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N.H. Medicaid bid winner AmeriHealth has rocky history in Iowa

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, or on Twitter at @ActualCAndrews.)

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