Care Providers Stuck with Transportation Costs for Iowa Medicaid Patients

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DES MOINES, Iowa -- Last week, Gov. Kim Reynolds was non-committal regarding the suggestion that able-bodied people should be employed to receive Medicaid benefits.  A similar policy was enacted in Kentucky.  Medicaid recipients and providers argue the state of Iowa recently made it harder, in many cases, for recipients to show up for the jobs they already have.

Shelly Chandler, the CEO of Iowa Association of Community Providers, said it all started a couple of years ago with a $15 million budget cut to the program that helps people with intellectual and physical disabilities.  AmeriHealth Caritas was eating that cut, until they backed out of Iowa’s new privatized Medicaid system.  On Dec. 1, 2017, UnitedHealthcare took over about 200,000 former AmeriHealth patients.  Chandler said United is paying less to care for them.  Also on Dec. 1, 2017, Iowa Medicaid Enterprise told providers like Candeo and Mosaic that providers would be responsible for figuring out how to transport their clients, and also responsible for paying for it.

“(The responsibility was) dumped into the laps of providers that support people with intellectual disabilities.” said Mosaic Executive Dir. Carol Mau.  Mau said she had 30 days to figure out how Mosaic was going to transport more than 100 people with disabilities to their jobs and activities.  She said, “(We would) have to have an entire fleet of specialized vehicles.”

Instead, Mau has been asking staff to drive people around and family members to fill-in when possible.  Oftentimes, there is no option but an expensive specialized lift van.  Mau said the cost burden will put Mosaic $500,000 over budget this year.  Spread across at least 5,000 Iowans, Chandler said about 50 providers are estimated to lose millions.

Chandler said about one-third of providers will see funding increases, as they take over transportation responsibilities.  The remaining third will break even.  Iowa Medicaid Enterprise released the following statement regarding recent changes:

“As legislatively directed, the Department has moved to tiered rate reimbursement for Daily Supported Community Living (SCL), Day Habilitation and Adult Day care for Intellectual Disability (ID) waiver members. This affects approximately 5,000 ID waiver members.

Rates previously varied among providers throughout the state, regardless of the needs of the member. Tiered reimbursement rates are designed to standardize the rate of reimbursement for services that is based on the severity of an individual’s disability and the intensity of their needs for supports. Our goal is to reimburse ID waiver services with a daily rate based on an objective measure of the severity of the individual’s disability. Most providers will see rates increase, others will see them decrease. Tiered rates are being phased in over 19 months to mitigate the effect of the change. This does not add cost or save money. Tiered rates redistribute the money more effectively based on member need. This is cost neutral. We worked closely with providers and revised rates three times based on feedback.

As it relates to transportation, this change only affects those on the ID waiver that use Daily SCL. It does not affect ID waiver members that get hourly services. It does not affect members on other waivers that use transportation.  If daily SCL is not part of the member’s service plan, transportation is available, with billing the same as it has been in the past. Non-emergency Medical Transportation (NEMT) continues to be a state plan service that members can use to get to and from medical appointments.”

-Matt Highland
Public Information Officer,
Department of Human Services


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