With six weeks to go before Iowa’s Medicaid program is tentatively scheduled to become privately managed, Medicaid Director Mikki Stier says she's "very confident" Iowa will be ready. The federal government delayed the state's plans to privatize Medicaid on New Year's Day, despite Gov. Terry Branstad and Iowa's Department of Human Services insisting the state was ready to make the switch.
One reason the Centers for Medicare and Medicaid Services cited for not allowing privatization to go forward was a lack of providers who had signed with the managed care organizations, or MCOs. Stier told the Senate Human Resources Committee on Monday that 75 percent of Medicaid providers have now signed with at least one MCO, and 45 percent have signed with all three.
"It's a broad network of providers," says Stier.
Democratic Sen. Joe Bolkcom of Iowa City says this number doesn’t seem sufficient, considering how near Iowa is to the privatization date of March 1.
"In order to have the choice that most consumers are going to want, and we really do want all of the providers to sign up with each of the companies," says Bolkcom. "We’re only at 45 percent...which I think is grossly inadequate."
The health policy group The Kaiser Family Foundation says privately-managed Medicaid programs should have a robust network of providers to meet the needs of patients. However, there is no suggested threshold from most researchers or CMS as to what quantifies as "adequate." The main concern is that patients won't have to choose between two providers they've seen over the years, or go out-of-network for care.
Another issue Stier says her department has addressed is a lack of communication between Medicaid recipients and the state. CMS says that in the first nine days of December, 49 percent of people who phoned Iowa’s Medicaid call center for information ended up disconnecting before speaking to someone. Medicaid patients were having a hard time getting through, in part because the call center needed more staff.
"Right now, with us adding that additional staff," says Stier, "our average wait time is about 2.4 minutes, three minutes, and it can go up as high as seven minutes, right now; and in the last two weeks, this is what we’ve tracked."
Several other concerns CMS listed in its denial letter for the January state date included worries about administrative burden and expense associated with out-of-network providers, a lack of information on provider reimbursement rates, and no fully-functioning long-term services and supports ombudsman office to field complaints against MCOs.
When DHS Director Chuck Palmer was asked to quantify the readiness of state's Medicaid system, he wasn't able to say.
"We would love to know, and so we're asking (CMS) the same question," says Palmer. "The plans are approved, they're regularly monitoring those on weekly information, we have not heard anything that caused us to believe that we are not making satisfactory progress."