State auditor to Iowa Medicaid recipients, providers: "Know your rights"

Iowans affected by UnitedHealthcare’s impending exit as a Medicaid managed-care provider should be aware that they have rights under the contract the state signed with the insurer, State Auditor Rob Sand announced at an April 1 news conference.

Sand reviewed the company’s 287-page contract with the Iowa Department of Human Services before news broke on March 29 that UnitedHealthcare will not continue to manage care for Iowans on Medicaid in the coming fiscal year, which begins on July 1. That development suddenly made the contract’s termination provisions “very important and relevant.”

All Iowa taxpayers have grounds for concern about the coming transition, Sand told reporters. “It was taxpayer money that got United rolling, it was taxpayer money that was invested into learning United’s systems, it’s taxpayer money that is going to help wind down United’s work with Iowa, and it’s taxpayer money that is going to help fund the transition to another MCO in Iowa.” Those expenditures represent public funds being spent on “something other than actually providing health care to Iowans under Medicaid, and that is a problem.”

Some of the most vulnerable Iowans will be particularly at risk, Sand added. Patients “deserve to have consistency and deserve to have continuity and deserve to have the health care that they get by qualifying for this program.” Key contract provisions Medicaid recipients should be aware of:

The Reynolds administration can require UnitedHealthcare “to continue to serve patients or require provision of services” until the transition to a new managed-care organization (MCO). In other words, UnitedHealthcare can’t “leave anybody out in the cold.”

Under the contract, the company is obliged to appoint a “liaison to address concerns related to the transition.” Patients need to know whom to contact if they run into problems receiving care.

The company must promote “an orderly transfer of patient care and patient records to providers.” The contract language (enclosed below) elaborates: “For those members in a course of treatment for which a change of providers could be harmful, the Contractor shall continue to provide services until that treatment is concluded or appropriate transfer of care can be arranged.”

UnitedHealthcare must “coordinate the continuation of care for patients with acute conditions” who are being treated. The contract specifically requires the company to “be financially responsible for inpatient services for patients hospitalized on or before the day of Contract termination or expiration through the date of discharge […].”