The state of Iowa’s current Medicaid model operates multiple care management approaches based on the population being served, however, this can contribute to a fragmented model of care. As a result, managed care arrangements for services such as behavioral health, physical health, and transportation are provided by separate entities.
This has led to the lack of care coordination among providers and limits financial incentives to actively manage a patient’s healthcare. In addition, by excluding Medicaid enrollees when they become eligible for Home and Community-Based Services (HCBS) waivers or long-term care, there is no financial incentive to prevent institutionalizations.
The Iowa Department of Human Services (DHS) recently released a Request for Proposal (RFP) to improve coordination and quality of care to modernize Medicaid. The RFP titled “The Iowa High Quality Health Care Initiative” is looking for bids from potential vendors as the state moves toward a risk-based managed care approach for the state’s Medicaid program.
DHS intends to contract on a statewide basis with two to four successful bidders that are able to demonstrate the capacity to coordinate care and provide quality outcomes for the Medicaid and Children’s Health Insurance Program (CHIP) populations.
Medicaid Modernization in the state would mean that DHS would be able to enroll the majority of the Medicaid, Healthy and Well Kids in Iowa, and Iowa Health and Wellness Plan enrollees in Managed Care Organizations (MCO, and address HCBS waivers
In turn, Medicaid modernizations would improve quality and access, achieve greater accountability for outcomes, and create a more predictable and sustainable Medicaid budget. Savings projected in Governor Branstad’s state FY 2016 budget are expected to be $51.3 million.
DHS will contract with MCOs to provide comprehensive healthcare services to include physical health, behavioral health and Long-Term Services and Supports (LTSS). This initiative would create a single system of care to promote efficient, coordinated, and high quality healthcare.
The MCOs will be required to develop a network of chronic condition health homes and would also be required to fund integrated health homes. Case management would be provided to assess, plan, implement, coordinate, monitor, and evaluate care based on an individual’s healthcare needs using their own staff or contracted staff.
Go to http://bidopportunities.iowa.gov/?pgname=viewrfp&rfp_id-11140 to view the RFP. Proposals are due May 8, 2015. For more information, contact Carrie Lindgren, clindgr@dhs.state.ia.us or phone 515-281-7795.