Big shift nears: Tips for using privatized Medicaid
By Tony Leys, email@example.com == 8:54 p.m. CDT March 25, 2016 - Des Moines Register
After months of delay and controversy, hundreds of thousands of poor or disabled Iowans are about to experience a dramatic shift in how they receive their health care.
Private companies are to start running the state's $4 billion Medicaid program on April 1, and Iowans have spent the past year hearing conflicting predictions about how the shift will go. Supporters expect some wrinkles. Critics expect a disaster.
Politicians and health-care leaders continue to argue about whether this change will help or hurt Medicaid participants, who make up more than one-sixth of all Iowans. But the experts agree on this advice for anyone facing the change: If you haven’t already done so, call your doctor, hospital and other health-care providers and ask if they’re signed up to participate in your new managed-care plan.
Q&A: Answers to some common questions about Medicaid changes
Many health-care providers in the state have signed contracts with at least one of the three national companies chosen for the job. If not, they can still provide care to Medicaid patients for a reduced payment, but they don’t have to.
Medicaid participants shouldn’t shy away from the subject just because it seems confusing and scary, said Deanna Clingan-Fischer, Iowa’s long-term care ombudsman. “If you have questions, ask them,” she said.
If they haven’t already, most Medicaid participants should be receiving cards in the next few days from one of the three national companies chosen for the job. State officials say all Medicaid participants — except for a few who have been exempted — have been assigned to one of the three companies, Amerigroup, AmeriHealth or UnitedHealthcare.
“Watch your mail. You’re going to get a lot of information by mail, so you’ll want to open that,” said Amy McCoy, a spokeswoman for the Iowa Department of Human Services. The cards should come in a large packet that includes an extensive booklet about the new plan, she said.
The shift to private Medicaid management was pushed through by Gov. Terry Branstad, who contends it will save the state millions of dollars while leading to more efficient and effective care for Medicaid participants. Critics fear it will lead to cuts in services as the national companies look for ways to profit.
It will be at least several months before we see whose predictions were right. In the meantime, experts urge Medicaid participants to look into the concrete ways the transition will affect them. “Plan now, not during an emergency or urgent situation,” McCoy said.
When going to appointments, participants should bring their new managed-care cards plus their existing cards from Medicaid or from Hawk-I, a related plan for children of moderate-income families. However, McCoy said people shouldn’t panic if they haven’t received a new card by the time they need to see a doctor or other health-care provider. Clinic staff members should be able to determine which managed-care plan patients are on, she said.
Amy Lorentzen McCoy, spokeswoman for Iowa Department of Human Services (Photo: Special to the Register)
McCoy suggested participants in the plans arrive early for their first health care appointments after the switch, to give clinic staff time to go over their new payment method. She predicted the process will settle down after an initial flurry of adjustment.
“We will have some bumps in the road,” she said.
Critics fear the bumps will be more like mountains.
“There are so many questions I can’t get answers to,” said Karol Krotz of Iowa City, who is on Medicaid because of a physical disability. Most of her care providers are affiliated with the University of Iowa, which has signed contracts with all three managed-care companies. That eases her mind about whether her providers will accept her new insurance. But she’s still worried about whether the managed-care companies will cover services she relies on, such as physical therapy and a dietitian’s advice.
Although she remains concerned, Krotz said some aspects of the situation are improving. For example, she said, the Human Services department phone center has become more responsive as staffing increased. Months ago, it took 45 minutes to get through. Now, she’s getting through within a few minutes. Krotz said the automated answering system can be baffling, so she’s taken to just pressing random numbers until a human picks up. “I pressed 2 because it’s between 1 and 3,” she said, chuckling.
Krotz noted that state officials and the managed-care companies often are urging people to go to their websites for information. But she said many Medicaid recipients lack easy access to the Internet. She suggests calling instead. And when asking about whether a service is covered, she said, “Don’t just take no for an answer.”
Iowa Department of Human Services:
Phone number: 800-338-8366 FREE
Phone number: 800-600-4441 FREE
Phone number: 855-332-2440 FREE
Phone number: 800-464-9484 FREE
A national group, the Patient Advocate Foundation, also has tips for people using managed care, which can be found atpatientadvocate.org/requests/publications/Managed-Care.pdf