Current Updates (as of 12/2/2019)
Managed Long-Term Services and Supports
The Iowa Department of Human Services (DHS) announced contracts with the state’s managed care organizations, Amerigroup Iowa and Iowa Total Care, have been signed for state Fiscal Year 2020. The new contracts include additional quality oversight for LTSS activities, particularly community-based case management activities. The contracts also include new protections for LTSS assessments related to level of care and Supports Intensity Scale (SIS) assessments; specifically, beneficiaries can have individuals of their choice present during assessments and MCOs must provide assessment notices to beneficiaries within three days.
(Source: New IA Health Link Contracts Signed; 7-10-2019)
Medicaid Managed Care
On January 20, 2015, state legislators announced Governor Terry Branstad’s plan to transition Iowa’s Medicaid program to private MCOs. The Department of Human Services plans to release an RFP for managed care plans by March 1, 2015; the new program’s implementation target date is January 2016. The estimated cost savings during the first six months of 2016 is $51.3 million. (Source: Des Moines Register, 1/20/2015)
On February 16, 2015, the Iowa Department of Human Services posted the Iowa High Quality Healthcare Initiative Request for Proposals (RFP) on its website, inviting health plans to bid to manage the state’s Medicaid managed care program. DHS intends to award two to four statewide managed care contracts in order to expand Medicaid managed care enrollment to at least 550,000 individuals, beginning in January 2016.
Contracts awarded under the RFP will cover nearly all Medicaid beneficiaries in Iowa, including LTSS recipients in nursing facilities and HCBS settings; dual eligibles; foster care populations; and the Iowa Health and Wellness Program expansion population. Individuals covered by the Health Insurance Premium Payment program; undocumented immigrants receiving temporary coverage; and voluntary PACE enrollees will be excluded from enrollment. Native Americans will have the option for voluntary enrollment.
Proposals are due on May 8; a notice of intent to award is scheduled for July 31; and the go-live date is scheduled for January 1, 2016. (Source: American Journal of Managed Care, 2/17/2015; Iowa Department of Administrative Services website)
Iowa High Quality Healthcare Initiative RFP (2/16/2015)
On May 8, 2015, the Iowa State Senate passed a budget placing limits on transitions to managed care. If adopted, the budget will cap profits for managed care contractors; create a commission to oversee transitions to managed care; and ban reductions in provider rates. The budget will now move to the Iowa House for debate. (Source: AJMC, 5/8/2015)
On August 17, 2015, the Iowa Department of Human Services announced the four managed care organizations (MCOs) that will provide services to the states’ 560,000 Medicaid beneficiaries beginning January 1, 2016. The four firms are Amerigroup Iowa, AmeriHealth Caritas Iowa, UnitedHealthcare Plan of the River Valley, and WellCare of Iowa. The new managed care program includes responsibility for long term services and supports (LTSS). (Source: Iowa DHS , 8/17/2015)
Iowa’s plan for transitioning its Medicaid program to managed care by January 1, 2016, has continued to face criticism for its very ambitious timeline and concerns regarding the impact on beneficiaries. On October 9, 2015, the state officially announced the signing of contracts with the four managed care organizations (MCOs) that will have responsibility for the states approximately 560,000 Medicaid enrollees. However, the plan has faced pushback from state Senate Democrats who say the transition should be delayed, and have raised questions over the estimated $51 million dollars in savings over the first six months of the transition. (Source: AJMC 10/20/2015)
Iowa’s transition to Medicaid managed care (Iowa Health Link) has led to a significant amount of administrative review and judicial action over the past several months. Court filings in November alleged inappropriate communication between the State Medicaid Director and a private consultant, which was followed by a lawsuit from the Iowa Hospital Association and 11 leaders of hospitals to halt the shift to managed care. More recently, an administrative judge recommended that the state withdraw its contract with one of the four winning bidders for the Iowa Health Link program, WellCare. Following a review by a high-level Iowa Medicaid official, the contract was terminated. WellCare has filed suit challenging this decision. Other managed care plans who were not selected in the procurement have also appealed, arguing that the process was flawed and the bids should be resolicited and rescored.
On December 17, 2015, CMS wrote to the Iowa Medicaid Director delineating concerns about the proposed transition timeline, and requiring that Iowa delay the start of the IA Health Link program to March 1, 2016. In order to exhibit proper readiness by March 1, Iowa must address 16 key actions, including: developing comprehensive communication mechanisms and call center capacities; address provider network deficiencies; establish a fully functioning LTSS Ombudsman, and; ensure all MCOs have proper pharmacy systems in place before the transition takes place.(Source: Iowa Letter, link no longer available; The Des Moines Register 12/22/2015)
Iowa's transition to Medicaid managed care (Iowa Health Link) was officially approved in a CMS letter dated February 23, 2016. CMS recognized the implementation progress the state has made and authorized a start date of April 1, 2016, in order to allow for a smooth and effective transiton. (Source: CMS Letter 2/23/2016)
On April 13, 2016 the Des Moines Register reported that Medicaid Director, Mikki Stier, has advised state lawmakers that the transition to managed care is going well. Despite some issues that have been identified the state’s call center has handled over 18,000 consumer calls, while reducing the wait time for callers to an average of 20 seconds. Some lawmakers remain skeptical of the shift to managed care, and continue to press for greater state oversight of the three MCOs responsible for managing care for Medicaid beneficiaries. (Source: Des Moines Register 4/13/2016)
On August 26, 2016, the Iowa Department of Human Services (DHS) released a report containing data for the first quarter of the state’s new managed care program, Iowa Health Link, which includes April, May and June 2016. Three MCOs—Amerigroup, AmeriHealth, and UnitedHealthcare—coordinate care for Iowa Medicaid beneficiaries. Of the 567,813 beneficiaries, the breakdown by plan is as follows:
Beneficiaries have the ability to disenroll from one plan and enroll in another within the first 90 days of their IA Health Link enrollment. Of the three MCOs, UnitedHealthcare had approximately 9,000 members change plans, Amerigroup 4,000, and AmeriHealth 1,000.
In terms of LTSS, as of June 2016 Iowa has 13,879 individuals (38 percent of LTSS enrollees) receiving facility-based services—that is, residents residing in an ICF/ID or nursing facility. 62 percent of LTSS beneficiaries, or 22, 586 individuals, receive home and community based services (HCBS). The LTSS managed care enrollment population of 36,465 breaks down by health plan as follows:
The Iowa DHS spent approximately $331 million on Iowa Health Link, which is $22 million less than the state projects it would have spent without the implementation of statewide managed care. The state also believes that it is on track to save $110 million for the first year. (Source: IA MCO Report 8/26/2016)
On October 31, 2016, Radio Iowa reported that Iowa would pay the three MCOs an additional $33 million. The state still expects to reap more than $140 million from the transition, and the additional funds are being allocated largely due to rapidly increasing prescription drug costs. (Source: Radio Iowa 10/31/2016)
An article from the Quad-City Times notes that recent financial filings from two of the MCOs, Amerigroup Iowa and AmeriHealth Caritas, show that they are losing significant sums, in excess of $100 million dollars each. However, statements from the Iowa governor’s office as well as the MCOs push back on the reported losses, claiming that they are simply start-up costs and will abate as the MCOs further adjust to the Iowa market (Source: IA MCO Report 11/30/2016; Quad City Times 11/30/2016; KCRG.com 12/2/2016)
State Demonstration to Integrate Care for Dual Eligible Individuals (Withdrawn)
In May 2012, the state submitted to CMS a Financial Alignment Demonstration Proposal to provide full benefit dual eligible access to comprehensive coordinated care management through a Health Homes model. The target population is persons with I/DD, and the proposed reimbursement model is a “Health Homes in a Fee-for-Service environment”. The originally proposed implementation date was January 1, 2013, but the MOU is still pending. (Source: Demonstration Proposal; NASDDS Managed Care Tracking Report Vol.1 No.2; NSCLC Dual Eligibles website)
As of July 2014, the state has withdrawn from the Financial Alignment Demonstration. (Source: Kaiser Duals Demonstration Proposal Status Map, 7/2014)
Balancing Incentive Program
In June 2012, CMS awarded the state an estimated $61.8 million of enhanced Medicaid funds (a 2% enhanced rate). (Source: Iowa Medicaid Enterprise Endeavors Update; State BIP website)
BIP application (Submitted to CMS: 4/30/2012)
CMS Award Announcement (6/13/2012)
IME Bureau of Long Term Care Revised Work Plan (1/2013)
Section 1915(i) HCBS State Plan Option
As of May 2014, CMS has approved the state’s §1915(i) HCBS State Plan Amendment; and the state is currently participating in the HCBS State Plan Option. (Source: Kaiser HCBS State Plan Option website, 5/2014)
In June 2012, CMS approved Iowa's first Health Home State Plan Amendment to implement Health Homes for individuals with two chronic conditions or one chronic condition with the risk of developing another chronic condition. (Source: CMS Health Homes Matrix, 6/2014)
Approved Health Homes State Plan Amendment, link no longer available (6/2012)
State Website on Health Homes
In June 2013, CMS approved Iowa’s second Health Home State Plan Amendment to implement Integrated Health Homes (IHH) for adults and children with SPMI. (Source: CMS Health Homes Matrix, 6/2014)
On June 23, 2014, CMS approved Iowa’s third Health Home SPA, for the Phase III expansion of the state’s SPMI Health Home Program for Medicaid eligible individuals as authorized under Section 2703 of the Patient Protection and Affordable Care Act. (Source: Medicaid State Resource Center website; Approved Health Home SPA, 6/23/2014