Monitor staff
Published: 2/18/2019 6:42:31 PM
A company facing
scrutiny for its abrupt departure from managing Iowa’s Medicaid system is one
of the three private organizations chosen by New Hampshire to manage the care
of 180,000 Granite Staters.
AmeriHealth Caritas
had the highest-scored bid out of four bids the state received to manage the
program, which is worth close to $1 billion over four years, according to
documents on the Department of Health and Humans Service’s website. Well Sense
Health Plan and New Hampshire Healthy Families, who the state currently
contracts with to manage its Medicaid program, were also selected to provide
health care services for pregnant women, caretakers and children, as well as
the elderly and disabled.
The contracts will be
discussed at Wednesday’s Executive Council meeting. If a contract is approved
by the Executive Council and the governor, AmeriHealth will start operating in
the state July 1 and continue until 2024.
Although AmeriHealth
manages Medicaid for more than a dozen other states, it made headlines for its brief
time in Iowa, where it was one of three companies managing the state’s Medicaid
program from 2016 to 2017.
According to the Des
Moines Register, AmeriHealth covered 74 percent of the state’s population
eligible for Medicaid until it terminated its contract in October 2017. The
company left the state a month later, leaving 215,000 people scrambling to find
coverage and many providers without reimbursement.
While it was in Iowa,
the company cut services for some of Iowa’s most disabled residents, resulting
in a 2017 federal lawsuit against
Gov. Kim Reynolds organized by advocacy group Disability Rights Iowa on behalf
of six residents.
Health care policy
experts say the blame doesn’t just fall on AmeriHealth.
Kelly Whitener, an
associate professor at Georgetown University’s McCourt School of Public
Policy’s Center for Children and Families, said AmeriHealth appeared to try and
do right by its customers, offering coverage in distant areas of the state and
covering more people with complex needs than the state’s two other providers.
But Iowa’s year-long
transition to a managed-care model was “unprecedented fast, like lightning
fast,” Whitener said.
That transition
happened despite two delays by the Centers of Medicare and Medicaid Services –
a bureau in the federal Department of Health and Human Services – who warned
the state that it wasn’t ready for the changeover.
“The picture over
there has been incredibly complicated and poorly planned,” Whitener said. “It
also became highly politicized ... It’s just kind of a hodgepodge of what not
to do.”
Whitener said
switching to Medicaid managed care models can typically take years, with
private organizations taking on certain populations first, like children and
parents, and then adding people with more expensive, long-term needs later.
In addition, the state
was warned that the company did not have enough contracts with providers to
support its program, Whitener said.
According to an investigation by
the Des Moines Register, state officials provided inaccurate rates
to AmeriHealth when negotiating the initial contract.
Those low rates caused
the company to lose money, according to a November 2017 report. And when the
state refused to provide an additional $150 million, the company pulled out,
the Des Moines Register later reported.
The company also had
more than $1 million in penalties assessed against it by the state for failing
to meet performance standards, according to another investigation by
the Des Moines Register. More than half of those penalties
were waived after the company challenged them, according to a December 2017
report.
An August report from
the Iowa newspaper found that the company owed $14.6 million to providers and
caregivers, causing many independent providers to close their doors.
The company’s
transition created challenges for Iowans who rely on Medicaid for services.
Catherine Gray is the
sole caregiver for her son, who is autistic and requires 24/7 care. She told
the Monitor that she would sometimes wait for two months
before her claims would be reimbursed, if they came in at all.
“It took weeks upon
weeks to get answers, bouncing from one number to the next of a ‘field
advocate’ or ‘provider advocate’ that you’d never get a call back from! So infuriating,”
she said in a Facebook message.
Gray later said in an
interview that her son’s services were never cut, and she was happy that
AmeriHealth let her keep her son’s caregiver. That changed when the company
abruptly dropped out, she said.
“Before privatization,
our local case manager knew my son for over 7+ years, was local and came every
month,” Gray wrote. “He loved her and trusted and looked forward to the visits
because she had a GENUINE interest in his life and ensuring its’ quality.”
Deborah Rowell Gleason
said in an interview with the Monitor that she was also lucky;
her daughter, who has been disabled since birth, never lost services under
AmeriHealth.
But “I know how to
advocate for what my daughter needs,” Gleason said. “For others who don’t, I
think they may be really struggling.”
At the Executive
Council meeting Wednesday, the contract is expected to be tabled to give more
time for consideration, DHHS Commissioner Jeffrey Meyer told the Union
Leader.
It was clear the
company has been working toward coming to New Hampshire for a long time, if you
knew where to look. AmeriHealth announced on its website that it intended to
bid on the state’s RFP, and has been advertising for jobs since mid-December.
(Caitlin Andrews can be reached at 369-3309,
candrews@cmonitor.com or on Twitter at @ActualCAndrews.)
https://www.concordmonitor.com/AmeriHealth-Caritas-Medicaid-New-Hampshire-23573528
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