Are you confused about the flurry of changes going on with Iowa’s privately managed Medicaid program?
Are you concerned about how you will be affected because you no longer will be covered by AmeriHealth Caritas of Iowa and have been switched to UnitedHealthcare? Do you wonder if you will be affected as an Amerigroup Iowa member?
The outreach staff at Promise Community Health Center in Sioux Center can help you navigate this confusing and complex situation. They can answer questions and help you understand the changes – whether you have been covered by AmeriHealth, Amerigroup or UnitedHealthcare.
The advice and assistance that they provide is free.
“I would encourage people to come to Promise and talk to our outreach department about any concerns they are having with the Medicaid changes,” said Jessica Mora, office manager and outreach coordinator for Promise.
Since April 1, 2016, three private insurance companies have been managing the care of Iowa’s Medicaid patients instead of the state – with the new program called IA Health Link. Since then, all Medicaid patients either were assigned to or chose one of these companies – which are referred to as Managed Care Organizations (MCOs) – for their health insurance coverage.
This system recently unraveled, however, when AmeriHealth announced on Oct. 31 that it planned to withdraw on Dec. 1. That decision affected 213,000 Iowans, including many Promise patients. The Iowa Department of Human Services decided to automatically transfer these Medicaid patients to UnitedHealthcare, unless patients chose the option to switch to Amerigroup instead.
However, the privately managed Medicaid system was further shook up when the DHS announced last week that Amerigroup no longer would accept any new enrollees. This affected both the former AmeriHealth members who had already switched this month to Amerigroup or any new Medicaid enrollees in the future – leaving UnitedHealthcare as the only managed-care choice for those Medicaid members. Amerigroup will continue to serve the members it was covering prior to Nov. 1, so their Medicaid insurance will not be affected for now.
Promise has had agreements in place with all three managed-care companies, so all Medicaid patients will continue to have insurance coverage for services provided at the health center – whether they are members of UnitedHealthcare or Amerigroup. However, patients who are referred to specialists or other health-care facilities in the region may be affected if UnitedHealthcare does not have agreements with those providers.
“The concern for payment coverage when patients need care from specialists concerns us,” said Nancy Dykstra, executive director of Promise. “Our patients and our communities are located near South Dakota, Minnesota and Nebraska, and we have experienced scenarios where specialists in outlying areas do not have agreements with Iowa’s Medicaid managed-care companies. Changes like this to Iowa’s Medicaid system have a significant impact on many of our most vulnerable citizens.”
Promise’s outreach staff will help the patients who have been switched to Unitedhealthcare better understand their insurance coverage and where they can go for covered services. In other words, they can help patients find providers that are “in network” with Unitedhealthcare.
The state has indicated that it will begin to work on securing new managed-care companies so that choice can be offered again to Medicaid patients, but that is expected to take months.
DO YOU HAVE QUESTIONS?
Anyone who has questions about the Medicaid system changes can stop in to talk to Promise Community Health Center’s outreach staff.
Promise’s hours are:
■ Monday: 8 a.m.-7 p.m.
■ Tuesday: 8 a.m.-6 p.m.
■ Wednesday: 8 a.m.-6 p.m.
■ Thursday: 8 a.m.-7 p.m.
■ Friday: 8 a.m.-5 p.m.
Or, call Promise at 712-722-1700 and ask for Jessica Mora, Fatima Arteaga or Stephanie Aguilar.
Outreach assistance at Promise is provided at no charge.
