Friday, April 15, 2016
The change to a new Medicaid system has been challenging. I’ve heard from Iowans, hospitals, nursing homes and providers. Change is difficult, especially when the change affects something as personal as health care.
In Iowa, Medicaid has operated as a “pay as you go” system. Under this system, Iowa taxpayers paid the medical bills of those who qualified for Medicaid coverage.
Each year the Legislature would estimate how many tax dollars Medicaid might require and set them aside to pay providers. One of the budget tricks that put Iowa in hot water was to intentionally underestimate the Medicaid amount so more dollars could be spent elsewhere in the General Fund. When the Iowa Legislature returned the following January, they would have to pass a supplemental appropriation to make the program solvent for the rest of the fiscal year.
The change to Managed Care allows Iowa to set the amount spent on Medicaid by negotiating the estimated need and the cost to cover this need. The three Managed Care Organizations (MCOs) are then responsible for paying for the health care needs of those who are in the Medicaid Program. They are allowed to find and create efficiencies, just like health insurance companies, such as setting up provider networks, requiring prior authorization and negotiating fees. In this way, Medicaid recipients are treated much the same way as private health insurance customers.
This change can be difficult for those recipients used to going to their provider and having the paperwork sent in and paid.
In order to help those who have questions or concerns about the new program, I have listed the contact information for those who can help find answers.
Thank you for allowing me to work for you in the Iowa Senate. If you have questions, please call the switchboard at 515-281-3371 or my cell at 712-269-2178. I can be emailed firstname.lastname@example.org