Rep. Linda Upmeyer: Medicaid modernization launches today

From Rep. Linda Upmeyer of Clear Lake –

The pieces are slowly coming together as we begin to wind down this year’s session. Talks continue on the state budget and the number of bills on the debate calendar continue to drop off as we complete our work.

Today, the state’s new Medicaid Modernization plan starts and managed care organizations (MCOs) will begin managing the care of Iowa’s 560,000 Medicaid recipients. This is a big change for the state as we move from a fee-for-service model to a coordinated one, but I’m optimistic that this change will be a benefit to the patients that rely on high quality healthcare from Medicaid.

So why is the state switching to a modernized Medicaid system? The reason is twofold.

First, the current Medicaid system is bureaucratic, inflexible, and unpredictable in cost. As the second biggest program in state government, behind K-12 education, the cost of Medicaid has skyrocketed over the last decade. According to the nonpartisan Legislative Services Agency (LSA), yearly state revenue grew by 2.6% between 2006 and 2015. During that same time, funding for schools grew yearly at 4.3% while Medicaid grew by a staggering 9.1%. This unsustainable growth threatens other functions of government– like education, public safety, and courts – at risk of being crowded out. The old Medicaid system simply does not operate like an efficient system should.

Second, the state’s antiquated Medicaid system doesn’t focus on making patients healthy, and simply works to treat diseases and illnesses as they occur. Under managed care, the new system will focus on preventative care to help patients lead healthier lives. This is done through coordinated care by promoting wellness measures and tackling chronic disease. These steps will help patients enjoy a higher quality of life.

Medicaid Modernization provides the state with an opportunity to control these ever-growing costs while also improving patient health.

Under the new system, benefits of Medicaid will continue to be offered. All current services available to Medicaid patients should not change and patient identification numbers should also remain the same. Patients can switch to a different managed care organization at any time for any reason between now and May 17. Following that date, patients are still able to switch for good cause, such as a provider not being signed up with an MCO. There will also be an annual open enrollment period in late fall to switch to a different MCO or remain with the current one.

As Medicaid Modernization rolls out over the next few days and weeks, please let me know if you run into any problems. I’m sure that there will be minor snags and hiccups during this transition and I’m ready, willing, and able to assist all of those Iowans who may be affected during this change.

Additionally, House Republicans have been working to craft legislation that provides a degree of legislative oversight to the Medicaid Modernization plan. This will likely be included within the Health and Human Services budget bill. House Republicans’ plan will focus on access, quality of care, and quality of outcomes to ensure that patients continue to receive the high quality healthcare that they expect.

Any change, especially one of this magnitude, is always difficult in the beginning. However, I’m optimistic that this is the right approach to make Iowans healthier and provide predictability to the Medicaid budget. I’m aware that this transition has been a point of controversy, but now is the time to come together and work to make this as successful as possible for those that count on Medicaid services.

More information on MCOs and the transition can be found at http://www.IAHealthLink.gov.