UPDATE: Iowa Medicaid Grants Exception for 9-Year-Old's Cancer Treatment at Mayo

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MCGREGOR, Iowa (KCRG-TV9) -- UPDATE 6:00 pm Sunday: Mayo Clinic said Sunday afternoon Iowa's Medicaid Managed Care Organizations have granted an exception for Iowa Medicaid to cover 9 year old Shaun Mohs cancer treatments at Mayo, according to Iowa Gov. Terry Branstad's office.

UPDATE 2:30 pm Thursday: Mayo Clinic now says it is advocating for Shaun Mohs to continue receiving cancer care at Mayo but is waiting for a decision under Iowa's privatized Medicaid system.

Mayo Clinic Spokesperson Ginger Plumbo received permission to discuss 9 year-old Shaun Mohs case Thursday, a day after KCRG-TV9 reported the McGregor boy was forced to delay treatment for an aggressive brain tumor because of the Medicaid switch.

Plumbo says Mayo plans to request an exception for Iowa Medicaid to cover Shaun Mohs cancer treatments at Mayo. However, it can't file that request until the three private companies take over Iowa's Medicaid system on Friday. Stumbo says Mayo does not know yet to which MCO it needs to send that request for Mohs treatments.

“Mayo Clinic has been caring for Shaun Mohs since he was a toddler," Plumbo said in a release, "and feels very strongly that he needs to continue care at Mayo Clinic due to the complexity of his case and for the sake of continuity of care for Shaun and his family."

Mayo Clinic has not signed agreements with Iowa's Medicaid Managed Care Organizations, or MCOs, meaning it will not offer care on a regular basis to Iowa Medicaid patients. Mayo will work on a case-by-case basis with patients to offer care through Medicaid.

Plumbo was uncertain Thursday what would happen if the MCO denies its request for an exception to treat Mohs or if Mohs will be able to get treatment while waiting for an answer.

Iowa Department of Human Services spokesperson Amy McCoy said there are several processes for out-of-system providers, like Mayo, to treat Iowa Medicaid patients on a case-by-case basis.

McCoy said the key is for the provider and MCO to agree on a price for the service under a contract. McCoy says the state and MCOs agreed to set up a continuum of care, allowing Medicaid patients already getting treatment from out-of-network providers to more easily get care under the new system. Mayo Clinic is not a part of that system. That means Mayo Clinic would need individualized agreements with MCOs on each case.

McCoy says there is a focus at DHS to help Iowans on Medicaid transition easily and quickly. She urged patients to contact DHS directly for any issues they are encountering with the privatized system in order to quickly start the process to find a solution.

UPDATE 12:00 pm Thursday: Shaun Mohs family tells KCRG-TV9 that Mayo is requesting an exception with Iowa Medicaid to continue Shaun's cancer treatments. Mayo told the family it was requesting that exception Tuesday when it notified the family of the changes and before our original story aired but Shaun’s treatments scheduled for this week are still on hold until Mayo gets an answer.

“A Mayo clinic social worker told me on Tuesday, Shaun’s doctors are asking for an exception from Medicaid to continue covering Shaun’s treatment," said Mohs' mother, Misty Jones. "Right now we haven’t heard whether that exception has been denied or approved.”

Amy McCoy with the Iowa Department of Human Services says Iowa Medicaid MCOs will work with Mayo on a case-by-case basis.

"In any situation where we hear a member may be having issues with accessing services, we will reach out to see what we can do to ensure they get the care they need," McCoy said.

The Mayo Clinic tells KCRG-TV9 there were inaccuracies with the story. However, Mayo spokesperson Ginger Plumbo says the hospital cannot give details of those inaccuracies due to patient privacy laws and declined to comment on the Mohs' case.

Plumbo did confirm earlier statements from the Mayo Clinic that it has not signed agreements with the three private companies that will take over operations of Iowa's Medicaid system on April first. Plumbo confirmed McCoy's statement that Mayo will still work with Iowa Medicaid patients on a case-by-case basis when services from Mayo are not available in Iowa.

ORIGINAL STORY:
At anytime, Shaun Mohs is ready to share his art projects and his I-pad with anyone who wants to play.

Mohs has been dealing with major medical issues most of his life. It all started when he was just two.

"We did a CT and found the brain tumor. We we're med flighted to Mayo to deal with it there. "

Shaun and his mom spent the next 8 months at the Mayo Clinic, where doctors gave him intense chemo therapy.

The surgery and treatment left him with vision, hearing and thyroid problems. Doctors had to put a shunt in his brain.

But the good news was, Shaun beat cancer.

At least for a little while.

"January of this year he had another routine MRI where they told us he had another brain tumor. "

They family was shocked and stressed. But they had a plan.

"We came to a plan to do chemo, which was suppose to start today. We were suppose to have it weekly for roughly a year. "

Then, just yesterday, the doctors and nurses at Mayo who've become like family to Shaun, told them they can't treat him anymore.

In a statement last week, Mayo Clinic has not signed agreements with any of the private companies that will manage Iowa's Medicaid patients starting April 1st. As a result, it will work only on a case-by-case basis with patients, particularly when services are not offered in Iowa.

Instead, they suggested he transfer to a hospital in Iowa City or Des Moines.

"His endocrinology, his sodium all of that is too complex to just hand a file and say 'here's Shaun'. "

So they wait, and try to figure out how, where and when he'll get his chemo.

When all she wants to being doing his helping her sick son.

"You have all these worries and then to have another one of insurance just doesn't seem right. "

Ben Hammes, Spokesperson for Governor Branstad's office said, "Managed Care has not started. Mayo Clinic, a Minnesota Hospital, denied an Iowa Medicaid patient. This is a sad decision, but nonetheless a Mayo Clinic decision only. Mayo Clinic, as it currently operates, sees Iowa Medicaid patients on a case by case basis. Our managed care partners on April 1 have already indicated that they will continue working with Mayo Clinic on a case by case basis. Medicaid Modernization will improve Medicaid patients health by providing the right care, at the right time, in the right place. Benefits under Managed Care do not change for Medicaid patients."