Here’s where you’ll find our updates on fixing Iowa’s Medicaid program. The newest information will appear at the top, and will include material from the Iowa Senate Democratic Research Staff and other sources.
Privatized Medicaid Timeline
| DATE | WHAT HAPPENED |
|---|---|
| January 2015 | Branstad tells Legislature he has decided to unilaterally privatize Medicaid. |
| February 16, 2015 | The Iowa Department of Human Services (DHS) releases RFP to procure private Managed Care Organizations (MCOs). |
| August 17, 2015 | MCOs awarded contracts: AmeriHealth Caritas, United, Amerigroup and WellCare. |
| November 2015 | Senators Mathis, Ragan and Jochum travel to DC to talk with White House officials and the Centers for Medicare & Medicaid Services (CMS) about delaying or rejecting Iowas application to move to managed care. |
| December 2015 | CMS makes a site visit to Iowa. |
| December 15, 2015 | CMS delays Iowa privatization implementation to March 1, 2016. |
| December 18, 2015 | WellCare contract is terminated for failure to disclose wrongdoing in other states. |
| December 31, 2015 | Wellmark hawk-i contract ends. Because of the delayed implementation, hawk-i members have only one option: United Healthcare. |
| January 1, 2016 | Original date for implementation before CMS delay. |
| February 11, 2016 | Senate votes to terminate Medicaid privatization contracts 29-19 (with Rs Chapman, D. Johnson and Shipley voting yes, and a note in the journal from Zaun, who was absent, saying he would have voted yes). |
| March 1, 2016 | Privatization delayed again by CMS until April 1. |
| April 1, 2016 | Privatization begins. |
| Fall 2016 | Governor Branstad increases rates for MCOs due to rising pharmaceutical costs and other emerging trends. At the time, it was estimated to cost $33.2 million from state funds and $94.5 million from federal funds, for a total increase to the MCOs of $127.7 million. Emerging Trends and Risk Corridor Fiscal Information |
| February 2017 | MCOs report to the Legislatures Health and Human Services Budget Subcommittee that they are losing a combined total of $450 million. |
| March 24, 2017 | An FOIA request from the Des Moines Register reveals that the State had signed contract amendments with the MCOs giving them an additional $235 million in a risk corridor arrangement. Since this was mostly due to Health and Wellness Plan members, the state portion was estimated at $10 million and the federal portion at $225 million because of the enhanced match rate for the Health and Wellness Plan (Medicaid expansion). Risk corridor plan was later denied by CMS. |
| May 31, 2017 | Chuck Palmer announces June 16 retirement. |
| June 16, 2017 | Jerry Foxhoven starts as new DHS director. |
| August 23, 2017 | Mikki Stier reassigned from Medicaid Director to Deputy Director of DHS. |
| October 1, 2017 | AmeriHealth gives 60 day notice to DHS that they will leave Iowa. |
| October 31, 2017 | DHS announces AmeriHealth will leave Iowa in 30 days. |
| October 31, 2017 | DHS announces the MCOs will receive a 3.3% increase ($60 million in state funds; $80 million federal) in capitation rates for fiscal year 2018 (after negotiations stretched into FY18). The emerging trends payments will actually total almost $78 million in state funds as opposed to the Fall 2016 estimate of $33.2 million. The risk corridor arrangement for Health and Wellness Plan members was not approved by CMS. The emerging trends increases will be paid retroactively to the beginning of the program, April 1, 2016. |
| October 31, 2017 | DHS announces 215,000 members will be auto enrolled to Amerigroup and United. |
| November 7, 2017 | DHS announces that all 215,000 members will instead be enrolled with United but members can choose to change to Amerigroup. |
| November 7, 2017 | DHS announces that new RFP for additional MCOs will be delayed from July 2018 to July 2019. |
| November 21, 2017 | Amerigroup will not accept any new members. |
| November 22, 2017 | DHS announces CMS has granted temporary permission to offer no choice of MCOs. |
| November 23, 2017 | DHS clarifies it has only communicated with CMS on the no choice situation. |
| November 27, 2017 | DHS announces that 10,000 members that tried to sign on with Amerigroup before November 16 will be covered instead under traditional Medicaid fee for service and all other former AmeriHealth members will be assigned to United. |
| November 29, 2017 | Senators Ragan and Mathis ask Governor Reynolds to give all former AmeriHealth members the choice between United and fee for service. |
| December 1, 2017 | 10,121 former AmeriHealth members that chose Amerigroup before November 16, 2017 are in the Medicaid fee for service program. |
| December 1, 2017 | Approximately 208,000 former AmeriHealth members getting coverage from United, regardless of their preference. |
| December 4, 2017 | New Medicaid Director, Michael Randol, begins work in Iowa. He was formerly the Medicaid Director in Kansas, the only state with a Medicaid disaster worse than Iowas. |
| February 2018 | Iowa Medicaid ends contract with Milliman, the actuarial firm that determined payment rates to MCOs, and hired a new actuarial firm, Optimas. |
| April 2018 | Amerigroup begins accepting more Medicaid members after four months of no choice. This allows 10,000 members who temporarily had been in fee for service to be shifted to Amerigroup. |
| May 2018 | HHS FY19 budget includes NO money for any capitation rate increases for the MCOs, and negotiations with the MCOs continue even though Director Foxhoven promised resolution before the end of session. |
| May 2018 | Iowa Total Care is selected an MCO through RFP (two applicants) to begin service July 1, 2019. |
| June 2018 | Iowa Medicaid Enterprise (IME) announces a new $1,000 cap on Dental Wellness Plan services for adult members. |
| June 2018 | University of Iowa Dental College announces it will no longer accept Medicaid patients. |
| June 2018 | Director Randol explains yet another estimate of the savings provided by privatization. The original amount was $232 million per year. That decreased to $47 million per year in Fall 2017. In May 2018, the amount was revised to $140.9 million. There is NO data on how the savings are achieved (through fewer hospitalizations, healthier Iowans, etc.). |
| July 2018 | Iowa Total Care (Centene) is selected as Iowas third MCO, to begin providing services in July 2019. This creates another round of disruptions for Iowa Medicaid members. Many are concerned that members will not be able to keep their provider; providers wont sign up with the new company because of previous problems. In addition, Iowa Total Care has had at least $23 million in penalties assessed to them in other states. |
| August 2018 | Negotiations with MCOs for FY18 (which began July 1, 2017) are finally complete. The Reynolds Administration agrees to a 7.5% increase for MCOs, which is actually an 8.4 percent overall increase when state and federal funds are added togethermore than double the 3.3% increase granted the previous fiscal year. State: $103 million; federal: $241 million; total increase: $344 million. |
| September 2018 | DHS announces they will move to calendar-year contracts with MCOs. |
| December 2018 | The supplemental appropriation for FY19 Medicaid is $141 million; revised to $150 million in March 2019. |
| February 2019 | DHS shares information and timeline on transition and auto reassignments for Iowa Total Care starting service on July 1, 2019. |
| March 2019 | With the approaching addition of Iowa Total Care, letters to all Medicaid members reassign their MCOs. |
| March 2019 | United Healthcare announces its departure from Iowa Medicaid program. |
| March 2019 | A new Medicaid forecast document reveals that DHS is no longer moving to calendar year contracts with MCOs. In addition, DHS has signed contract Amendment #8, giving the MCOs another 0.5% raise in capitation payments from January through June 2018. This raises the FY19 supplemental need by $4 million. |
| April 2019 | To cover MCO increases, DHS gets a $150 million FY19 supplemental in the FY20 budget bill for Medicaid. |
| April 2019 | DHS enters contract negotiations for FY20. |
| April 2019 | DHS develops a transition plan due to United Healthcares departure. |
| June 17, 2019 | Governor Reynolds asks for Director Foxhovens resignation and appoints Gerd Clabaugh to Acting DHS Director. Liz Matney moves to Governors office. |
| June 30, 2019 | United Healthcare departs Iowa Medicaid Program. |
| July 1, 2019 | Iowa Total Care begins serving Iowa Medicaid members. |
| July 10, 2019 | FY20 MCO contracts are signed, with MCOs set to receive an 8.6% increase. |
| September 5, 2019 | Governor Reynolds hires Kelly Kennedy Garcia from Texas as DHS Director starting on November 1, 2019. |
| September 10, 2019 | FY21 DHS budget request shows a $106 million supplemental need for Medicaid for FY20: $67.8 million for MCO increases; $9.1 million for budgeted shortfall; $7.9 million due to less from HCTF; $17.2 million due to decreased pharmacy rebates; and $4.5 million in other changes. |
| January 3, 2020 | DHS withholds $44 million from Iowa Total Care for failure to pay claims and resolve issues. |