For Immediate Release

Medicaid Modernization: High Quality Health Care Initiative

April 14, 2015

Media Contact:
Jessica Brown
jbrown@eastersealsia.org
515-309-2396

The following information was originall shared by Polk County Health Services.

On February 16, the State of Iowa released a Request for Proposal (RFP) called Medicaid Modernization: Iowa High Quality Health Care Initiative.

OVERVIEW
The State of Iowa is responsible for funding Medicaid services for individuals with intellectual disabilities (ID) and mental health (MH) related needs. To date, a private company called Magellan has coordinated services for the majority of individuals with mental health related needs. Additionally, the State of Iowa’s Health & Wellness plan provides a part of managed health care. Iowa reports the cost of serving individuals enrolled in Medicaid grew by 73% since 2003 and is expected to grow by 21% in the next three years. Participation in some aspects of the Affordable Care Act reduced Iowa's responsibility for some expenses to 10% of actual cost. In fiscal year 2018, the State’s percentage is projected to increase to about 50%.

As a solution to controlling costs, the State intends to implement a program titled Medicaid Modernization. Medicaid Modernization would place nearly all Medicaid services under the control of Managed Care Organizations (MCOs). The State says the goal of Medicaid Modernization is to 'create a single system of care which delivers efficient, coordinated, and high quality health care that promotes member choice and accountability in health care coordination.'

Under Medicaid Modernization there will be two to four MCOs coordinating Medicaid services. The State expects to save $51.3 million for the first six months of the program which would begin January 1, 2016. Conceptually; this would be achieved by:

• Requiring recipients of Medicaid to select an MCO
• The State setting a monthly payment amount for each MCO participant
• The MCO coordinating all aspects of an individual’s physical and behavioral health
• The MCO establishing a network of preferred providers for participants.


QUESTIONS RAISED BY CHANGE TO MEDICAID MODERNIZATION
1. The effect of Medicare Modernization on the individual is not known. Some issues will be:
a. How will I/my family member be able to determine which MCO would best meet my/his/her needs?
b. What safeguards will be put in place to make sure the MCOs will not decrease funding for services to an already chronically under-funded mental health and disability system of care in order to make a profit?
c. What is the dollar amount allocated per person? How was this sum calculated?
d. What is my monthly dollar allocation for services? How was this sum calculated?
e. How does the State expect to save over $51 million in the first six months when the RFP outlines services and providers that are to remain unchanged for two years?
f. What services does the State believe are duplicated? How will elimination of duplication be balanced with ongoing inflationary costs?
g. How will the State ensure, regardless of which MCO is chosen, that all MCOs will be consistent and support a single system of care for individuals receiving long term supports and services?
h. What review system will be used to determine that each participant receives adequate services?
i. Who or what is establishing the standards to assure optimum care for each participant?
j. How will the State ensure individuals accessing ongoing long-term services will not be decreased when individual needs do not change?
k. How will the State ensure the proposed management of care will benefit individuals with Intellectual Disabilities since MCOs have little to no experience managing services for this targeted group?


2. The effect on local care coordinators is not known. Rules should be implemented to assure the least possible disruption between local Coordinators (Integrated Health Home- Intensive Care Managers and Targeted Case Managers) because they are the bedrock of stability between the individual served and the services needed. Do not take my Integrated Health Home (IHH) or Case Manager away!


3. There should be a mandate for milestones in the timeframe for the State to identify and modify existing regulations to modernize Medicaid. (Note: State regulations include service mandates for Community Providers. The RFP does not address how regulations will be changed to allow for a more flexible, outcomes-based system of care.)


4. There should be a mandate to ensure MCOs ensure timely access to services. (Note: There are currently waiting lists for Home and Community-Based Services (HCBS) waiver services and one of the primary objectives is cost containment initiative.)


TAKING ACTION
How can you, your friends, family members, & colleagues take action?
1. Contact Governor Branstad, Office Phone: 515-281-5211, WHO’s “Call the Governor” Radio Show Tuesdays at 6:00 p.m. 515-284-1040 or 800-469-4295
2. Contact Your Legislative Representatives. Find your legislator: http://polk.ia.networkofcare.org/mh/legislate/state-officials.aspx
3. Write letters to the Editor of the Des Moines Register. Submit letters to The Des Moines Register, 400 Locust Street, Suite 500 Des Moines, IA 50309  Fax: 515-286-2504  Email: letters@dmreg.com
4. Learn more about Medicaid Modernization on the DHS Website: https://dhs.iowa.gov/ime/about/initiatives/MedicaidModernization
5.  Send Comments/Questions/Feedback: MedicaidModernization@dhs.state.ia.us

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