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Iowa Medical Society: Medicaid Managed Care Update

May 01, 2019

This week, staff from the IMS Center for Physician Advocacy met with Mike Randol, Iowa Medicaid Director, and Liz Matney, Bureau Chief for Managed Care Oversight and Supports, to discuss the impending departure of UnitedHealthcare (UHC) from Iowa Medicaid managed care system. In this meeting, they confirmed that the UnitedHealthcare transition plan, which is scheduled to be finalized this week, will include a June 30 end date for active administration of Medicaid benefits. With this impending departure and Iowa Total Care not scheduled to start taking Medicaid members until July 1, all newly eligible Medicaid patients will be assigned to Amerigroup.

State officials are still working to refine their reattribution model in light of the UHC departure, with the goal of as evenly dividing members between the two MCOs as possible. In the first week of May, they plan to mail new MCO assignments to those patients who were assigned to UHC during the last round of reattribution a few weeks ago. Those Amerigroup members who were reassigned to UHC from Amerigroup will be assigned back to Amerigroup and the remaining UHC assigned members will be evenly split between the two MCOs, as will 80,000 of the high-risk patients who were previously exempt from auto-assignment but allowed to choose an MCO and ultimately selected UHC. All members will have until September 30th to change MCOs for any reason.

The State is still finalizing details for the transfer of authorizations as patients move to their new MCOs. As a new MCO, Iowa Total Care is required to honor up to 90 days of service authorizations issued by a patient’s prior MCO. Amerigroup is only required to honor 30 days of prior MCO authorizations, however, state officials are in negotiations in hopes of reaching an agreement for Amerigroup to also recognize 90 days of authorizations to help smooth the transition.

In the next few weeks, Iowa Medicaid will be releasing an Informational Letter outlining the first round of quarterly, regional provider trainings. The first of these new, more frequent trainings will be held during the middle two weeks of May and will focus heavily on information regarding the UHC and Iowa Total Care transition. Watch IMS publications for additional information on these trainings and on the managed care transition. As a reminder, if you are encountering issues with the transition or in contracting with Iowa Total Care, please contact Dennis Tibben with the IMS Center for Physician Advocacy.