Among the concerns... Providers were being given false and contradictory information by the state and by the MCOs. Other MCOs who failed to land bids with the state issued complaints of cronyism -- a complaint that has been substantiated by state courts. Providers were being asked to sign off on provider contracts with little information. Medicaid recipients were being told to sign up with MCOs, even though they had little information about which of their doctors, case managers, or hospitals were signed with the MCOs, if any. The call centers offered little substantive information for confused recipients -- or they experienced dropped calls after hours of waiting to speak to somebody.
The Centers for Medicare & Medicaid Services (CMS) has been in Iowas reviewing Iowa's transition progress. They are the federal agency who is ultimately charged with approving Branstad's transition plan. Advocates have been pushing CMS hard to delay Iowa's Medicaid modernization plan due to its lack of readiness.
Today was the day when Medicaid recipients were supposed to be signed up with one of the four MCOs. Today is also the day that CMS told Branstad and Iowa to delay implementation of its Medicaid Modernization process:
Federal administrators have ordered Iowa to wait at least 60 days before shifting its Medicaid program to private management...I have read a copy of the letter written by CMS director Vikki Wachino to Medicaid director Mikki Stier. Here were some of their findings (as of 12/11/15):
One of the main complaints has been that Iowa Medicaid participants were supposed to choose a managed-care plan by Thursday, even though they had little information about which plans their doctors, hospitals and other health care providers would participate in.
Branstad needs federal permission to make the switch, because the federal government pays more than half the cost of Medicaid. The Centers for Medicare and Medicaid Services administrators made their position known Thursday in a letter to the state’s Medicaid director, Mikki Stier.
“Based on our review last week of Iowa’s progress, as well as the information you have provided, CMS expects that we will ultimately be able to approve Iowa’s managed care waivers. However, we do not believe that Iowa is ready to make this transition Jan. 1,” the letter says. “CMS previously outlined the requirements to provide high quality, accessible care to Medicaid beneficiaries, and Iowa has not yet met those requirements, meaning that a transition on January 1 would risk serious disruptions in care for Medicaid beneficiaries.”
Only one MCO provider network contained more than 42% of non-critical access hospitals. Only one MCO provider network contained more than 18% of critical access hospitals and none of the MCOs contained more than 34% of critical access hospitals. None of the MCOs had contracted with more than 36% of elderly waiver agency providers and intellectual disability wavier agency providers for home and community based services (i.e., group homes, vocational providers, day programs, care aids, etc.). The MCOs had only contracted 13-33% of ICF/IDs (residential nursing facilities for severely mentally disabled individuals) -- and three of the four MCOs had only contracted with the ICF/IDs.
Additionally, they noted that the state call center representatives have done a horrible job with communicating with Medicaid recipients and family members. They reported a 49% abandonment rate on calls to the call centers and 10,000 called drops in the first nine days of December. They also noted that callers received only small amounts of useful information when they were able to actually get through to call center representatives. There were also concerns that Iowa still lacks "a fully-functioning LTSS (long-term services and supports) Ombudsman to assist Iowa's elderly and disabled communities with this transition to modernized Medicaid.
Iowa's transition to managed care has been pushed back to March 1, 2016 -- but will need to show that they have met sixteen different signs of readiness in order to get approval to fully transition by that date. In other words, this process might continue to get pushed back further and further in time if Iowa Medicaid Enterprise continues to flounder with its preparations.
Governor Terry Branstad issued this statement following CMS' decision:
The decision by CMS formally puts the wheels in motion to implement our Medicaid Modernization plan on March 1...The CMS letter effectively gives the green light to Iowa as long as steps are taken to build on the progress already made. Iowa’s Medicaid Modernization plan is similar to plans CMS has approved in 39 other states. From the very beginning, our focus has been on improving patients’ health outcomes. Current Medicaid patients should continue working with their Managed Care Organizations for a March 1 kick-off.AFSCME Iowa Council 61 President Danny Homan issued this statement following CMS' decision:
All across Iowa, we have been hearing about the massive confusion that has been caused by Branstad-Reynolds Medicaid Outsourcing Plan. We are pleased that CMS has delayed the implementation of a transition for sixty days; the Branstad-Reynolds Administration is clearly not ready to implement any sort of changes at this time. The Branstad-Reynolds Administration needs to listen to Medicaid consumers. The health care of those counting on Medicaid must come first as CMS continues to evaluate the Branstad-Reynolds plan.I'm an AFSCME member, so I have always supported their opposition to Branstad's Medicaid modernization plans. But I also appreciate their continued reminder that Lt. Governor Kim Reynolds is also part of their executive governmental team effort to outsource Iowa's Medicaid dollars to out-of-state for-profit MCOs.