DES MOINES, Iowa (AP) – Officials say more than 220,000 poor or disabled Iowans could lose access to Mercy Health Network because of a contract dispute with a Medicaid management company.

The patients receive Medicaid through AmeriHealth Caritas, one of three companies the state hired last year to run the program. The Des Moines Register reports that AmeriHealth has told those patients in a recent letter that it’s been unable to negotiate new contract terms with Mercy. AmeriHealth says the Mercy system no longer would be an AmeriHealth network provider if a deal isn’t struck by July 1.

AmeriHealth says Mercy could continue serving those patients if it were to accept lower, out-of-network fees. The Mercy Health Network includes Mercy Medical Center in Des Moines, hospitals in 12 other cities, plus about 200 clinics.