One advocacy group in Iowa helping people with chronic disabilities and long-term care needs is frustrated with the many changes to Medicaid in the state.

This comes amid the latest Iowa Department of Human Services announcement that some 10,000 Iowans will shift back to the state’s Fee-for-Service program after Amerigroup said it cannot take on any more members at this time.

Jane Hudson, executive director of Disability Rights Iowa, says many of her organization’s members—Iowans with chronic disabilities and illnesses that require long-term care—decided they would switch to Amerigroup, after news broke that AmeriHealth would pull out of Iowa’s Managed Care system. Most clients, she says, were with AmeriHealth before the company exited the state’s Medicaid program Thursday.

DHS said that the 215,000 Iowans would automatically switch the UnitedHealth by December 1, but Medicaid members had the option to choose the other remaining provider, Amerigroup, if they met the November 17 deadline. Then there was yet another shift when DHS announced that Amerigroup said it did not have the capacity to take on any new members, prompting the state to resume oversight of Medicaid coverage for some 10,000 Iowans through its Fee-for-Service, the state-run Medicaid system in place before Medicaid management shifted to three private companies in 2016.

“It’s not fine at all. It’s changing every week. It’s chaotic. It’s a self-destructive system—people do not know what is going on,” Hudson said. She said Disability Rights Iowa has seen a surge in calls from clients trying to make sense of all the changes ever since AmeriHealth announced it would leave the program October 31.

Governor Kim Reynolds (R) said Tuesday she believes Amerigroup will “ramp up” and reach a point where it can take on the members that requested the group to manage their care.

“Our hope is that once [Amerigroup] builds the capacity to do [take on more members], that they can move back into Amerigroup which was their choice when we had this transition taking place,” Reynolds said. “Our goal is to make it as seamless as possible to make sure that we continue to offer continuity of service again to Iowans who really need a coordinated care and need that extra help and to really do everything that we can to eliminate as much disruption as possible.”

Hudson says for the clients her organization works with, Iowa’s managed care system just does not adequately served their needs.

“We think people with high need and long term services should be carved out from this managed care system completely,” she said.

Legal Director for Disability Rights Iowa Cyndy Miller echoed Hudson, calling managed care not the right answer to fulfill long-term care needs.

“Managed care may have its place in the world, but it may not have its place with the long-term services population,” Miller said. “There is a part of me that would like to see that carved out and returned to the state-run system, where things seemed to be a little more smooth and there was more clarity with the process.”

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Amid Medicaid shift in Iowa, advocacy group concerned for members with disabilities