State makes change in Medicaid program

Iowa’s making a change in the way it operates its Medicaid program, and Department of Human Services spokesman Roger Munns says other states are watching carefully to see how it works. He says most states have one “giant company” operate their Medicaid systems because only the biggest computer-service company can handle all the services they need. The two-Billion-dollar Medicaid program covers healthcare for the low-income, and kids in un-insured families in Iowa. It was decided years ago that it’d be more efficient to contract out the work than have state employees do it all, and Munns says most states do it this way. Munns says Iowa’s now broken up the work of administrating the Medicaid program into parts, and asked for competitive bids in each of the parts. Eight contracts have been awarded for the various parts of that business, and Munns says two more are on the way. He says a benefit of doing this way is allowing regional and “niche players” bid for some of the work, something they never were big enough to do under the old “winner-take-all” system. Munns says it’s part of the head-to-toe revamping of the agency started when Kevin Concannon took over as its new director. This work includes claims processing, pharmacy medical services, provider support for doctors working with the program, audits, collections, and reviews that ensure neither users nor healthcare providers are improperly using the program or billing it. The one company that’s done all the work for eight years — a 20-million-dollar-a-year contract — is based in Texas. Munns says he state hopes to see better quality service now it’s broken into parts and he says other states might make similar changes if they see it producing the desired improvements in Iowa. The Iowa Healthcare Foundation is one provider that’s won two of the first contracts and others are still to be awarded.