Changes in Iowa Medicaid System

Iowa will implement a plan titled Medicaid Modernization. Simply stated, Iowa will select 2 to 4 managed care organizations to help administer the Iowa Medicaid program.  This includes services such as case management, Home and Community Based Services, Medicaid ABA and ICF/ID.  Nearly all of those served by The Homestead will become a part of the new system which is scheduled to begin January 1, 2016.

Many other states have already moved to managed care or are in the process of moving to managed care. There is hope that by hiring an outside entity that there can be efficiencies in administration of the Medicaid program that are currently not available.  The governor is already forecasting a savings of $51.3 million in the first six months of the transition.

There are many questions surrounding this transition.  For example, where does the state see savings at this rate?  The managed care companies will have administrative costs and shareholders that expect profits.  Where is the funding to pay this overhead and retain the same access to services?  What existing costs will be eliminated from the system?  What oversight will be retained by the state and what will be the responsibility of the managed care organization?

Bottom line is the state is struggling to meet increasingly larger Medicaid costs.  These costs are tied to the enhanced Medicaid program that expanded under the Affordable Care Act, the formula that governs the state co-pay for Medicaid and other costs.  In fiscal year 2016 the state will need to balance a $200 million shortfall.  We have already seen a waiting list for adults wanting HCBS services – a new thing for Iowans with intellectual disabilities.

The Homestead is working closely with the Iowa Department of Human Services staff, our state association and other providers to provide input into this transition.  We are meeting with some of the managed care organizations to learn about their operations.  To date the DHS and the managed care organizations say there is not a need to decrease service access or rates.

We want to ensure that the service needs and rights of Iowans with autism are protected in this transfer.  We have gained valuable experience in the past few years working with managed care and private insurance for our children’s projects.

Iowa DHS has been hosting informational meetings and updating a web site to help explain what this means to individuals served and their families.  Continue to check this web site regularly for more information:  https://dhs.iowa.gov/sites/default/files/MedicaidModernization_FAQ.pdf