Area healthcare and health
service providers who care for Iowa’s low-income residents through Medicaid began
the transition to privatized care effective April 1. Traditional Iowa Medicaid patients will now be
under the supervision of three state contracted health plans or Managed Care
Organizations (MCOs): Amerigroup Iowa, Inc., AmeriHealth Caritas Iowa, Inc.,
and UnitedHealthcare Plan of the River Valley, Inc. Together these three MCOs
will oversee the care of approximately 608,000 Medicaid patients across the
state.
Locally, each primary care
medical provider, mental health provider, and long-term care facility
contracted with MCOs with which it wanted to do business. For example, Grinnell
Regional Medical Center and the GRMC affiliated clinics currently have
contracts with Amerigroup Iowa, Inc., and AmeriHealth Caritas Iowa, Inc.
Mayflower, St. Francis Manor, and Grinnell Health Center have contracted with
all three MCO providers. Physicians’ clinics and mental health clinics have
contracted with at least one provider, with the option to add an MCO in the
future.
The MCO transition is
complicated because Hawk-I plans are considered separate from the adult plans,
and both patients and providers have the opportunity to make changes. Medicaid
patients have been auto-enrolled into one of the three MCOs and should receive
a member ID cards via the mail. The patient’s primary care doctor’s name should
be listed on the member ID insurance card. If a member missed receiving a card
in the mail, he or she may contact the member service number to get in contact
with their assigned MCO. Important to note, if a patient’s local provider is
not contracted as an in-network provider, patients will have the option to
switch MCO carriers until June 16, 2016.Medicaid members with questions about
the primary care doctor listed on the card or do not know which MCO has been
assigned should call Iowa Medicaid Member Services at 1-800-338-8366.
“We were changing signage and
flyers almost daily in the past month as the rules and implementation plans
were unrolled,” says Joann Salsman, GRMC’s patient billing manager. “Big
transitions that affect a large population have so many adjustments as the
state and MCOs solidified the nuts and bolts of each plan and process. We
continue to work on the process here at the hospital to ensure, to the
best of our ability, our patient’s experience with this transition is a
positive one.”
“On Friday, April 1, we
experienced a large volume of calls and meetings with patients as they tried to
set up their provider relationships to coincide with MCO at Grinnell Regional
Medical Center,” Salsman says. “Overall, the transition is going as expected
considering the magnitude of the change and the nuances of the program.”
“Grinnell Regional remains
committed to serving all community members, regardless of insurance status,”
says Kyle Wilcox, GRMC vice president of finance. “With that, we also remain
committed to providing the highest quality experience through amazing team members,
excellent facilities, and the best technology. To accommodate both commitments,
we believe AmeriGroup and AmeriHealth have provided GRMC a fair contract to
serve our community members who use Medicaid health benefits. We will continue
to work with the third Medicaid Managed Care contractor to find a mutually
beneficial arrangement but do not have a sense of when that arrangement will be
accomplished.”
Anyone needing help with
enrolling or switching plans may call Iowa Medicaid Member Services at 1-800-338-8366.
Medicaid representatives are available Monday through Friday, 8 a.m. to 5p.m.
Sidebar:
Iowa’s Medicaid Managed Care
Organizations
Amerigroup Iowa, Inc.
Phone: 1-800-600-4441
Website: www.myamerigroup.com/IA
AmeriHealth Caritas, Inc.
Phone: 1-855-332-2440
Website: www.amerihealthcaritasia.com
UnitedHealthcare Plan of the River Valley, Inc.
Phone: 1-800-464-9484
Website: www.UHCCommunityPlan.com/ia
No comments:
Post a Comment