOs. In the lead-up to the switch, many of those who benefit from Medicaid have struggled with getting information about coverage, payment, and benefits.

"So far my family is utterly confused," says Heather Young. "My daughter got on the phone yesterday and was trying to get through but couldn’t get through the phones because they’re all jammed up and their hours are only until 6 o clock at night, so it’s going to be a process before we even get on the right plan." 

Three generations of Young's family are affected by Medicaid. Amy McCoy, public information officer with the Department of Human Services, says many of the kinks will get worked out with time.

"When someone has complex care needs, it is complex, there are a lot of moving pieces. That's exactly what the health plans are here to help do," she says. "As we go through this transition, we really do have to have people call to get connected, whether it's through their case manager or through their health plan."

But concerns remain for many recipients.  Karol Krotz says while many of her services are covered by the University of Iowa Hospitals and Clinics, which is signed up with all three managed care organizations, another one of her providers has faced hurdles in getting signed up with any of them.

"He has gotten no response from anybody and doesn't really know where he's standing, and he's very confused, the process is very confusing for him. So one of my questions would be: how can they make it easier for providers to sign up with all three who want to do that?"

McCoy points out that, despite news of high-profile providers like Mayo Clinic declining to sign contracts with any of the MCOs, more than 96% of the currently active in-state providers have signed with one of the MCOs, more than 75% have with two, and 70% have with all three.

"Those numbers are a little old, so I would expect that those would actually be even higher. But what those show is very robust networks across the three managed care organizations," McCoy says.

On this edition of River to Riverhost Ben Kieffer talks with Krotz, McCoy, and Young. Kim Foltz, CEO of United Healthcare of Iowa, and Cynthia MacDonald, Iowa president for Amerigroup, also join the program.