Chelsea Keenan

The Gazette

CEDAR RAPIDS — Sen. Liz Mathis, D-Robins, asked providers two questions Tuesday afternoon. “Raise your hand if payments have been slow or you’ve run into issues,” Mathis said.

More than a dozen hands shot up.

“Now raise your hands if you’ve had no problems.”

No hands went up.

The physicians, administrators and nonprofit employees attended Mathis’ listening post for Medicaid beneficiaries and providers in Marion. More than 65 people came to voice issues regarding the Medicaid’s transition to managed care. Representatives from the state and managed-care organizations listened to complaints and answered questions for more than two hours.

“You’ve got a group here, and we can listen today,” said Chad Piper, director of long-term services and supports for AmeriHealth.

The state handed over its $5 billion Medicaid program to three private insurers — Amerigroup Iowa, AmeriHealth Caritas Iowa and UnitedHealthcare of the River Valley — on April 1. Gov. Terry Branstad has touted a smooth transition, pointing to more than 300,000 claims paid and more coordinated care.

But Mathis said that rosy picture he’s painting isn’t complete.

Health care providers from small behavioral health clinics and durable medical goods suppliers to UnityPoint Health-St. Luke’s Hospital spoke on a host of issues, including low reimbursement rates, long wait periods for preauthorizations or denial of claims.

“We operate at a fast speed — the average length of stay is six days,” said Kent Jackson, director of St. Luke’s behavioral health services. “In my experience, this is a slow and cumbersome system. … Battles have to be fought to just get medications approved — a child psychiatrist had to wait four days to get approval on medication. Can we speed things up? We’re operating in window of six days.”

Medicaid recipients, meanwhile, talked about challenges getting listed as their family member’s guardian.

Cindy Smothers has been battling with Department of Human Services and her managed-care organization since 2015 to be listed as the legal guardian for her adult-dependent son, Tyler. Before managed care, she had been his guardian for 13 years.

Helane Golden said the provider networks still are underdeveloped, adding that those with multiple doctors aren’t likely to find a managed-care organization with all prior providers who are needed. And for those with mental health issues such as herself, that could mean choosing between a psychiatrist and primary care doctor.

“It is absolutely hurting people with mental health issues to have to change doctors,” she said. “I can’t find a MCO with at least the majority of my providers, and I represent thousands more. There’s too much future talk.”

Rhonda Shouse, a Medicaid recipient and administrator of MCO Watchdog — a Facebook group with more than 1,700 Medicaid caregivers and beneficiaries — said the help was appreciated but too little, too late.

“We have a system in place. You should be able to fix your own problems,” she said.

“We shouldn’t have to have a town hall to have problems fixed. That’s not practical. I appreciate your efforts in coming out, but it’s almost June 1. … We need to step up the game.”

Medicaid providers, patients vent
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