Governor Branstad's Plans for Medicaid Managed Care

posted by Chris Sparks on Thursday, March 12, 2015

In Iowa alone, Medicaid covers 546,000 people which is 18 percent of the population.

In Iowa total Medicaid expenditures by state and federal government top $4.2 billion annually, which includes $1.5 billion of state money. EPI receives over $13 million in Medicaid reimbursement providing services to persons with disabilities.

Many states have already placed managed care shifts in order to help cut Medicaid costs.

Managed care is described as a set of techniques to be used for reducing unnecessary health costs while improving the quality of health care.

Governor Terry Brandstad recently introduced plans to hire a private managed care company, or companies, to help run Iowa’s Medicaid program.

Private companies are involved in managed care arrangements to help oversee health care programs and share the savings they obtain by making care more efficient.

Governor Branstad believes if the government is able to spend less on Medicaid, the quality of care should improve greatly by lowering medical costs and hospital visits.

Though the full plan will not be available until after March 1 Branstad is projecting it would save $51.3 million during the first six months after implementation.

The focus of managed care is not to be based purely on saving money, but rather on improving the care and health of Medicaid recipients.

Legislators are being careful to make sure this shift won’t lead to cuts in services or payment rates to medical providers.

What Does This Mean for EPI?

Managed care is likely to present both challenges and opportunities for service providers. There will be an emphasis upon the development of natural supports with dual goal of improving community inclusion and quality of life while managing costs. Managed care companies will pay attention to preventable health conditions (like diabetes, obesity, and hypertension) and their management.

We anticipate continued scrutiny of large congregate and segregated services. There will be tools utilized to guide the approval of service levels in an effort to achieve "rate rationality" or an objective base for rate determination.