March 19, 2024

Latest Medicaid concerns voiced at forum

Treatment pre-authorization remains an issue

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COLFAX — One of the first thoughts expressed at Tuesday’s Medicaid privatization forum at the Colfax Senior Center was a rare sentiment.

Scott Pritchard and Amy McGhghy of Clearview Recovery in Prairie City offered up something to three state leaders they haven’t heard often regarding Iowa’s three managed-care organizations: praise.

“We’ve actually started to make some progress with AmeriHealth Caritas,” said McGhghy, a substance counselor at Clearview. “The other two (Amerigroup Iowa and United HealthCare), we’re still struggling most of the time. The hardest part is when we tell them what level of care a client needs, and we’re told, no, this level is authorized. So the MCOs are dictating what level of care (residential, outpatient, halfway house) our clients can receive.”

While the praise was few and far in between, the three officials who arranged the forum seemed to accomplish their mission. Sen. Chaz Allen (D-Newton), House District 29 representative-elect Wes Breckenridge (D-Newton) and Rep. Mark Smith (D-Marshalltown) listened to concerns about the process of dealing with Medicaid MCOs, promising to take those concerns with them into the upcoming 2017 Iowa legislative session.

The three held a similar listening post forum in Baxter in August. Tuesday’s forum didn’t have as many clinicians in attendance as the Baxter forum, but the ones who came to Colfax focused heavily on pre-authorization and how tough it is to get proper care approved.

Pritchard, Clearview’s director for the past 12 years, said his facility reunites mothers who are in substance abuse recovery with their children, and treatment authorized typically was nine to 12 months under Magellan before the three MCOs were brought in by Gov. Terry Branstad. Now, not only has Clearview had clients stay for shorter times, but the staff is constantly on the phone getting seven-day re-authorizations or similar extensions or maintaining levels of care.

“It could get to the point where we can’t house women and their children together,” Pritchard said. “Well, that’s what we do.”

Smith said the need is urgent, but with a Republican majority in both houses of the Legislature, he isn’t sure what kind of Medicaid oversight the three Democrats and other members of their party will see enacted this year. Allen said legislators can at least use their early-morning point of privilege time at the start of daily sessions to drive home the importance of Medicaid oversight.

One couple at the forum, who asked their names not be used in print, talked about their sick child and the runarounds they received trying to get pre-authorization for long-term treatment. Colfax Mayor David Mast was also among the small crowd at the forum.

Breckenridge, who was elected to he Legislature last month, didn’t make many statements, but asked many questions of those in attendance.

Smith told the group he’d continue to have Medicaid oversight high on his agenda.

“The belief is that 25 percent of Iowans will need some form of mental health or substance abuse services within the next year, and Medicaid is a huge component of that,” Smith said. “We’ll keep doing whatever we can.”

Contact Jason W. Brooks at 641-792-3121 ext. 6532 or jbrooks@newtondailynews.com