The three healthcare companies taking over Iowa’s Medicaid system next week each say they are ready and that their network contains the vast majority of providers who have been serving Iowa’s Medicaid recipients.
"We have a very comprehensive network across the state and across all types of services," says Cheryl Harding of AmeriHealth Caritas.
Network adequacy was one reason the federal government delayed Iowa's implementation of privatized Medicaid. There were concerns that not enough providers had agreed to continue serving Medicaid recipients.
Some key providers, including the Mayo Clinic, have decided to not contract with the companies except on a case-by-case basis. Other providers have stopped serving Medicaid members completely, or discontinued certain services.
The Iowa Department of Human Services say these providers are outliers, but critics of privatization say they're proof that managed care doesn’t benefit patients.
Reasons for provider reluctance to work under a privatized Medicaid system include low reimbursement rates, and the increased administrative burden of submitting billing and credentialing to three separate healthcare companies. The healthcare companies say they're using many of the same forms and centralizing billing to make it easier for providers to continue serving Medicaid recipients.
"It's a very high collaboration of our three plans, and actually it’s refreshing," says Cynthia MacDonald of Amerigroup. "Are there some ways that we could work together, [to] figure out some of those streamline processes? I think we are highly motivated to do that."
Some legislators say that what the managed care companies are reporting is vastly different from what they're hearing from constituents.
Sen. Bill Dotzler says he's particularly concerned that providers aren't getting enough information about reimbursement rates. The Democrat from Waterloo adds it's not clear if certain services will continue to be provided.
"This is going to be pure chaos," says Dotzler. "I think this problem is systematic, and it's really going to be a huge problem."
DHS says the managed care model is a better way to coordinate patient care, which in turn saves money. Next week, Iowa Medicaid recipients begin to find out if privatization works.