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Rep. Upmeyer: “Time to question the status quo”


This news story was published on December 12, 2015.
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From Rep. Linda Upmeyer of Clear Lake –

Rep. Linda Upmeyer

Rep. Linda Upmeyer

Since the end of last session I have been receiving emails and calls regarding the state’s upcoming transition to Medicaid managed care. As your State Representative, it is my duty to represent you in Des Moines and ensure that you are kept in the loop about your state government. This newsletter will provide an update on the transition and hopefully answer any questions you may have about the status of Iowa Medicaid.

Over the last several years Medicaid spending has increased rapidly, which is limiting the Legislature’s ability to make meaningful investments in Iowans’ priorities. Funding for things like education, public safety, and courts are being put at risk because of the unsustainable growth in this inflexible federal program. This problem is not confined to Iowa, as every state is working to slow down the costs of Medicaid.

Protecting the status quo is no longer an option and we must be open to finding solutions to contain the ever-growing costs of Medicaid, while also improving patients outcomes

In response to the increasing unpredictability, Governor Branstad, in January, proposed transitioning Iowa’s Medicaid program to a managed care model. What that means is that rather than state employees administering the program, private insurance companies will do so. Managed care is not a new concept nationally, or even in Iowa. Iowa has used a form of managed care since 1990 for a portion of the state’s Medicaid population. Across the country, nearly 40 states use some sort of managed care model for services, and more than half of Americans covered by Medicaid have their healthcare delivered through this system.

One of the biggest concerns during this transition has been that the timeline is too aggressive and it’s moving too quickly. However, safeguards have been put in place to ensure that Medicaid recipients experience minimal disruption of services. For physical and mental health services, there will be a 6 month transition period from January 1 to July 1. Those services have the shortest timeline because mental health is the only sector of Iowa Medicaid that was previously in managed care. Additionally, nursing homes will have a two year transition period and will be fully phased in by January 1, 2018.

Earlier this week Governor Branstad announced an extension of the provider safe harbor period by an additional three months to April 1, 2016. This gives patients peace of mind and allows providers to be fully reimbursed while they have additional time to review contracts.

Another concern has been a lack of communication from the Department of Human Services. Informational toolkits were sent to Medicaid recipients in September and enrollment packets with enrollment assistance details should already be out to members. The delay in providing information to Iowans was due to the fact that the federal government had to approve what material was being sent out, and they prevented DHS from sending it out sooner.

Currently, Medicaid members have until December 17 to choose which MCO they would like to manage their care that begins on January 1. While provider networks are not fully complete, I have been assured that new contracts adding more providers are being signed with MCOs on a daily basis. Members then have until March 18, when provider networks are more complete and robust, to make a final decision on which MCO they would like to manage their healthcare.

With any big change comes some fear of the unknown. However, I am optimistic that as long as both the State, health care providers, and consumers engage in constructive dialogue, Iowa’s Medicaid program will be better in future years. As this process moves forward, the Legislature will keep a close eye on the changes and assist our constituents to ensure they receive the care and services they need.

Additionally, the Department of Human Services has established two toll-free hotlines to troubleshoot any problems that providers or consumers experience during the transition.

If a consumer has questions, they should contact Iowa Medicaid Member Services at 1-800-338-8366.

If a provider has questions, they should contact Iowa Medicaid Provider Services at 1-800-338-7909.

If you have any questions at all about the state’s transition to managed care, please don’t hesitate to contact me. You can reach me at linda.upmeyer@legis.iowa.gov or (515) 281-3521.

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30 Responses to Rep. Upmeyer: “Time to question the status quo”

  1. Avatar

    Reality Check Reply Report comment

    December 14, 2015 at 5:02 pm

    Managed Care = Managed Profits = Screw You!

  2. Avatar

    Watchdog Reply Report comment

    December 14, 2015 at 8:29 am

    Managed Care? What does that really mean and why the need to change? This is about money and controlling the cost and placing the decision making for health care out of the reach of the user.

    When we shift that responsibility to the private sector it will shield the politicians from taking the heat when services for medical care are cut.

    I know for a fact (currently) many cases of people being turned down by their private health care for services and medications because the Insurance Companies rules are set up in such a way they can say no to the recipient in spite of the Doctor orders. The cases I am familiar with absolutely affect their health and have negatively effected their life and ability to work.

    This is nothing more then a shell game where we are turning over responsibility to someone else to get it off our hands, or in this case the State Government’s hands.

    It’s all in the rules and regulations regardless of who manages Medicaid!

    • Avatar

      LVS Reply Report comment

      December 14, 2015 at 8:57 am

      @Watchdog-I guess you could say this is similar to Obamacare in that they both take decision making away from the patient. I am on Medicare as a primary and have run into it several times where I have been denied health care because it was not covered. I was in the hospital for two days for observation on my back and was very surprised to find out my medications were not covered. They said it would be covered by the R/X Plan but most of them were not and the others came under the damn donut hole. All this because Obama stoled money from Medicare to fund his losing health plan which is failing all over the country.

      • Avatar

        Watchdog Reply Report comment

        December 14, 2015 at 12:18 pm

        @Lvs, I too am on Medicare and have found the same thing. My wife and I have been observing little changes here and there.

        What is so unfair about the whole heath care takeover is, it just wasn’t necessary in the first place. When we were able to get our health coverage in an open market that was completive, everything was covered.

        Single payer and Government involvement is wrong at every level.

        When you think about it, it is not about helping the poor and needy at all. It’s about running the lives of every single citizen.

        To top it off, “we the people” are powerless to change it. That is the real head-shaker!

        • Avatar

          LVS Reply Report comment

          December 14, 2015 at 2:07 pm

          @Watchdog-we have the power. We just need to vote in the right people to help us. The Democrats are the ones who got us into this mess, but the Republicans have done very little to fix it except run off their mouths. That is why I like Trump. No one owns him and he just might be the answer. All the others have been bought by special interest.

        • Avatar

          Bodacious Reply Report comment

          December 14, 2015 at 4:29 pm

          Everything was covered for you maybe. My wife and I had to search for insurance when I turned 65 and lost my employer based insurance. At that time, no one would cover her reasonably because of a foot injury she had.. We couldn’t find insurance that was reasonable – the best we found for her was $1280+ dollars a month. Once the ACA became law, we went to the ACA website and found insurance for about $440 a month. Still expensive but a heck of a lot better than before. Did you know that Anthem, an arm of BC/BS earned over $800 million in profits the first quarter this year? Are your rates going down? I doubt it and I doubt they will. You seem to think these companies have your best interests as their primary motivation. Wrong.

          • Avatar

            LVS

            December 14, 2015 at 5:22 pm

            @Bodacious-I retired at 63 and had a insurance polity with AARP that I had carried for ten years and never used it. Right after I retired I was diagnosed with diabetis and they promptly cancelled my insurance. I couldn’t buy insurance at any cost and if you are not aware diabetis is a very expensive disease. I had to wait until I was 65 to get medicare and by then a lot of damage had been done. Medicare is a decent policy for seniors that is not very expensive. Of course you have to have a supplemental or your cost go up. Obama stole 9 billion dollars from Medicare to fund his joke of a insurance plan that is failing all over the country. But the medicare money is long gone.

          • Avatar

            Anonymous

            December 15, 2015 at 7:03 am

            LVS, I have diabetes also. I know some of your pain.

          • Avatar

            LVS

            December 15, 2015 at 8:20 am

            @Anonymous-Diabetis is just a excuse for the medical and particularly the drug fields to rip you off. When a pack of insulin cost $500 and you have to take two types of insulin it doesn’t take to many months to enter the dreaded donut hole. Three drug company’s have controlled the cost of insulin for years and years and artificually keep the cost high. Profits of over 500% are nothing but a cost fixing scam by the drug company’s. The cheaper drugs such a Metformin will kill you kidney’s in a few short yars and most other cheap drugs also affect the kidney’s. If they really want to help people go after the drug company’s/

          • Avatar

            LVS

            December 15, 2015 at 8:25 am

            @Bodacious=My monthly insurance cost are about $450.00 per person and there are two of us. So, we are paying $900.00 a month for coverage. That is a lot of money for someone on a fixed income and to have our government steal from Medicare to fund a B/S. insurance called Obamacare should be illegal. On top of that supplemental insurance is age qualified which means the older you get the more it cost.

          • Avatar

            Bodacious

            December 15, 2015 at 10:09 am

            LVS, I quit taking Metformin because it was really screwing with my intestinal system. My doc said I could try something else but they were much more expensive than Metformin. I decided to try diet and exercise but soon I will have to go back on some other drug. (and pay through the butt)

          • Avatar

            LVS

            December 15, 2015 at 10:32 am

            @Bodacious-Metformin works pretty well but after about two years it loads up your kidneys and it never goes away. It is a cheap drug but if it leads to dialysis it just isn’t worth it. Diet and exercise work well. My sugar goes way down in the spring and summer when I can get outdoors and be active. It really pisses me off that we donate millions for research and the drug company’s take it and then never give back. They do the same thing with cancer.

        • Avatar

          Bodacious Reply Report comment

          December 14, 2015 at 4:32 pm

          For some reason on this site, my comments don’t show up for a while, then they magically appear when I post another comment. I don’t understand.

          • NIT Publisher

            NIT Publisher

            December 14, 2015 at 5:22 pm

            Your longer, recent comment was on hold due to its length. I had to approve it before it could be made public.

          • Avatar

            Anonymous

            December 15, 2015 at 6:59 am

            Thanks I didn’t know that

      • Avatar

        Bodacious Reply Report comment

        December 14, 2015 at 1:32 pm

        That is not true and you know it. Medicare has been a losing money proposition for most health care providers for years. Some states are finally realizing that if they want profitability, they are going to have to base it on Medicare rates rather than the rates they feel is “reasonable”. Did your rates ever go up before the ACA? How much?
        Insurance companies have seen costs go up because of the ACA I will agree. But that is due to the fact that thousands of people finally were able to get care for things they couldn’t get care for before the ACA. That is a well known fact. Many of the groups that watch health care costs believe that within the next couple of years, rates will stop spiking because the system will finally catch up. You want a personal story about that? My wife couldn’t get low cost insurance prior to the ACA because of a foot injury she suffered about 7 years ago. When I went off my employer-sponsored health plan because I reached retirement age, we searched for a company to cover her. None would -at least reasonably. The cheapest rate we were quoted was over $1270 a month because of a ‘previous condition’. With the ACA, we found one for $400. No restrictions. Anthem, one of BCBS’s companies had a profit for the 1st quarter of 2015 of over $800 million dollars. And they want a 30-50% increase in their rates. Don’t blame this on the ACA. Put the blame where it belongs – on greedy, predatory corporations who are reaping the benefits because of millions of dollars they provide to politicians to vote and enact legislation that will keep them living the vida loca.

  3. Avatar

    buffalobill70 Reply Report comment

    December 13, 2015 at 1:42 pm

    From Time : Pot is a boon for tax revenues in Colorado, outpacing revenue from alcohol taxes in the fiscal year ending on June 30.

    Colorado collected almost $70 million in marijuana taxes during that time, nearly double the $42 million collected from alcohol taxes.

    Problem solved Rep. Upmeyer

  4. Avatar

    Bodacious Reply Report comment

    December 12, 2015 at 2:08 pm

    Of course Terry’s lap dog would repeat his line of b.s. almost verbatim. What else could we expect?

    • Avatar

      LVS Reply Report comment

      December 12, 2015 at 2:17 pm

      @Bodacious-ur problem is you are just not used to hearing the truth. That will all change when Trump is president.

      • Avatar

        Bodacious Reply Report comment

        December 13, 2015 at 8:44 pm

        The Medicaid plan is going to fall apart because of all Terry’s backdoor, illegal dealing with the people who run these for profit businesses. Time and time again, people within Terry’s realm committed illegal and unethical acts with, and for, these companies who rip the government off more than almost any one except the defense companies. She hasn’t had an original thought since her first kiss.

        • Avatar

          LVS Reply Report comment

          December 14, 2015 at 8:07 am

          @Bodacious-and yet they keep getting re-elected, time after time after time.

        • Avatar

          Watchdog Reply Report comment

          December 14, 2015 at 3:52 pm

          @Bodacious you just don’t get it do you. The Government you are so fond of is just as much “For Profit” as the private sector.

          The Private sector calls is profit and the Government calls it taxes.

          Private business’s don’t waste their profit while the Government wastes tax dollars on any whim they can think of. Not to mention all the over staffed departments all through out government.

          At the end of the day, free enterprise and competitive for profit companies keep prices down for the consumer.

          • Avatar

            Bodacious

            December 14, 2015 at 4:21 pm

            Private companies “don’t waste their profit”? Of course they don’t ‘waste’ it. They give it their executives, they build new office buildings to replace the ones they just built, and they give millions to the politicians they want to make sure they continue to rake in those huge profits. Do they lower prices when they make their yearly profits? No, they don’t. They raise them, just like insurance companies do to continue their profiteering.

          • Avatar

            Watchdog

            December 14, 2015 at 9:23 pm

            @Bodacious, If you only could understand how the Medicare program and Socialized Medicine started the upward price spiral for the cost of health care in the first place then we could begin the fix.

            But no, instead you shoved Obamacare down our throat which only added insult to the injury. Now we see more price increases for health care.

            The big rub here is, you are now only paying 440 dollars for 1280 dollars worth of health care and you seem proud to take that money from some other poor soul. It don’t seem to bother you one bit that you are taking that money from the backs of the working stiff.

            You should have been saving your money and working 2,3, and 4 jobs like I did to afford health care on my own. I am not a rich person but I still don’t believe in forcing someone else to pay for my well being.

            That is just what this selfish liberal society has become.

            FYI: I have been in the trenches of this issue since 1965 and saw this coming totally due to the Democratic/Socialists pushing free stuff to get voted back in. We have a mess and it ain’t getting any better thanks to people like you!

          • Avatar

            Bodacious

            December 15, 2015 at 7:12 am

            My comment in response to LVS entered as anonymous. I forgot to re-type my name.

          • Avatar

            Bodacious

            December 15, 2015 at 7:13 am

            I am not going to respond to your ‘holier than thou’ bs. The costs associated with the ACA are rising but most experts (except inane, obstructionist republicans) believe this is temporary because so many people went without for years when insurance wouldn’t cover illnesses like LVS’s diabetes. This spike is due to the number of people finally able to obtain care and it is believed that this will eventually catch up in the next 2-3 years. That isn’t saying costs will drop because insurance companies won’t lower rates but the big increases won’t be the norm.

  5. Avatar

    LVS Reply Report comment

    December 12, 2015 at 1:11 pm

    Thank you Linda-It is nice to see someone come out with facts instead of fear mongering for political reasoning like the spend sisters are doing.

    • Avatar

      Anonymous Reply Report comment

      December 14, 2015 at 4:34 pm

      You are gonna need the spend sisters working for you when Donald Trump comes to take away your social security benefits as you waste away in a nursing home.

      • Avatar

        David Reply Report comment

        December 14, 2015 at 5:02 pm

        really??? I just watched congress vote on taking 150 million from S.S. and use it on other things. You are saying when trump gets in they will take it all well little boy they are taking it all right now.

        • Avatar

          LVS Reply Report comment

          December 14, 2015 at 5:24 pm

          @David-I believe the number was 9 billion that was stolen from Medicare. They have been borrowing from S.S. for years and years and mostly by Democrats.