Every day a lot of behind-the-scenes work occurs in the IA Health Link program. It often goes unnoticed and unrecognized but it's the kind of work that is making a big difference in the lives of nearly 700,000 Iowans across the state.
Take the recent case of an Amerigroup (AGP) member from Altoona, whose chronic illnesses require much care coordination and a high level of specialized services. Amerigroup case managers spent several months lining up the right care and support for him.
Due to a hospitalization that lasted several months last year, he no longer met the federal and state requirements to be eligible for Home- and Community-Based Services. Without this waiver, he didn't meet the financial requirements for traditional Medicaid. After temporary funding from other sources ran out, he would be uninsured.
If the eligibility issue could not be resolved, his stay at a facility that specializes in services for people with his condition would be at risk. In fact, a date was set when the man would be discharged from this stable environment to his guardian, who would not be able to provide the level of care and support needed to maintain a good quality of life.
The AGP clinical staff and case managers anticipated the risk to the patient and quickly took the lead to solve this complex situation. In the course of a couple days, AGP coordinated with Iowa Department of Human Services, Iowa Medicaid Enterprise, county officials and the facility to solve the problem. The focus was always on the patient's needs, ensuring all stakeholders in the Medicaid system were coming together on his behalf.
The teamwork paid off, the AGP member got their Medicaid coverage restored. As a result, the member would continue to receive the necessary services without any interruption. The member's guardian was thankful and told AGP that she was afraid of what might have happened were it not for the team's intervention.
