Iowans warned: Medicaid patients may lose doctors

At least one health care provider is warning patients that Iowa's plan to switch to privatized Medicaid management may force them to find new doctors.

And the state last week acknowledged the possibility after the Hematology & Oncology Center of Iowa distributed fliers warning its patients of the possibility.

That’s because Iowa has contracted with four separate corporations that will work like insurance companies to oversee management of the 560,000 poor and disabled Iowans on the program, which is slated to launch on Jan. 1.

People with multiple doctors may find that some of their current physicians haven’t contracted with and won’t accept some — or even any — of the four insurers.

And, if that’s the case, those patients may be told that their doctor can no longer treat them.

Health care advocate Deb Rieck said a Des Moines cancer patient approached her this week about the Oncology Center flier warning that unless he chooses a specific carrier “we will NOT be able to treat you.”

“This comes from a cancer doctor, so he’s a specialist. The odds are that his patients are going to have to choose between their cancer doctor and their primary provider and that’s alarming,” said Rieck, the CEO of Aging Advocates, a Pleasant Hill company that helps Iowans in 23 Iowa counties manage their health care.

MORE ON MEDICAID:

Medicaid to maintain provider pay during shift

Is Iowa ready for Medicaid shift?

UI Hospitals give mixed messages on Medicaid

The issue stems from the largest privatization effort in Iowa government history. If approved by federal regulators, the $4.2 billion annual program will be managed by the for-profit companies.

Gov. Terry Branstad’s administration estimates the plan will save $51 million in the first six months through things like reducing duplicative health services and focusing on preventive care.

But critics contend the companies — which will be paid as much as $540 million in the first year — have a track record of fraud and mismanagement in other states that will translate into reduced services for Iowa’s poor and disabled populations.

Health care providers are being asked by the Iowa Department of Human Services to sign contracts with all four companies. But many have resisted, telling federal regulators they are reluctant to sign incomplete contracts that don’t specify some rates of pay or other terms that doctors say could cost them hundreds of thousands of dollars in financial losses each year.

As of Dec. 7, none of the four companies hired to manage Iowa’s Medicaid program had signed up more than 66 percent of the state's current health care providers, according to a summary provided by DHS. One company, AmeriHealth, has signed contracts with just 43 percent, the summary shows.

Mitch Harris, a manager of the Hematology & Oncology Center in Des Moines, says his staff is providing the fliers to warn patients against choosing the wrong providers and to educate them about potential problems.

Harris contends that the state has done a poor job of providing Medicaid recipients with information about the transition. The center’s patients deserve honest and straightforward answers in an effort to avoid further frustration and confusion, he said.

“I believe most (Iowa Medicaid recipients) are clueless about how exactly this affects them, and the state hasn’t made it any easier,” Harris said.

Harris’ center currently has a signed contract with UnitedHealthcare and plans to have contracts with Amerigroup and AmeriHealth. But the center has no plans to sign with WellCare, citing the company’s past history that includes three of its former executives sentenced to prison in 2014 for fraud.

Harris acknowledges that not having contracts with all four companies may force some of his patients to make tough choices.

Iowans in the Medicaid program are being asked to select by Dec. 17 one of the four companies as their insurance carrier. Some Iowans have publicly noted their frustrations in trying to determine which of the four companies would best serve them.

In response, a DHS spokeswoman notes that Iowa Medicaid recipients will have until March 17 to switch carriers for any reason, giving them time to assess which of the four companies best meets their needs.

Iowa also plans to penalize any health provider who fails to sign contracts but still provides Medicaid services with a 10 percent reimbursement reduction. On Monday, Gov. Terry Branstad announced that penalty will not be enforced until April 1, allowing more flexibility so Medicaid recipients can better assess the health plans.

Branstad’s administration calls it the “safe harbor extension.”

“With the safe harbor, providers have more opportunity to get to know the plans and continue the contracting process to ensure members have access to quality services,” said DHS spokeswoman Amy McCoy.

McCoy acknowledged that some Medicaid recipients may have to switch doctors if each of their medical providers doesn't contract with the same insurance network. But she said the state is trying to minimize those types of situations through strong contracting efforts and provider education meetings.

For her part, Rieck, the case manager whose client received the flier from the cancer clinic, says she advised him to prioritize his health care providers so that “when push comes to shove” he can select an insurance company that at least covers the key doctors he wants to retain.

“I really hate that I would even have to suggest to him that that’s a scenario that he may have to face in the future,” Rieck said. “It’s not fair.”