Changes to Iowa’s Medicaid system means the three managed care organizations in charge of services for more than 560,000 Iowans will shift how case management services are provided.
UnitedHealthcare plans to hire a majority of its own case managers, the people who help coordinate services for Medicaid’s elderly and disabled members.
Amerihealth and Amerigroup will use a hybrid model of existing case managers and case managers the company will hire internally.
For Dubuque mother Alyson Beytien, whose son, Zachary, is diagnosed with severe autism, the probability of some families losing case managers they’ve worked with for long periods of time is unsettling.
“She advocates for us, because she can explain it. That helps us with our timing,” Beytien said of her son’s case manager. “We don’t have to spend all our time advocating and calling. She’s doing it for us.”
Zachary’s case manager has worked with the Beytien family for about a decade. That case manager helps coordinate the staff members that work around the clock in Zachary’s group home.
“She knows Zachary’s background, his history, his behaviors. And she knows what services are available to help him in our area,” Beytien said. “That expertise is built up over time.”
Beytien is also worried internal case management controlled by the managed care organizations will create a conflict of interest, a concern state Sen. Pam Jochum (D) shares.
“If you’re working for a managed care organization, it’s a for profit company,” Jochum said. “If I am an employee of that managed care company, I’m going to get an awful lot of pressure from my employer to turn a profit. That may mean I’m not going to be able to put together the kind of program that person needs.”
According to a Department of Human Services spokeswoman, a system will be in place to prevent conflicts of interest and provide Medicaid members with an avenue to appeal cuts to services.
“The plans have protections in place for their members, and state and federal law includes protections as well,” said DHS spokeswoman Amy McCoy in an email. “If a member has any change in level of care, DHS will review their case to ensure they are getting the services they need. A member can appeal decisions to their MCO. If they are not satisfied with the outcome, they can continue through the state fair hearings process.”