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Iowa awards two health care companies contracts for state Medicaid program | News

Iowa’s Medicaid advantages will likely be administered by three health insurance coverage companies, the state Department of Health and Human Services introduced Wednesday.

The state introduced its intent to award managed care contracts with Amerigroup Iowa and Molina Healthcare of Iowa. These new contracts will go into impact whereas the state finishes out its present contract with Iowa Total Care, which is ready to run out in 2025.

These companies will handle Iowa’s $7 billion program, which mixes federal and state funding for health care assist of greater than 790,000 disabled and low-income Iowans.

Amerigroup and Iowa Total Care have already got managed care contracts with the state, however the brand new settlement set a course for the long run. While Iowa HHS introduced the successful bids this week, the companies are nonetheless going by negotiations to finalize the agreements.

Iowa Medicaid Director Liz Matney stated these new contracts will take steps to mitigate present issues with the state system. The Legislature voted to denationalise Medicaid in 2016, a transfer which each medical suppliers and recipients stated created obstacles to accessing health care.

Matney, who assumed her present function in 2021, stated she spent the previous 12 months having discussions with folks enrolled within the program and health care suppliers to study what points existed. These new contracts will assist enhance Iowa Medicaid infrastructure, she stated, along with different steps the division is taking.

“While this managed care announcement is very huge and a long time coming, it is only one piece of the enormous amount of strategy and investment that we’re making to improve the overall Medicaid program,” she stated at a information convention Wednesday.

Changes from the contracts embrace new necessities on continuity of care, higher communication with health care suppliers on cost, and new testing for claims submissions.

Privatized Medicaid has confronted challenges for sufferers, suppliers

These new stipulations come following a rocky begin to the state program’s privatization. Iowa began out with three companies holding managed care contracts, however AmeriHealth Caritas withdrew in 2017, and UnitedHealthcare in 2019. Both companies reported main monetary losses due to their contracts with the state, concurrently recipients reported cuts to medical companies.

Amerigroup is the one firm which has regularly offered companies for the reason that state switched to a personal system. Iowa Total Care stepped in after UnitedHealthcare’s exit. Matney stated Molina was chosen to affix these companies as a result of it has expertise offering managed care companies in state insurance coverage marketplaces, working with greater than 5 million Medicaid and Medicare members nationwide.

“We really wanted to make sure we were choosing an entity that had proven experience and demonstrated positive outcomes,” Matney stated.

Kelly Garcia, director of the Iowa Department of Health and Human Services, praised Molina’s coming function in Iowa’s Medicaid program and the work Matney has accomplished to enhance the system.

“Under Director Matney’s leadership, the Iowa Medicaid program is really addressing the needs heard from the Iowans who rely on us,” Garcia stated in an announcement. “Making sure those we serve and those who advocate on their behalf are embedded in the conversation is the right thing to do and the work we’re doing reflects that.”

But some critics argued that irrespective of which companies administered the program, the privatized system itself would proceed to trigger issues.

“Privatized Medicaid has failed to save tax dollars or make Iowans healthier,” state Sen. Sarah Trone Garriott, D-Waukee, stated in an announcement. “Year after year, the Reynolds’ administration has disrupted the lives of Iowans while refusing to provide real oversight or accountability. Iowans need new leadership.”

There are not any fast adjustments for Medicaid recipients. The newly introduced four-year contracts with Amerigroup and Molina begin July 1, 2023.

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