BAXTER — From contractual issues to timely payments to providers, there seem to be more than a million issues to be worked out as Iowa transitions its Medicaid system to a managed-care format.
Two state legislators and a candidate for another legislative seat tried to take on some of the headaches involved with Iowa’s Medicaid system and its three managed-care organizations at a Baxter forum Tuesday evening. Rep. Mark Smith (D-Marshalltown), the Democrats’ House minority leader, along with Sen. Chaz Allen (D-Newton) and Iowa House District 29 Democratic candidate Wes Breckenridge listened to health care providers and parents of patients discuss their individual difficulties.
“We’re about $200,000 in payments due to us since April 1, and we’ve had to take out loans to make payroll,” said Capstone Behavioral Healthcare Director Julie Smith. “It’s been very frustrating.”
These were the same types of stories Allen heard last week when his Senate Human Resources Committee held a special out-of-session hearing at the statehouse to address Medicaid. Tuesday’s meeting, which drew about 40 people to the Baxter Community Center, brought out more of the same types of frustrations, and contact information was collected from those in attendance to follow-up on their concerns.
Baxter Mayor Stephen Smith talked about the small health clinic that was staffed only by a nurse practitioner. The Baxter clinic was forced to close July 19 because it wasn’t receiving Medicaid reimbursements quickly enough to meet expenses, he said.
“It was only the nurse practitioner and her husband trying to complete forms and everything else,” Stephen Smith said. “They had $8,000 on the books out to Medicaid that they could not collect on, so we lost our clinic. We gave her six months rent-free in a building. They were getting rejection notices on claims and being told to re-submit them.”
The long list of concerns voiced Tuesday had a few common themes: snags in getting patients approved for certain treatments, delays in Medicaid payments to providers and unexpectedly small payments to providers. Several providers at the forum said they are receiving payments as if they were out-of-network providers, when those providers had pre-negotiated contracts with the three MCOs for the expressed purpose of being in-network.
Quarterly re-assessments (as opposed to annual assessments), approving lower-grade or shorter-term treatments, massive hours needed by clinicians to understand and submit claims and long maneuvers through phone trees were among the other concerns.
Jessica McNeer, of Newton, discussed the lack of availability of specialists, including the ones needed to help treat her son’s cerebral palsy. She said she’s concerned experienced and valued doctors will either retire sooner, leave medicine altogether or find ways to avoid Medicaid if problems with coverage, contracts and payments persist.
When asked if there would be more legislative oversight of Medicaid in the future, Mark Smith said he doesn’t like to describe it as a partisan issue, but he said there is some Republican resistance to that idea. He said the House Human Resources Committee has not held an out-of-session Medicaid hearing this summer, while the counterpart committee for the Democrat-majority Senate has delved into Medicaid issues.
Mark Smith said he plans to meet with providers at his office and discuss issues, just as he has done recently with Marshall County providers. He invited everyone at the forum to contact him.
Breckenridge said the three men would do whatever they could to help patients, parents and providers with individual cases or questions, but they also hope to hear about patterns, such as a specific and consistent issue with one of the three MCOs.
Allen echoed the sentiment from other Democrats around the state recently in declaring Medicaid issues an emergency that requires attention.
“One person calls me about an issue, I get information and deal with it,” Allen said. “Two people call me about something, and that’s a real concern. Three people on a subject, and that’s a crisis. I’m getting more than three calls on this every single day.”
Contact Jason W. Brooks at 641-792-3121 ext. 6532 or firstname.lastname@example.org