Public Health Board discusses concerns about Medicaid reimbursement process

By Xiomara Levsen

The JOURNAL

At the Washington County Board of Public Health meeting last Wednesday, staff members discussed their frustrations and concerns with the new Medicaid system in Iowa.

Fiscal administrator Peggy Wood said since the first of May Washington County Public Health hasn?t received reimbursement from Iowa Medicaid for home health cases and therapy.

?On the flip side we have been successful submitting some immunization claims,? Wood said. ?United Healthcare was very responsive. It got turned around in a week. They only reimbursed us at 30 percent at what we billed.?

The good news is that an electronic claim went through, Wood added.

?Aren?t these insurance companies used to seeing the bill?? board member Virginia Bordwell asked. ?Approving only a portion of it and paying only a portion of what they approve??

Wood said that depends; with private insurance they get reimbursed what they billed, which they do very little with. However, Medicaid is paid weekly and usually they get reimbursed for what they bill.

Wood went back to discussing the immunization claims. She said they sent bills to all three of the Medicaid Care Organizations (MCOs). They have heard from two. One reimbursement was approved and the other claim was denied. The final MCO hasn?t responded.

The good news is Washington County Public Health (WCPH) is getting claims to the MCOs, Wood said. The bad news is there are some contract and clinic classification errors, and they?re trying to figure out why.

Wood said usually WCPH receives $35,000 in reimbursements for services they give. They won?t have that money for the month of May, which means their revenues will be down and there are two more months until the end of the fiscal year.

?We?ll just see what happens,? Wood added.

Home Health Clinical Nurse Manager Karri Fisher spoke a little bit about how the claims were going for her department.

?I think this is the honeymoon phase,? Fisher said. ?Of the three, only United Healthcare does not require us to prior-authorize services for our home health care clinics.?

Medicaid, Fisher added, previously would only pay the services. She has heard from one MCO and stopped doing prior authorization requests with United Healthcare. She hasn?t heard from the final MCO.

In the next round of claims, the MCOs are going to look at the patients and evaluate their medical necessity.

?So that will be where the rubber meets the road,? Fisher said. ?Where they kick people off or try.?

WCPH administrator Danielle Pettit-Majewski said she is hearing from other public health departments in the state this is happening everywhere. No one has a good story to tell about how Medicaid Modernization is going.

Wood said they should feel good about the work they did to get signed up with MCOs. There are other agencies contacting them who haven?t signed up with an MCO or don?t know what process they?re supposed to take to file a claim.

?I feel good about the fact that we?ve at least tried,? Wood added. ?We?ve had claims go through successfully. Now whether we?re getting paid, that?s the other side, but at least we have that door open and that is working for us. There are many, many others that aren?t to that point.?

Pettit-Majewski also spoke about the waiver process. She said WCPH has a one-year agreement with them to provide services and Ameritaus has a six-month agreement. Both companies said they would re-assess the agreements to see if they would want WCPH to provide those services if they can?t find a case manager in its area.

?What we have seen and what we are hearing now, especially from United Healthcare and what is approved for case management services ? they?re only going through the end of September, which is six months and we were told a year.?

Then the case management services would be internalized, which means no one will be around to help people, Pettit-Majewski. They won?t be around to help people get into Medicaid. Pettit-Majewski told legislators in January if they don?t get reimbursement for case management services, WCPH wouldn?t be able to afford to continue to do that.

?It is concerning, for sure, because we?re not sure how that?s going to go forward,? Pettit-Majewski said.

She said there aren?t cost savings but more of cost shifting. If someone isn?t available to help people sign up for Medicaid, then that?s how money will be saved, because people aren?t going to be able to get into the system.

?Didn?t we say that?? Bordwell asked.

?We said this a year ago,? Pettit-Majewski replied.

At the governor?s conference a year ago, the Jefferson County Public Health administrator told Gov. Terry Branstad she was concerned there would be cost shifting, Pettit-Majewski said. They were told ?too bad,? the money had already been allocated and spent elsewhere and public health departments needed to figure out how to change. Pettit-Majewski believes people will fall through the cracks because of this.

Sen. Kevin Kinney has spoken to Pettit-Majewski. Kinney has been very responsive even though he?s not on that committee. He told her legislators are trying to get more oversight on the process but haven?t been successful.

Pettit-Majewski said she has not heard from Iowa state Representative Jarad Klein.

Board member Jack Seward Jr. asked for a copy of the correspondence Pettit-Majewski sent to Klein. Pettit-Majewski said she would send him everything.

Pettit-Majewski hadn?t heard from Representative Dave Heaton, which surprised her.

All the local legislators know Pettit-Majewski will call them and advocate for people who need assistance with Medicaid, she added.