Iowa’s largest health care system may sever ties with one of the two remaining companies that manage care for Iowa Medicaid patients.

UnityPoint Health operates hospitals, clinics and home-care services throughout Iowa. UnityPoint executives say if negotiations with Amerigroup aren’t resolved by the end of the year, UnityPoint may not renew its contract with the company. About 54,000 Iowans who are having their care managed by Amerigroup have been notified of the impasse — and the possibility they may have to switch to the other managed care organization overseeing the state’s Medicaid program.

UnityPoint will continue its Medicaid-related contract with United Healthcare in 2018. A third company had been managing care for Medicaid patients in Iowa, but will no longer do so after November 30.