Amerihealth Caritas withdraws from Medicaid program


Sergio Flores

The Iowa State Capitol is shown on Tuesday, Jan. 13, 2015.

AmeriHealth Caritas, a Medicaid insurer dealing with the largest percentage of the special-needs population in Iowa, announced that at the end of November, it will withdraw from the Medicaid program after no agreement could be reached on contract rates and terms.

Members of AmeriHealth have been assigned to UnitedHealthcare — until people transition to a different program themselves — and this coverage will begin on Dec. 1.

“UnitedHealthcare has Medicaid experience in 26 states, and specifically with [long term services and supports] populations in 13 states,” Matt Highland, the interim public-information officer at the Department of Human Services and the communications specialist at Iowa Medicaid Enterprise, said in an email.

Highland said UnitedHealthcare is confident it can serve the members who have complex needs.

Juliann Egizio, the primary representative for the University of Iowa’s Special Olympics,

said the insurer represents a large number of special-needs individuals.

“This population, at times, may have difficulties advocating for themselves,” Egizio said.

The concern, she said, is [those affected] might not be fully informed and might not be able to find the resources they need to make the transition as seamless as it seems it should be.

Highland said the members affected can join Amerigroup of Iowa if they choose to, and they have until Thursday to do so. If this deadline is not met, they can still change their managed-care organization up until March 1, 2018.

However, Human Services “has issued a request for proposal to recruit an additional health plan, which will be available July 1, 2019,” Highland said.

While going through the process of picking a replacement for AmeriHealth, “we will ensure that the new [managed-care organization] has policies and procedures in place, is ready to authorize services and pay claims, and has a provider network which must meet network adequacy standards,” Highland said.

A transition plan has been put into place by Human Services and AmeriHealth to make sure members still get the care they need.

Overall, Human Services officials said, they are trying to make this transition as smooth as possible. All of the members’ service plans and member information will be shared with the new managed-care organization so members can go to their providers as they have in the past.

Regional President of AmeriHealth Russell Gianforcaro also said Human Services wants the transition to be as seamless as it can be for its members, and it is working with the state to make this happen.

Even though it has chosen to leave the Medicaid program, Gianforcaro said in a news release, “we have delivered on the promise of Medicaid managed care, and the results have been noteworthy.”

While in most cases members can continue visiting their normal doctors, there are a few that are experiencing something not so simple.

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