End of United Healthcare agreement

Tuesday, April 9, 2019

Last week, Governor Reynolds and the Department of Human Services announced that negotiations with United Healthcare have ceased.

Governor Reynolds cited UnitedHealthcare's demand for more money for less accountability as the reason for the breakdown.

Governor Reynolds fought for Iowans. I applaud her leadership skills in knowing when to walk away. She is dedicated and committed to get the best deal possible for Medicaid members, providers and taxpayers.

I expect a smooth transition with no gaps in service to vulnerable Iowans. DHS is actively working on a transition plan with Amerigroup and Iowa Total Care to match members with their current case managers, credentialing out of network providers throughout the transition, ensuring comprehensive data file transfers for care coordination, and honoring existing prior authorizations. The call center is prepared to assist members and providers with any questions during the transition.

During the transition, Medicaid members will have a choice between the two remaining Managed Care Organizations (MCOs) and be able to switch plans for 90 days from the date they are moved from UnitedHealthcare. Even after that 90-day choice period, members will be able to change MCOs at any time for "good cause," which includes their provider not being in their current MCO's network.

Providers should also be reassured that even after United leaves the Medicaid program, they are required to maintain claims processing for 12 months to complete adjudication of all claims.

This week, the House Appropriations Committee passed the Health and Human Services Budget, which includes actuarially sound Medicaid rates based on actual experience to ensure a sustainable program for the future. For the last 3 years, the legislature has passed, in a bipartisan manner, some of the strongest managed care oversight in the country.

Please reach out to me if you are a provider or member experiencing a specific issue, and I will help assist in resolving the problem.