Tag Archives: IA
Market Overview PDF
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IA Medicaid Managed Care Enrollment is Up 5.4%, Jun-20 Data
Medicaid managed care enrollment in Iowa is up 5.4% to 672,445 in June 2020 compared to year-end 2019, after increasing 4.0% in 2019 and 4.9% in 2018. AmeriHealth Caritas left the state’s Medicaid managed care program in December 2017. Following the plan’s departure, the state selected Centene subsidiary Iowa Total Care to join the state Medicaid program. However in June 2019, UnitedHealthcare of the River Valley exited the state’s Medicaid managed care program. The state evenly distributed UnitedHealthcare’s members between Anthem/Amerigroup and Centene. Centene began services on July 1, 2019.
IA Medicaid Managed Care Capitation Rates, SFY 2019
Iowa Medicaid Managed Care Statewide Rates by Eligibility/Program, SFY 2019
IA SNP Membership at 15,261, Mar-20 Data
Iowa had 15,261 Special Needs Plan members as of March 2020.
IA Medicaid Managed Care Enrollment is Up 4.2%, May-20 Data
Medicaid managed care enrollment in Iowa is up 4.2% to 664,277 in May 2020 compared to year-end 2019, after increasing 4.0% in 2019 and 4.9% in 2018. AmeriHealth Caritas left the state’s Medicaid managed care program in December 2017. Following the plan’s departure, the state selected Centene subsidiary Iowa Total Care to join the state Medicaid program. However in June 2019, UnitedHealthcare of the River Valley exited the state’s Medicaid managed care program. The state evenly distributed UnitedHealthcare’s members between Anthem/Amerigroup and Centene. Centene began services on July 1, 2019.
MLRs at IA Medicaid MCOs Average 91.5%, 2019 Data
Average MLR between two Medicaid MCOs in Iowa was 91.5% in 2018. The average PMPM premium was $686.
IA Medicaid Fee for Service vs. Managed Care Penetration, 2014-19
Total Medicaid enrollment in Iowa was 692,089 in 2019. About 92.2%of Medicaid beneficiaries were enrolled in a managed care plan. The remainder are in fee-for-service Medicaid. Total Medicaid expenditures were $5.2 billion in 2019, with about 92.1% through managed care and the rest through fee-for-service.
IA Improperly Claimed $37.1 Million in Medicaid Reimbursements, OIG Report Says
Home Health Care News reported on April 10, 2020, that Iowa improperly claimed at least $37.1 million in federal reimbursements for payments made to home care providers, according to the U.S. Office of Inspector General (OIG). OIG recommends the state refund the money to the federal government, improve monitoring of its health home program, and better define documentation requirements. Read more
IA Medicaid Managed Care Enrollment is Flat, Apr-20 Data
Medicaid managed care enrollment in Iowa is up 2.0% to 650,212 in April 2020 compared to year-end 2019, after increasing 4.0% in 2019 and 4.9% in 2018. AmeriHealth Caritas left the state’s Medicaid managed care program in December 2017. Following the plan’s departure, the state selected Centene subsidiary Iowa Total Care to join the state Medicaid program. However in June 2019, UnitedHealthcare of the River Valley exited the state’s Medicaid managed care program. The state evenly distributed UnitedHealthcare’s members between Anthem/Amerigroup and Centene. Centene began services on July 1, 2019.
CMS Approves Section 1135 Medicaid Waivers for Seven More States
On March 25, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that it has approved Medicaid 1135 waivers for seven additional states in response to COVID-19, bringing the total approved states to 23. The seven states are: Indiana, Iowa, Kansas, Kentucky, Missouri, Oregon, and Rhode Island. The waivers give the states significant flexibility in how Medicaid services and funds are used to respond to COVID-19.
