Source: The Gazette, July 7, 2018
More than two years has passed since Iowa moved to privatized Medicaid. This board, as well as others statewide, have demanded transparency. Unequivocally, we’ve said Iowa taxpayers have a right to know if the switch is saving money, how much is being saved and how those savings are being realized. Amid these calls, nearly every agency remotely connected to Medicaid has sounded alarm bells. Iowans who rely on the program’s coverage report denied services. Providers who care for these patients point to unresolved claims. Medical suppliers have presented unpaid bills. The Iowa Office of the Ombudsman saw a 157 percent increase in cases connected to Medicaid managed-care organizations, leading the agency to issue one of the most scathing annual reports in its history. Accurate numbers and a full, public accounting of the program isn’t unreasonable and shouldn’t be this difficult. Such transparency is, after all, what the governor promised. …
Iowa’s new private Medicaid manager has paid millions of dollars in penalties in a dozen states
Source: Jason Clayworth, Des Moines Register, July 1, 2018
The corporation selected to help manage Iowa’s controversial privatized Medicaid system has faced serious charges of mismanagement resulting in at least $23.6 million in penalties in more than a dozen states, a Des Moines Register investigation shows. Iowa Total Care, a subsidiary of Centene, was awarded a state Medicaid contract in May by the Iowa Department of Human Services despite scoring nearly 14 points lower on its evaluation than when it had applied and was rejected in 2015, public records show. But with only two companies bidding for the work, Iowa Total Care won a spot managing Iowa’s annual $4.8 billion Medicaid program. The Centene subsidiary replaces AmeriHealth Caritas, which pulled out because it said it was losing too much money. …
The state has no data to support Medicaid savings claim, health care official says
Source: Michaela Ramm, Sioux City Journal, June 30, 2018
As Iowa Medicaid Enterprises Director Michael Randol continues to assure lawmakers and the public that the state’s managed-care model is saving money, the Iowa Hospital Association contends the director has no data to back up the claim. And as the dispute continues, Iowa hospitals say the state is saving money because the Medicaid insurance companies are not adequately reimbursing health care providers for their services — including a Vinton hospital that says it is owed $90,000 in emergency room visits alone. According to the latest estimates from the Iowa Department of Human Services, the state of Iowa is saving $140.9 million from having privatized the Medicaid program. …
Iowa Medicaid director on privatization: ‘Regardless of the methodology, there are savings’
Source: Tony Leys, Des Moines Register, June 13, 2018
Iowa’s Medicaid director offered a general explanation Wednesday of how his staff estimates taxpayers’ cost savings from having a privately managed Medicaid system, but he didn’t give details on why that estimate abruptly tripled last month. “Really, what we were looking at was cost in the Medicaid program overall with and without the managed care organizations,” Mike Randol told an advisory council for the Department of Human Services. The estimates are part of a simmering controversy over whether Iowa should have hired for-profit companies to oversee care for 600,000 poor or disabled Iowans who use it. Supporters, including Randol, say the shift is bringing efficiencies that will make the program sustainable for years to come. Critics doubt it is saving much, and they say it is causing dangerous cuts in services to vulnerable Iowans. …
Iowa auditor agrees to examine privatized Medicaid savings to see why estimates abruptly tripled
Source: Tony Leys, Des Moines Register, June 8, 2018
Iowa’s state auditor has agreed to look into the see-sawing estimates of how much Iowa taxpayers are saving by having private companies run the state’s $5 billion Medicaid program. Department of Human Services leaders last month abruptly tripled their estimate of those annual savings, from $47 million to $140.9 million, without explanation. The new estimate was still 39 percent less than the $232 million that former Gov. Terry Branstad predicted state taxpayers would be saving by now under his controversial decision to privatize the health care program for 600,000 poor or disabled Iowans. State Sen. Pam Jochum, an outspoken critic of Medicaid privatization, asked State Auditor Mary Mosiman last month to look into what was going on with the estimates. …
Iowa’s estimated savings from Medicaid privatization triples to $141 million, after plummeting 80 percent
Source: Tony Leys, Des Moines Register, May 18, 2018
The state’s official estimate of how much Medicaid privatization is saving Iowa taxpayers has suddenly tripled, a few months after it had plummeted 80 percent. The Iowa Department of Human Services provided no explanation of how it came up with the new number. State administrators now estimate the annual savings at $140.9 million, according to a letter they sent this week to a legislator. In December, their savings estimate was $47 million for the current budget year, which runs through June. Former Gov. Terry Branstad predicted in 2017 that the savings for this budget year would be $232 million. David Hudson of Windsor Heights, who leads an official advisory committee on Iowa’s Medicaid program, expressed frustration after reading a letter from the department to a legislator who asked for the savings estimate. …
Iowa House again passes Medicaid oversight legislation
Source: James Q. Lynch, The Gazette, April 23, 2018
The Iowa House once again has unanimously approved legislation providing oversight of Medicaid managed care to deal with what the bill’s manger called “bumps in the road.” The House earlier passed similar legislation, but it failed to meet a deadline in the Senate. So the House passed House File 2483 on a 95-0 vote. The earlier version was approved 97-0. … The bill makes a statement “to the Department of Human Services, to the citizens out there who are being served by these managed care organizations, to the providers, that we feel very strongly in doing what we can to provide oversight over the process of this privatized Medicaid approach that has created so many bumps in the process and taken up so much of our time,” Heaton said. …
Iowa Democratic gubernatorial candidates ready to reverse Medicaid privatization
Source: Paige Godden, Des Moines Register, April 11, 2018
Six Democrats in the running to be Iowa’s next governor made it seem as though nearly all the state’s problems could be solved by reversing Medicaid privatization during a recent forum hosted at Simpson College. Candidates were asked questions ranging from how they’d help veterans to how they’d save rural Iowa, and their answers kept circling back to Medicaid.…
Iowa lawmakers stake out positions on state’s privatized Medicaid woes
Source: Jason Clayworth, Des Moines Register, April 8, 2018
There’s a lot of politics entangled in Iowa’s privatized Medicaid problems. Since then-Gov. Terry Branstad first proposed transferring management of the state’s Medicaid program to for-profit companies, back in April 2016, Democrats and Republicans have staked out positions on the wisdom of the plan. Since then, Iowa’s privatized Medicaid program has come under fire for failing to do right by the state’s 680,000 poor or disabled patients. …
Boulton unveils his labor agenda
Source: Ed Tibbetts, The Courier, February 22, 2018
Iowa would reverse the year-old limits on collective bargaining rights for public employees, start a new family and medical leave plan for workers around the state and raise the minimum wage under an agenda Democratic candidate for governor Nate Boulton unveiled this week. Boulton, a state senator from Des Moines, is one of seven candidates for the party’s nomination for governor. And his plan is an attempt to lay out a vision for Iowa. … In releasing the plan, Boulton’s campaign said he would seek to implement it in his first legislative session if elected. The agenda essentially packages a number of proposals he and other Democrats have introduced in the Republican-controlled Legislature that have gone nowhere. The proposals include reversing the move to put the state’s Medicaid program under the management of private insurance companies and closing the state-run mental health institutions. …
Gov. Reynolds supports bill that cuts reporting requirements on state’s privatized Medicaid program
Source: Paul Brennan, Little Village Magazine, February 12, 2018
During her regular weekly press conference on Monday, Gov. Kim Reynolds said she is committed to transparency, but also came out in favor of cutting the amount of publicly reported information about how well the state’s controversial privatized Medicaid management program is performing. The proposal to cut the amount information published about Medicaid comes one month after a report from the Iowa Department of Human Services (DHS), the agency responsible for overseeing Medicaid, showed that privatizing the management of the program that provides health coverage for approximately 600,000 Iowans has produced only a fraction of the savings that were promised when privatization began. …
Senate Democrats call on federal officials for Medicaid look over
Source: Michael Ramm, The Gazette, February 1, 2018
As Iowa enters its second year of privatized Medicaid managed care, every Iowa Senate Democrat, plus one independent, has called on the federal government to step in, saying the state is “approaching a crisis.” Senate legislators sent a letter last week to the Centers for Medicare and Medicaid Services, urging its officials to do a field visit to the state “so that you can learn firsthand about the problems that providers and Medicaid beneficiaries continue to experience,” the letter states. “Hospitals, nursing homes and other Iowa health care providers — especially in Iowa’s small towns and rural areas — are telling us it’s not working,” the Jan. 24 letter states. “They are strapped with delayed or reduced payments, red tape and bureaucratic nightmares that are putting them in financial jeopardy.” …
Iowa lawmakers return with to-do list on taxes, Medicaid
Source: Barbara Rodriguez, Associated Press, January 7, 2018
Iowa lawmakers return to the state Capitol on Monday with a to-do list ranging from overhauling state taxes to possibly addressing issues with the privatized Medicaid program. Republicans, entering a second year of complete statehouse control, will work amid another budget crunch and a looming election year. …
Medicaid privatization is saving Iowa 80% less money than predicted, state report says
Source: Tony Leys, Des Moines Register, January 5, 2018
Iowa’s controversial shift to privately managed Medicaid will save the state 80 percent less money this fiscal year than originally predicted, a recent state estimate suggests. Iowa now stands to save $47.1 million this fiscal year by having private companies manage the $4 billion program, according to a quarterly report prepared by staff members from the Department of Human Services. After then-Gov. Terry Branstad ordered the shift in 2015, he predicted it would save the state $232 million in fiscal year 2018. That is the current budget year. In fiscal year 2017, which ended last June 30, the state saved nearly $119 million over what it would have spent having government administrators run the program, according to a DHS report using the same criteria used in the new estimate. …
‘We’re completely in the dark’: Families still uncertain after Iowa Medicaid transition
Source: Stephen Gruber-Miller, Iowa City Press-Citizen, December 12, 2017
Ryan’s case is one example of the uncertainty that has played out in households around the state in the wake of AmeriHealth’s decision this fall to leave Iowa after it could not reach an agreement with the state on reimbursement rates. Join now for as low as $29/YR Subscribe Now AmeriHealth and the two other companies chosen to manage Iowa’s Medicaid program when it was privatized last year by then-Gov. Terry Branstad have complained of losing hundreds of millions of dollars. When AmeriHealth announced it was leaving, state officials first gave families a choice between UnitedHealthcare and Amerigroup, the third company. Then they backtracked, saying Amerigroup did not have the capacity to handle new clients. In late November, the Department of Human Services said it would resume oversight for more than 10,000 Iowans who had tried to switch companies before the deadline. …
Iowans on privatized Medicaid: ‘Please Governor Reynolds, do something’
Source: KCCI, December 6, 2017
Iowans packed the Des Moines’ downtown library Tuesday as the Iowa Department of Human Services held a public comment meeting on the state’s privatized Medicaid system. When the privatized Medicaid system was first introduced by Governor Terry Branstad, Iowans had three providers. This November, AmeriHealth Caritas pulled out. Now, AmeriGroup says it does not have room to accept new applicants – leaving UnitedHealthcare as the only option. Several attendees shed tears as they shared personal stories about how the new privatized Medicaid system has hurt them. …
More questions for Iowans after Medicaid changes
Source: Michaela Ramm, The Gazette, November 28, 2017
On Tuesday, Gov. Kim Reynolds said in her weekly news conference the Department of Human Services has put together a transition plan for the state’s managed-care program. “Our goal is to make it as seamless as possible, to make sure that we continue to offer continuity of service again to Iowans who really need a coordinated care and need that extra help, and to really do everything we can to eliminate as much disruption as possible,” Reynolds said. AmeriHealth — one of the state’s three managed-care providers — announced it would withdrawal from the Medicaid program on Dec. 1. UnitedHealthcare of the River Valley and Amerigroup have re-signed contracts for 2018. DHS officials stated in early November that all former AmeriHealth members would be transferred to UnitedHealthcare. But members could switch to Amerigroup before Nov. 16. …
State to resume handling of 10,000 Iowa Medicaid members being dropped by AmeriHealth
Source: Tony Leys, Des Moines Register, November 27, 2017
State administrators will resume direct oversight of Medicaid benefits for some of the 215,000 Iowans who are being dropped this week by a private management company, the state Department of Human Services confirmed Monday. The department posted a statement saying that Iowa Medicaid member who tried to switch from AmeriHealth Caritas to Amerigroup by Nov. 16 “will have coverage through Iowa Medicaid Fee-for-Service.” Fee-for-service is the state-run Medicaid system that Iowa used before it made the controversial decision to hire three private companies to run the giant health care program last year. AmeriHealth is leaving the state due to a contract dispute. Amerigroup is one of the other two management companies serving Iowa’s Medicaid program. …
Many Iowa Medicaid patients won’t be able to switch coverage
Source: Barbara Rodriguez, Associated Press, November 21, 2017
More than a third of patients in Iowa’s privatized Medicaid program will be unable to switch into one of the two remaining insurance companies as originally announced because the company doesn’t have the capacity to add more people, a state agency announced Tuesday. The Iowa Department of Human Services said in a press release that Amerigroup will continue to serve people currently enrolled in its coverage but not additional patients. The announcement means UnitedHealthcare will keep about 215,000 patients being sent to it after a third company, AmeriHealth Caritas, said it was leaving the health care program for the poor and disabled. AmeriHealth Caritas announced it was exiting at the end of the month over failed negotiations with the state regarding money. The state recently signed new contracts with Amerigroup and UnitedHealthcare, and it intends to hire a third company for coverage in 2019. …
Disabled Iowans upset about privatized Medicaid seek to sustain lawsuit against DHS leader
Source: Tony Leys, Des Moines Register, November 17, 2017
The departure of a controversial Medicaid management company from Iowa strengthens disabled residents’ legal claims against a top state official and should not lead to their federal lawsuit’s dismissal, their lawyers contend. The advocacy group Disability Rights Iowa is suing Iowa’s Department of Human Services director on behalf of six disabled Iowans who say the state’s 2016 shift to private management of its Medicaid system has led to illegal cuts to services. State lawyers earlier this month asked a federal judge to dismiss the lawsuit because all six plaintiffs have their care overseen by AmeriHealth Caritas, a national company that is dropping out of the Iowa program. The state lawyers contend the plaintiffs haven’t shown they would be harmed by having their care overseen by one of the other two managed-care companies helping run the program. …
Iowa hires Kansas official to oversee privatized Medicaid
Source: Associated Press, November 17, 2017
Iowa’s privatized Medicaid program has new leadership. The state Department of Human Services announced Friday that Michael Randol has been appointed director of the health care program for poor and disabled people. He begins Dec. 4. Randol served recently as Medicaid director in Kansas, which privatized its program in 2013. Kansas Republican Gov. Sam Brownback and his allies contend privatization there has controlled costs, while critics say it has reduced coverage and transparency about the program. …
Iowa Will Delay Plans to Add 3rd Company Back Into Medicaid
Source: Associated Press, November 7, 2017
An Iowa agency is delaying plans to add a third company back into the state’s privatized Medicaid program. Iowa Department of Human Services Director Jerry Foxhoven says the agency will hire another company to offer Medicaid coverage in 2019. The agency originally said such a company would start next July. Foxhoven says the agency will begin its search for a company soon, but the 2019 delay ensures adequate time. Foxhoven provided the information Tuesday to a health care council. It comes one week after AmeriHealth Caritas announced it will drop Medicaid coverage in Iowa at the end of the month after failed contract negotiations with the state. Two other private insurance companies, Amerigroup and UnitedHealthcare, will continue Medicaid coverage. …
DHS: Iowa Will Give $60M More to Companies for Medicaid
Source: Associated Press, November 2, 2017
An Iowa official says the state will spend an additional $60 million this budget year for private insurance companies to keep running the Medicaid program. Iowa Department of Human Services spokesman Matt Highland said Thursday that additional costs announced this week as part of new state contracts with two companies will total $140.4 million. The state will pay $60.8 million of that. The federal government will pay about $80 million. …
Private insurance company to leave Iowa’s Medicaid program
Source: Barbara Rodriguez, Associated Press, October 31, 2017
An insurance company that helps run Iowa’s new privatized Medicaid program is withdrawing its participation after less than two years, state officials announced Tuesday, a move that highlights failed negotiations between the company and the state over future coverage expenses. AmeriHealth Caritas will end its Medicaid coverage in Iowa at the end of November, the company confirmed in a press release. It offered no details on why a new contract with the state, through the Iowa Department of Human Services, could not be reached. DHS officials also declined specifics and focused attention to new contracts with the remaining companies, Amerigroup and UnitedHealthcare. …
Disabled Iowans could be exempted from private Medicaid management
Source: Tony Leys, Des Moines Register, September 13, 2017
Iowa might resume direct oversight of care for people with serious disabilities instead of having private Medicaid-management companies continue doing it, the state’s human-services director said Wednesday. Many of the most serious complaints about Iowa’s privatized Medicaid system have come from disabled Iowans and their families. Numerous families have reported having their services cut and their hassles multiplied by the management companies. Their plight has sparked a federal lawsuit against the state. “We are examining patients that may not be the right mix” for managed care-companies to oversee, Department of Human Services Director Jerry Foxhoven told an advisory council for his agency Wednesday. …
As complaints pile up, lawmakers overseeing Medicaid privatization haven’t met this year
Source: Jason Clayworth, Des Moines Register, August 20, 2017
A legislative committee tasked with oversight of the for-profit companies that manage Iowa’s Medicaid system hasn’t met this year, undercutting the state’s contention that the companies are being held accountable, critics say. The Legislature’s Health Policy Oversight Committee was tasked in 2015 with evaluating the state’s privatization of its Medicaid system, specifically to ensure the effective administration of the program, which provides health care to 568,000 poor or elderly Iowans. But despite a record number of complaints and a federal lawsuit alleging Medicaid services are being illegally or improperly cut, the 10-member legislative committee has yet to convene in 2017. …
Hundreds of millions of taxpayer dollars on the table in closed-door Medicaid haggling
Source: Tony Leys, Des Moines Register, July 3, 2017
The three companies running Iowa’s $4 billion Medicaid program contend they need millions more dollars from taxpayers, starting this month — but there’s been no public hint of how much more money the state will have to fork over. Iowa hired the companies last year to manage the state’s Medicaid program, which covers health care for about 600,000 poor or disabled residents. The shift has been intensely controversial, with critics complaining it has led to tangles of red tape for care providers and cuts in services for Medicaid recipients. Supporters, including Gov. Kim Reynolds, say the new system is saving money for the state by leading to more efficient, effective care. …
Disabled Iowans, fed up with cuts under privatized Medicaid, sue Gov. Reynolds
Source: Tony Leys and Jason Clayworth, Des Moines Register, June 13, 2017
Iowa’s roiling controversy over its for-profit Medicaid management spilled into federal court Tuesday when six Iowans with disabilities filed a lawsuit against Gov. Kim Reynolds. The lawsuit alleges that the state’s chaotic shift to a privately run Medicaid program is depriving thousands of Iowans with disabilities the legal right to live safely outside of care facilities. The suit holds Reynolds and her human services director responsible for the private management companies’ actions. …
Complaints about Iowa’s privatized Medicaid are spiking
Source: Jason Clayworth, Des Moines Register, May 9, 2017
Centered largely on allegations of terminated or reduced health services, complaints about Iowa’s privatized Medicaid program have spiked in recent months, according to information presented to state officials Tuesday. State quarterly reports show grievances and appeals filed with the three companies managing Iowa’s Medicaid program have spiked by almost 270 percent — from 343 to 1,268 — in the latest three-month report published in March. …
Editorial: Privatized Medicaid is worst prank ever
Source: Des Moines Register, April 1, 2017
Saturday was the first anniversary of Gov. Terry Branstad’s Medicaid privatization experiment. On April 1, 2016, Iowa abandoned state management of the $4 billion health insurance program for more than 500,000 poor Iowans and hired three for-profit insurers to take over. … The joke is on numerous health care providers underpaid or not paid by the managed care companies. These include an Iowa nursing home forced to borrow $150,000 while waiting for reimbursements, a mental health facility owed $300,000, and a family planning clinic that finally had no choice but to close its doors. One insurer recently notified patients it may stop covering services at Mercy Health Network, which has more than 200 hospitals and clinics across the state. The joke is on taxpayers now funding insurers’ administrative costs to the tune of hundreds of millions of dollars annually. Taxpayers will also bankroll the additional $130 million Iowa agreed to pay MCOs in October after they complained about losing money.
And Iowans get a good ribbing every time Branstad says his privatized Medicaid is accompanied by “unprecedented transparency.” There is nothing transparent about any of this. Just the opposite. … Insurers refuse to explain why claims are denied and providers are not paid. They will not talk about the specifics of financial reports with the media, and by extension the public. When an Iowa lawmaker recently asked companies if they planned to seek more money this year, their responses included: “We really just don’t discuss these things in public settings” and “We do not play it out in a public arena.” … The most recent batch of such records reveal the kind of Medicaid antics going on behind closed doors. In February, state leaders signed contract amendments with insurers establishing “risk corridors.” These are intended to financially protect insurers by paying the difference if they spend more for medical care than they collect in revenue. … Meanwhile, Iowa lawmakers, who appropriate state dollars for Medicaid, didn’t know about this amendment until after it was signed. One didn’t learn of it until a reporter told her. The cost of this one contract change is an estimated $235 million in state and federal money. …
Iowa to spend about $10 million to help Medicaid firms cover losses
Source: Associated Press, March 25, 2017
Iowa officials have agreed to help private Medicaid management companies pay for huge losses suffered in covering more than 500,000 poor or disabled Iowa residents, documents released Friday show. The three national companies have complained about losing about $450 million in Iowa’s shift to private Medicaid management, which started in April, and have pleaded with state officials to help them make up for the loss. The agreement to shoulder some of the losses is expected to cost the state about $10 million.
Medicaid firms spending less on care for Iowa’s poor, disabled
Source: Tony Leys, The Des Moines Register, March 15, 2017
The three private firms running Iowa’s Medicaid program have found ways to trim spending on care for the poor or disabled Iowans they cover, a new report suggests. But all three continue to lose tens of millions of dollars on the controversial project. The companies’ per-member monthly spending on health care for adults fell by as much as 28 percent from the three months ending in September 2016 to the three months ending in December 2016, the new report shows. The three companies took over management of Iowa’s $4 billion Medicaid program last April. Supporters, led by Gov. Terry Branstad, predicted the companies could make the system more efficient and effective, reining in the cost of care for the 600,000 poor or disabled Iowans using the program. The new report reiterates that the state expects to spend nearly $119 million less this fiscal year on the privately run Medicaid system than it would have spent if the program had continued to be run by state officials. But skeptics say that the for-profit management companies have mainly added red tape and hassles, and that the companies are cutting costs by limiting services and payments to care providers. … The new quarterly report also shows the companies continue to lose tens of millions of dollars running Iowa’s Medicaid system. However, two of the companies’ bottom lines have improved in Iowa. …
Iowa’s private Medicaid insurers to lose $450 million in first year
Source: Chelsea Keenan, The Gazette, February 22, 2017
The three private insurers managing the state’s nearly $5 billion Medicaid program expect their one-year losses cumulatively to reach $450 million, they told legislators on Wednesday morning during a joint Senate and House Health and Human Services Appropriations Subcommittee meeting. Pressed by lawmakers to give “ballpark” figures as to what the state can expect to see in end-of-year reports, AmeriHealth Caritas Iowa said it anticipates to have lost upward of $200 million; Amerigroup Iowa will have lost $150 million; and UnitedHealthcare of the River Valley said it expects to have lost around $100 million. Financial reports detailing the information will be filed with the Iowa Insurance Division on March 1. … The state of the managed-care organizations’ financial health has dominated headlines in recent months. … Starting in April, the state and insurers will begin negotiating capitation rates that will begin July 1. … But legislators of both parties remained concerned, peppering the MCO officials with questions about rates, losses and provider payments. …
Hospitals’ legal challenge to Medicaid privatization tossed
Source: The Associated Press, January 24, 2017
A district court judge has dismissed a lawsuit challenging privatization of the Iowa Medicaid program filed by a group representing hospitals across the state. The Iowa Hospital Association sued in November 2015 seeking to reverse Gov. Terry Branstad’s plan to privatize the Medicaid program claiming it violated state law because it diverted money hospitals have historically been paid to the three health care corporations the state hired. The state contends the hospitals will continue to be paid. By law about $34 million a year is paid into a trust fund by the hospitals and matched by federal funds. It’s used to reimburse hospitals providing Medicaid services. Judge Robert Hanson says if the hospitals don’t get the money, they can sue for financial damages.
In Iowa, financial pain follows Trump-style Medicaid reforms
Source: David Steen Martin, STAT, January 24, 2017
When President Donald Trump tapped policy consultant Seema Verma to run Medicaid and Medicare in his administration, he called her part of a health care “dream team.” But the health policy changes she helped design in Iowa have felt more like a nightmare to providers serving poor and disabled residents across the state. Verma has helped several states revamp Medicaid, including Kentucky and Indiana. Here in Iowa, she worked on an aggressive effort to privatize the program, which provides health care to about 600,000 adults and children. … Even so, complaints poured in when the new program went live on April 1, 2016, shifting all Medicaid recipients at once to managed care. Nearly a year later, the complaints are still coming: Hospitals, nursing homes, and clinics that provide care to Medicaid patients say they’ve lost hundreds of thousands of dollars in expected reimbursements — and have had to spend untold hours chasing down payments. The three for-profit managed care organizations running the program aren’t happy either, saying they are hemorrhaging money and accusing the state of vastly underfunding Iowa’s $4.2 billion Medicaid program. … If confirmed, Verma is expected to give states even more flexibility to design new Medicaid programs — including more privatization.
Local organizations worry Iowa’s Medicaid privatization program will hurt clients
Source: Alicia Tarancon, KCRG, December 22, 2016
That waiver allows private managers and companies to run Iowa’s Medicaid System. He claims Iowa’s privatized program isn’t working and the Arc of Southeast Iowa agrees. The Arc provides a place for people with developmental disabilities to grow and learn. They offer activities like field trips and painting, and it’s a place to go for community support. But without Medicaid, the Arc stresses all of that will go away. The majority of their funding comes from the Medicaid waivers to help pay for certain services. …
Iowa Medicaid payment shortages are ‘catastrophic,’ private managers tell state
Source: Tony Leys, Des Moines Register, December 21, 2016
The for-profit companies running Iowa’s Medicaid program have been complaining to state administrators that the controversial project is “drastically underfunded” and that the situation has been a “catastrophic experience,” newly released documents show. One managed care executive wrote that Iowa’s recent offer to give the companies an extra $127.7 million in state and federal money this budget year “is not acceptable.” He added that without major changes, the privately run Medicaid program could be unsustainable. None of the three companies has agreed to accept the size of the increase in money they would receive for covering poor and disabled Iowans. … The companies’ complaints were included in recent memos and emails The Des Moines Register obtained under the state’s open-records law. The three companies, Amerigroup, AmeriHealth Caritas and UnitedHealthcare, told state officials that their reimbursement rates were based on deeply flawed cost estimates provided to them before the project began. Gov. Terry Branstad last year ordered the shift to private Medicaid management, which took effect April 1. Branstad, a Republican, predicted the private companies could allow the state to save tens of millions of dollars by helping the program’s 600,000 poor or disabled participants stay healthy. Critics are skeptical of the savings estimates, and they say the main effect of the switch has been to tangle Medicaid recipients and care providers in red tape. …
Lawmakers continue questioning state officials about Medicaid privatization progress
Source: Steffi Lee, Fox28, December 13, 2016
About eight months into the transition of privatized Medicaid in Iowa, some lawmakers say they’re still hearing about problems accessing services and reimbursements to providers. … Representatives of the three managed care companies in charge of Iowa’s Medicaid program, along with state officials, met with lawmakers from the bipartisan Health Policy Oversight Committee at the statehouse Tuesday. An ongoing issue lawmakers brought up was the reported losses by the private companies, despite the success stories highlighted by Iowa Medicaid officials the representatives from the private companies. Cynthia MacDonald, with AmeriGroup Iowa, says their company made a large investment when starting up their operations in Iowa. … Bolkcom also addressed how the state will now pay $33 million more to the companies, increasing the fixed rates those private companies get for each enrolled patient. Governor Terry Branstad said in November this was due to rising prescription drug costs, but the state would still be saving more than $110 million. However, the spokespersons for the managed care organizations declined to comment when Bolkcom asked them about potential increases in the future. …
Trump tags consultant who helped Iowa privatize Medicaid
Source: Tony Leys, Des Moines Register, November 29, 2016
A national consultant who helped the state of Iowa make the controversial shift to private Medicaid management is Donald Trump’s choice to run the federal government’s giant health-insurance programs. Seema Verma leads an Indianapolis consulting firm that works with state governments on health-care programs. Trump announced Monday that he would nominate her to lead the Centers for Medicare and Medicaid Services, better known as CMS. The agency oversees health-insurance coverage for tens of millions of Americans. Iowa’s Department of Human Services has twice hired Verma’s firm, SVC Inc., to help the state redesign its Medicaid program. SVC helped guide the state as it made the shift earlier this year to private management of the $4 billion program. Supporters say the change will bring more efficient, effective care, but detractors argue it is a giveaway to private business and is causing struggles for thousands of poor or disabled Iowans.
Editorial: One Medicaid complaint Branstad hears: Insurers’
Source: Des Moines Register, November 3, 2016
Gov. Terry Branstad’s unpopular privatization of Medicaid is turning out to be an even bigger train wreck than anticipated. Since he handed over administration of the government program to for-profit insurers on April 1, numerous Iowans have been denied health services, providers have closed their doors and seniors have lost in-home care. The governor has ignored or dismissed these complaints. Yet when the managed care companies collecting hundreds of millions of public dollars for “administration” started grumbling, Branstad snapped to attention. Less than four months after taking over Medicaid, the insurers claimed they were experiencing financial losses. They refused to provide public documentation to support the assertion. The spokesperson for one company told a Register reporter it was “not appropriate” to discuss the company’s financial report. … On Monday, Branstad announced the state would pay the three companies an additional $33 million this fiscal year. This compels the federal government, which picks up the majority of the cost of Medicaid, to fork over an extra $94.5 million. The governor largely blamed the additional costs on an increase in prescription drug prices. … Branstad has never produced reliable evidence that privatizing Medicaid improves health outcomes or saves money. Of course, such evidence is difficult to come by. Studies show privatization saves nothing or ends up costing more than state-run Medicaid, according to a 2012 report from the Robert Wood Johnson Foundation. That’s because government does a good job containing costs, especially in Iowa. In fact, in 2015, prior to privatization, the governor’s own administration reported saving more than $300 million through recovery efforts, identifying overpayments, coding errors and fraud. The state does not seek to please stockholders and is required to be transparent. …
Branstad pumps $33 million more into Medicaid privatization
Source: William Petroski and Tony Leys, Des Moines Register, October 31, 2016
Gov. Terry Branstad confirmed Monday that an additional $33 million in state money will be spent on Iowa’s controversial new Medicaid privatization program. But he said the program is more efficient than expected so the state will still meet its goal of $110 million annually in projected Medicaid cost savings. The nonpartisan Legislative Services Agency issued a memo Friday which said, based on a review of recent Medicaid data by the Iowa Department of Human Services and actuaries, the Branstad administration decided to increase per patient rates paid to private firms managing Medicaid health care by $33.2 million in state money and by $94.5 million in federal funding. The contract period covers the final months of fiscal year 2016 and for fiscal year 2017, which began July 1, 2016. … Senate Democrats, who strongly opposed the shift of government-managed Medicaid health care to a privately managed program, were sharply critical of the Republican governor. Medicaid is one of the state’s most expensive government programs, serving about 560,000 low-income and disabled people at an annual cost of more than $4 billion. …
Editorial: Branstad’s unproven Medicaid claims piling up
Source: Des Moines Register, October 22, 2016
Here we go again. Iowa’s governor is making cheerful claims about the benefits of his unpopular Medicaid privatization without providing evidence to back them up. On July 25, Gov. Terry Branstad’s office announced the release of “new data” showing Iowans “have more choice, access and accountability” under the new system. That doesn’t jibe with scores of complaints from Iowans since the governor handed over administration of the health insurance program to for-profit insurers on April 1. Low-income residents say they cannot visit their regular doctors or get access to care and medications. Health providers, including those offering in-home care, are not being paid for services by the managed care companies. … One quickly scrolls through the rhetoric to click on the link promising a “complete list of data” to substantiate the assertion. This consists of a one-page chart simply comparing the number of provider contracts under state-run Medicaid and the new privatized Medicaid. It says, for example, there are 9,309 more contracts with doctors and a 26 percent increase in psychologists now. … The agency did provide a database of more than 169,000 provider contracts, but an examination of that shows some providers who had one contract last year now have dozens of them. Or hundreds. Lifeline Systems, for example, had a single contract last year and now has 422. That translates to more pieces of paper, not more providers or care for Iowans. After the reporter waited more than two months for more information, the DHS sent a database of “access points” it said shows nearly 5,000 new locations where doctors are providing care. With no information to compare the number of Medicaid providers before and after privatization, that claim could not be verified either. Apparently, Iowans are just supposed to take the governor’s word there are more providers under his pet privatization project. But his word on this issue has not been reliable. …
Editorial: Anonymous Medicaid happy tales not enough
Source: Des Moines Register, September 26, 2016
… In the absence of happy tales, last week the governor’s office took matters into its own hands. It issued a press release to “highlight a new series” of “success stories” about privatization. This amounted to anecdotes about three unidentified patients gathered by and told from the perspective of workers at one of the private insurers now pocketing millions of dollars to manage Medicaid. They included statements such as “Amerigroup case managers quickly built a trusting relationship with this patient …” Rather than unverifiable, anonymous stories, the governor should provide meaningful information about how Iowans are faring under his pet privatization project. It would be helpful, for example, to have data about specific patient health outcomes. How about an independent survey of Medicaid providers and beneficiaries? …
Editorial: Is Obama hearing Iowans’ Medicaid concerns?
Source: Des Moines Register, September 13, 2016
It has been more than five months since Gov. Terry Branstad handed over administration of Medicaid to for-profit insurers. Elderly Iowans have lost in-home care workers. Patients cannot get prescriptions refilled. Managed care companies are not paying health providers, forcing some of them to borrow money to stay afloat or close. … During a 90-minute conference call on Monday, federal officials got an earful from struggling Iowans. About a dozen providers, patients and family members spoke before the clock ran out. But “this call could go on for the next seven days continuously and you wouldn’t hear all the concerns,” said Sen. Joe Bolkcom, D-Iowa City. President Barack Obama, who has taken great pride in delivering health insurance to the American people, should listen to the recording of the conference call. Perhaps he will instruct his administration to rethink the waiver it granted the state of Iowa to privatize Medicaid management. He might even use the opportunity to remind federal workers of his promise to create “an unprecedented level of openness in government.” …
Hospitals: after 6 months, Medicaid privatization still ‘deeply frightening’ to patients, providers
Source: O. Kay Henderson, Radio Iowa, September 13, 2016
he Iowa Hospital Association’s legal counsel is pushing back against Governor Terry Branstad’s statement that having private companies manage care for Iowa Medicaid patients since April 1st has prevented “significant fraud and abuse.” Natalie Ginty of the Iowa Hospital Association spoke yesterday during a “listening post” with federal officials. “IHA wants to emphasize that historically Medicaid fraud is extremely rare in Iowa and that if MCOs were actually finding fraud in billing from providers, there would be news of indictments for these supposed crimes,” she said. … “Instead of fraud, providers are seeing a sharp increase in unpaid or denied Medicaid claims from the MCOs due to increased prior authorizations, unclear claims filing procedures and complete confusion by the MCOs on proper reimbursement requirements,” Ginty said. … Governor Branstad released a statement Monday morning, saying “managed care is working for Iowa taxpayers by stopping improper payments.” According to the governor, there were $318 million worth of “improper” Medicaid payments to Iowa hospitals, doctors and other health care providers in 2014. Since April 1 of this year, Dani Valentine of Iowa Specialty Hospitals and Clinics in Belmond and Clarion has tracked down nearly 30 payments due to her organization for care of Iowa Medicaid patients, but the checks were sent elsewhere. Some went to facilities in other states. …
Iowa Medicaid frustrations vented after privatization
Source: Chelsea Keenan, The Courier, September 13, 2016
Five months into the state’s move to Medicaid managed care, federal officials on Monday fielded more than an hour’s worth of complaints and frustrations from beneficiaries and health care providers during a public listening post. Iowa handed over its $5 billion Medicaid program to three private insurers — Amerigroup Iowa, AmeriHealth Caritas Iowa and UnitedHealthcare of the River Valley — on April 1. Since the transition, providers have reported late and inaccurate payments, while some beneficiaries have said they’ve experienced gaps in care. … Also on Monday, Branstad touted the more than 365 meetings Department of Human Services and MCO representatives have held or attended since the transition was announced in early 2015. …
Editorial: Branstad should schedule ‘Medicaid tour’
Source: Des Moines Register, September 3, 2016
… Lawmakers received an earful, just as they have in previous “listening” sessions. In fact, Democratic legislators have held more than 40 such public meetings around the state since last fall, Sen. Joe Bolkcom, D-Iowa City, told a Register editorial writer last week. The governor who insisted the state privatize Medicaid management has not attended a single one. So it’s time for Branstad to schedule a series of his own public meetings to hear from constituents on Medicaid. Because it’s not clear where he is getting information about how things are going. As low-income Iowans reported confusion and loss of health services, this governor characterized the transition to privatization as “smooth.” When providers reported not being paid, he said the new system is “stopping significant fraud and abuse.” …
In Webster County, Medicaid privatization called ‘debacle’
Source: Joe Sutter, The Messenger, August 31, 2016
Public health officials in Webster County say they haven’t been paid thousands of dollars for services they’ve provided months after a major change in how Iowa manages its Medicaid program. “It’s a little over $113,000 outstanding between the three MCOs,” said Jen Sheda, chief financial officer for the Webster County Health Department. “That’s for April, May, June.” Three Managed Care Organizations – Amerigroup, AmeriHealth Caritas and United Healthcare – took over management of Iowa’s Medicaid program in April as part of what’s called the Medicaid Modernization project. … Every program the department runs has its own National Provider Identifier number, Chance said. With United Healthcare, the wrong numbers are associated with the wrong programs, so it’s been impossible to get paid. Chance claims this wasn’t the fault of the Webster County department. … With the maternal health program, the MCO has told the health department it won’t pay for claims because the department has a grant to pay those claims, Sheda said. But she said the grant is supposed to be payor of last resort – and only get billed after Medicaid. Each company has a different process for billing, Sheda said. The health department works with all three MCOs in all of its programs, because Medicaid clients choose which of the three MCOs they will sign up through – or are automatically assigned to one. …
UnitedHealthcare official confirms Medicaid losses
Source: Barbara Rodriguez, The Republic, August 29, 2016
The new program, which supporters said would improve care and contain costs, has been under scrutiny over reports of delays in care and payments to health care providers. AmeriHealth Caritas and Amerigroup, the other insurance companies, filed reports with the state recently that showed losses in the tens of millions of dollars in the first six months. AmeriHealth Caritas said it had a $42.6 million deficit on its Iowa operation; Amerigroup reported a loss of $66.7 million. UnitedHealthcare, which has other lines of business in Iowa, did not break down those costs in its filing. …
Lawmakers scrutinize Iowa’s first few months of privatized Medicaid
Source: Forrest Saunders, KCRG, August 29, 2016
Is Iowa’s new Medicaid system busted, or simply hitting a few bumps out of the gate? State lawmakers aimed to find out during their first Health Policy Oversight Committee meeting since the new managed care system started. … Critics have called the transition rushed and say providers and Iowa’s 560,000 Medicaid users are suffering. Before the meat of the meeting, legislators got a flavor for how users, providers and watchdogs are feeling since the MCOs took over. The reviews at that listening post roasted, not just the three companies, but the governor as well.” The key grilling points, providers continue to report thousands of dollars in delayed payments. Also, that previously covered claims are now being denied. Watchdogs said the state’s Medicaid patients are seeing slower care overall. … State overseers with the Iowa Department of Human Services said MCOs are meeting their obligated benchmarks, that the variety of provider payment issues are being worked out with training, and, despite the millions in losses MCOs booked for the first quarter, financials are expected to improve as transition pains ease. Ultimately, DHS said no deaths, job losses or shuttered businesses have been directly tied to Iowa’s private Medicaid system. Plus, the state has already saved millions.
First quarterly report: $22.2 million saved through Medicaid privatization
Source: O. Kay Henderson, Radio Iowa, August 29, 2016
State officials say the three private companies now managing care for the 560,000 Medicaid patients in Iowa saved Iowa taxpayers $22.2 million in April, May and June, but exactly how that savings came about is unclear. Liz Matney of the Iowa Department of Human Services said there are “pretty wide variances” in how the companies report paid claims. … In the department’s quarterly report on Medicaid spending, there’s a “top 10” list of why claims for prescription drugs were denied. UnitedHealthcare’s number one reason was because of an error. The number two reason AmeriHealth hadn’t paid those claims was because the “claim has not been paid.” …
DHS says over 225 grievances filed under new Medicaid system
Source: Daily Journal, August 26, 2016
The Iowa agency overseeing the state’s transition to a privately managed Medicaid program recorded over 225 grievances in the first three months of the new system, according to a new report released Friday. The Iowa Department of Human Services said in a roughly 60-page quarterly report that three out-of-state insurance companies now running the program received the notices of dissatisfaction in April, May and June from Medicaid patients. The grievances were resolved within 30 calendar days, according to the report. Roughly 115 appeals were also resolved within 45 calendar days. … The new information also allows the public to compare the data to ongoing reports of problems involving late payments and delayed care to patients. Some Democratic lawmakers say they continue to receive complaints from constituents. DHS has repeatedly said in public meetings that any reported issues are not systemic and are being addressed. The report also has information about sanctions issued against the companies involving corrective action plans and fees. All three companies received several corrective action plans regarding timeliness, completeness and accuracy of reporting, among other things. They included fines of more than $1,200 for Amerigroup; $630 for AmeriHealth; and more than $2,500 for UnitedHealthcare. …
Report: For-Profit Companies Make Fewer Mistakes Managing Medicaid
Source: Joyce Russell, Iowa Public Radio, August 25, 2016
A federal report released last year shows in 2014, for-profit companies managing part of Iowa’s three billion dollar Medicaid program made far fewer faulty payments than the state-run portion of the program. Governor Branstad says that shows fraud and abuse will go down, now that for-profit companies are in charge of most of Iowa’s Medicaid patients. The report issued last November by the Centers for Medicare and Medicaid services covered 2014 when about 10 percent of Iowa’s Medicaid program was run by for-profit companies. The report says their error rate was less than one per-cent. That compares to nearly 10 percent for the traditional fee for service program. … Governor Branstad predicts similar results now that the bulk of Iowa’s program is privatized. “Managed care is an effective tool to combat improper payments,” the governor says in a statement. The report shows most improper payments involved billing for non-covered services or insufficient documentation. In 2014, that cost more than 300 million dollars. … On Monday afternoon state lawmakers will review data from the first three months of privatized Medicaid. …
Editorial: Branstad remains clueless about Medicaid woes
Source: Des Moines Register, August 24, 2016
Last year, Gov. Terry Branstad’s spokesman told The Des Moines Register the governor believed Obamacare “is unaffordable, unsustainable and creates too much uncertainty for Iowans. The implementation of this law has been flawed from the very beginning.” Oh, the irony. Iowans currently are mired in the disaster of the Medicaid privatization plan Branstad foisted upon the state this spring. … In documents provided to the state, AmeriHealth Caritas reported it ran a $42.6 million deficit in the first six months of 2016, and Amerigroup reported it lost $66.7 million. It is hard to make sense of that. How can the companies be losing money when so many providers are not being paid? Did these established, experienced companies miscalculate the cost of such a huge undertaking before signing contracts with the state? Of course, the public can’t know, as the managed care organizations refuse to discuss the specifics of their financial reports with the media. … Welcome to privatized Medicaid, where it is apparently inappropriate for companies collecting millions of public dollars to administer a public program to give information to the public. …
… In Fiscal Year 2015, the state was administering Medicaid. According to the state’s own report, that year alone it collected $272 million through cost avoidance and recovery efforts and saved nearly $47 million identifying overpayments, coding errors, fraud and abuse. Coordinating home-based care contributed to a 19 percent reduction in emergency room visits and a 17 percent reduction in inpatient admissions to hospitals. And it paid health care provi
Branstad: Some Companies “Not Following” Medicaid Privatization Rules
Source: Joyce Russell, Iowa Public Radio, August 22, 2016
Gov. Terry Branstad confirmed on Monday that the for-profit companies now managing Iowa’s multi-billion dollar Medicaid program did not follow the rules in the first two months of operation. But the governor also says the state issued no warnings or fees, in spite of complaints of late payments to health care providers and delayed care to patients. A Freedom of Information request by the Associated Press revealed no sanctions for violations for April or May, despite these rule violations. Branstad says the Department of Human Services wants to work with the companies, not against them. … Lawmakers told the AP they were not informed of the plan to have a grace period before the companies would be fined for violations. A committee led by Iowa Senate democrats which is overseeing Medicaid privatization will receive a quarterly report ahead of its meeting next week. …
Agency overseeing Iowa’s transition to privatized Medicaid keeps quiet on waived sanctions
Source: Associated Press, August 22, 2016
The state agency overseeing Iowa’s transition to a privatized Medicaid program waived any possible sanctions against three insurance companies during the first two months of the new system but did not inform health advocates or lawmakers of that policy. The Iowa Department of Human Services issued no written warnings or corrective action plans in April or May to the insurance companies that now run the state’s Medicaid program, according to information obtained by the Associated Press through a public records request. Fees for any purported violations were also waived. … The decision to delay sanctions wasn’t shared outside the agency, and the news was a surprise to some health advocates and lawmakers monitoring Medicaid, which provides health care to roughly 560,000 poor and disabled Iowa residents and switched to a privatized system on April 1. The program is under scrutiny over reports of late payments to health providers and delayed care to patients. DHS has said those issues are not systemic. … No documentation exists to show that the department planned to delay sanctions or to formally issue them beginning in June. McCoy said data on possible infractions recorded during June isn’t yet available because it’s tied to information submitted by the insurance companies on Aug. 1. That data is still being analyzed. Information on infractions collected for July is due on Sept. 1. …
Editorial: Branstad’s legacy: Killing health care jobs
Source: Des Moines Register, August 20, 2016
For someone who talks big about job creation, Gov. Terry Branstad is doing a stellar job of jeopardizing the solvency of some Iowa employers. Four months after implementation of his plan to privatize Medicaid administration, the carnage is in full swing. Stories of small employers not being paid by managed care companies are being reported across the state. Cedar Rapids-based JVA Mobility is no longer selling medical equipment to nursing homes. Despite obtaining prior authorizations from the insurers to repair or provide wheelchairs to residents, the company is not being reimbursed for the cost. … Senior Resources in Muscatine, a nonprofit organization that helps older Iowans live independently, may soon need to take out more loans. It has no other way to make up for the loss of revenue after being stiffed by private insurers. During a meeting this month at the Baxter Community Center, Baxter Mayor Stephen Smith talked about a small health clinic that was forced to close in July because it wasn’t being paid quickly enough to meet expenses. … These are not isolated incidents. A Medicaid provider survey released in July by Iowa lawmakers gathered responses from more than 400 doctors, hospitals, clinics and nonprofit health providers. Nearly half of them indicated they will or are planning to reduce services, and more than 60 percent say privatization has reduced the quality of services they can provide. Almost all reported an increase in administrative costs. It takes manpower and time to hound insurers for payment, particularly when they don’t answer the phone or return messages, as some providers report. …
Hospital CEO calls Medicaid privatization “horrible” for patients in conversation with congressman
Source: Insurance News Net, August 6, 2016
The lack of access many Iowans have to mental health care has become a statewide “crisis,” agreed hospital administrators and U.S. Rep. Dave Loebsack, D-Iowa. … Loebsack, who represents southeast Iowa in the state’s 2nd Congressional District, also wanted to hear from health care officials how they were handling the transition to privatized Medicaid. In April, more than 560,000 financially vulnerable and physically disabled Iowans began receiving their Medicaid services through IA Health Link, which replaced the system previously run and funded by the state government. The health care system was turned over to three private, for-profit insurance companies responsible for coordinating care for citizens relying on Medicaid for their health care needs. … “The level of complexity with how the transition has been with the (managed care organizations), there is a certain level of comprehension and understanding that you need to have even as a consumer, never mind the provider,” Sanchez added. “And to place that burden on mental health individuals, to expect them to understand … has put such an unmeasurable burden on them that you’re almost guaranteed failure.” Richardson called the transition the “worst policy direction” he’s seen in his 34 years as a health care CEO. …
Medicaid privatization still causing problems
Source: Megan Hoffman, KIMT, July 28, 2016
Iowa state legislators gathered in Des Moines on Tuesday to discuss the Medicaid issue. Among them was State Senator Amanda Ragan of Mason City. Ragan said the lawmakers listened to providers talk about the struggles they’re facing, some not having been paid by the private managed care organizations since the change happened. Ragan says the problems are starting at the top, and are spilling down to the 500,000 Iowans who are on Medicaid. …
Iowa’s Medicaid switch won’t be deterred, Branstad maintains
Source: Rod Boshart, The Gazette, July 27, 2016
Gov. Terry Branstad fired back Wednesday at critics of the state’s decision to contract with three managed care organizations to oversee Iowa’s $5 billion Medicaid program for more than 560,000 recipients — a change that has played to mixed reviews since the April 1 implementation. Branstad said the approach has been praised by governors — both Democratic and Republican — in other states that have employed private managed care organizations (MCO) to modernize service delivery more efficiently and effectively while ferreting out fraud and abuse by checking claims to make sure they’re legitimate before they’re paid. … One day earlier, members of the Senate Human Services Committee heard concerns that service providers such as hospitals, nursing homes and mental health agencies, have experienced delays or problems since April 1 in getting reimbursed that are threatening their financial viability and have forced some layoffs. At the heart of Tuesday’s committee meeting was provider payments — MCOs and the state say the majority of claims are being paid cleanly and timely, while providers testified otherwise. … Of the more than 4.9 million claims submitted during the first three months, about 3.4 million were paid while 1.2 million were denied, 300,000 were suspended and 101,000 were rejected — meaning the claims were missing key pieces of information. State officials also pointed to data that showed the three MCOs were paying at least 95 percent of claims within 21 days. …
Christian Opportunity Center Facing Changes Due to Privatized Medicaid System
Source: KNIA, July 28, 2016
Several significant changes are impacting the way in which Christian Opportunity Center (COC) provides residential and vocational services for adults with disabilities. The biggest change according to the organization is the privatization of Medicaid, or managed care, which began in April. COC has contracts in place with all three MCOs, and Executive Director Rod Braun says the biggest challenge with managed care has been getting the organizations to understand who COC is and what they do. Braun says there are a large set of other changes they’ve had to adjust to separate from the Medicaid privatization, including the phase out of sheltered employment opportunities for the people they serve. COC provides residential and vocational support and services to more than 300 people with disabilities in Marion, Warren, Mahaska, Dallas, and Polk counties. …
Senate Human Resources Committee Meets After Issues with Medicaid Privatization Raised
Source: Stephanie Moore, WhoTv, July 26, 2016
Lawmakers came back to the statehouse for a rare summer hearing Tuesday. The Senate Human Resources Committee met after concerns were raised from an Iowa health provider survey. For hours, members of the committee heard from providers and caretakers about the problems they’re having with the Medicaid switch after claims providers have seen increased costs, reduced services and are not getting paid on time. … Starr said on top of the payment, the transition has also taken its therapists away from client care. … But the Iowa Department of Human Services says it’s only seen a 10-15 percent denial rate in claims which it says is similar to the previous program. …
Problems with Medicaid Privatization Called “Shocking”
Source: Joyce Russell, Iowa Public Radio, July 26, 2016
Dozens of health care providers and others crowded a committee room at the statehouse today. Democrats in the Iowa Senate held a hearing on problems with Iowa’s new privately managed Medicaid program, which provides health care for the poor and disabled. … Hospitals and others say they’re borrowing money to cover expenses while they wait for reimbursement. Others have laid off employees because of the shortfall. … Critics say some health care providers have laid off employees or even closed down services because of the delays. Program officials disagree with some of the complaints. … By one estimate, officials say as many as 25 percent of claims are being denied. …
Survey: Iowa Medicaid providers not getting paid on time, running into billing issues
Source: Chelsea Keenan, The Gazette, July 25, 2016
Hundreds of Medicaid providers have run into billing issues since the April 1 transition of the state’s $5 billion Medicaid program over to three out-of-state, private insurers, according to a survey released by Iowa Democratic legislators on Monday. The survey includes responses from more than 400 Iowa providers, including doctors, hospitals, clinics and not-for-profit agencies. Legislators used social media to solicit the responses over about a month’s time, during June and July. … According the survey, 90 percent of respondents have seen their administrative costs increase and nearly two-thirds have received lower reimbursement rates. Nearly eight in 10 providers who completed the survey said they are not getting paid on time and 28 percent of providers have been forced to take out loans to cover their expenses while waiting for payment. …
Editorial: Providers’ Medicaid nightmare becomes reality
Source: The Des Moines Register, July 16, 2016
Now perhaps it is becoming clear how the Medicaid belt will be tightened: by not paying health care providers for services. Three months after the governor’s pet privatization project was implemented, the billing problems are piling up. Many Iowans who provide in-home care for disabled people have gone without pay for weeks or months, according to a state workers’ union. These are individuals who change bedpans, bathe and feed patients while earning $9 to $12 per hour. “Missing even one paycheck can be detrimental,” said Danny Homan, state president of the American Federation of State, County and Municipal Employees. … So maybe Branstad’s privatization mess will end up reducing spending in Medicaid. It is certainly less expensive to insure people when you don’t pay for their care. And when reimbursement problems cause providers to close or stop treating Medicaid patients, the savings will really start kicking in. Of course, this also devastates vulnerable Iowans and the state’s health care system. Iowans did not support Branstad’s push to privatize Medicaid, according to a March Des Moines Register/Mediacom Iowa Poll. The governor dismissed public opposition, disregarded concerns raised by essentially everyone, ignored problems in other states and moved forward with his plan. Now his constituents are paying the price. The state-managed Medicaid he insisted on abandoning has never looked so appealing. Government is not beholden to stockholders. It is not seeking to turn a profit. It has low administrative costs. The system operated by this state for decades was accountable, familiar and reliable. It also reimbursed providers what it had agreed to pay them for services — and it did so quickly.
PRIVATIZING MEDICAID RUNS INTO DEEP TROUBLE, AS WAS EXPECTED
Source: Jacob Prall, Daily Iowan, July 20, 2016
But hey, Terry knows times are tough. It’s time to buckle down, penny-pinch, chase the almighty dollar, right? Now, Terry had an idea. Iowa should give billions of public dollars to for-profit private companies to handle Medicaid claims. This privatization, Terry assured us, would save the taxpayers lots of greenbacks. His administration never produced any figures or data to support the claims. In fact, a lot of people thought this to be a very bad idea. Other states were losing on the bid of privatized Medicaid. The public decided against it in the Des Moines Register. State legislators and colleagues urged him to resist the allure of big money. I’m sad to say that they failed. Terry triumphantly started the process of privatization in September 2015. And we are now starting to reap the rewards. … Terry’s little experiment isn’t paying off, and in big ways. Many health-care providers aren’t being paid; they’ve gone weeks or even months without paychecks. The state workers’ union won’t stop bothering poor Terry over this little issue. Workers from all sides of the health-care spectrum are affected: assistants to the elderly or disabled, speech and hearing therapists, pediatric-care providers, they’re all going unpaid after doing some of the most important work for our society. They deserve the best and are getting the worst. …
Union: In-home care workers go weeks with no pay
Source: Tony Leys, The Des Moines Register, July 8, 2016
Many Iowans who are supposed to be paid by the state for providing in-home care for disabled people have gone for weeks or months without pay because of the state’s shift to private management of its Medicaid program, the state workers’ union alleged Friday. … The dispute involves Iowans who work in a program that lets people with disabilities or long-term illnesses choose someone to provide services such as bathing, medication and feeding assistance in their homes. Medicaid contracts with the service provider. The arrangements are significantly cheaper than having the clients move into nursing homes. State officials estimate 6,700 Iowans work in the program, called Consumer Directed Attendant Care, or CDAC. Homan said his union has received numerous complaints of such providers going without pay despite filling out mounds of paperwork with the private management companies that took control of Iowa’s Medicaid program April 1.
Some Iowa in-home care providers run into Medicaid billing issues
Source: Chelsea Keenan, Iowa Gazette, July 8, 2016
Iowans providing in-home care to loved ones through the Medicaid program are experiencing major payment problems, according to the union that represents them. Consumer Directed Attendant Care, or CDAC, providers work with clients — oftentimes family members or friends — to provide caretaker services, including housekeeping, medication administration and cooking. The Medicaid beneficiary receiving the services acts as the employer and the caretaker receives payments through the Medicaid program for services. This care is designed to keep people in their homes and out of facilities, which ultimately is more costly. But since the state’s April 1 Medicaid transition to managed care, claims checks have been delayed, missing or incorrect. …
Iowa union official: Payment issues under Medicaid program
Source: Barbara Rodriguez, Quad-City Times, July 8, 2016
Some health providers are not being properly paid under Iowa’s privately managed Medicaid program, the president of Iowa’s largest state employees’ union said on Friday, and state officials were unable to provide data on any reported issues to quell concerns. Danny Homan, president of AFSCME Iowa Council 61, told reporters in a conference call that his office has received multiple phone calls over several weeks from health providers who help Medicaid patients with services in their homes. He said those providers have reported not being paid or payments being delayed, as well as other billing issues. Homan said such providers make on average $9-$12 an hour, “so missing even one paycheck can be detrimental.” He called on health officials to resolve the problems. …
Iowa Senate leader says medical care providers not being paid under Branstad’s Medicaid system
Source: North Iowa Today, July 3, 2016
Iowa Senate President Pam Jochum says data needs to be collected from medical care providers in Iowa that are struggling to be paid under the new privatized Medicaid system introduced this year by Governor Branstad. … Jochum says that “failing to promptly pay local health care providers is unacceptable. Payment delays and mistakes disrupt Iowa businesses, put Iowa jobs at risk and make health care for every Iowan less accessible and more expensive.” She also says that to understand the scope of the problem and to gather more data, House and Senate Democrats have launched a Medicaid provider survey. …
Iowa health advocates remain skeptical of Iowa Medicaid privatization, despite state oversight
Source: Sarah Tisinger, WQAD, June 6, 2016
Gov. Terry Branstad says the newly approved state oversight of Iowa’s privatized Medicaid program will make it among the nation’s most transparent, but some health advocates remain skeptical. State officials are also beginning to determine plans for organizing and delivering some information required under the oversight. … The reports will detail how three private insurance companies are running the state’s roughly $4.2 billion health care program for poor and disabled residents. Various groups will also monitor the program, which switched to private management on April 1. The companies will submit raw data to DHS.
Cedar Rapids family fights for guardianship of disabled son under privatized Medicaid
Source: Sarah McCarthy, KCRG, May 31, 2016
Representatives from the three private insurance companies now managing Iowa’s Medicaid system met with eastern Iowans to hear what problems and concerns they’ve experienced under the state’s newly privatized system. … For one Cedar Rapids mother, her questions revolved around a single piece of information she’s had problems with for months. … For the last 13 years, Cindy has managed her son’s healthcare decisions as his legal guardian. In December, she filed the paperwork necessary to maintain her guardianship. Now, dozens of phone calls, emails, and face-to-face conversations later, AmeriHealth Caritas – her son’s Medicaid managed care organization – still doesn’t have her listed as Tyler’s guardian. That makes it nearly impossible for Cindy to access Tyler’s healthcare information. … An AmeriHealth representative at the forum declined to explain in an interview why Cindy’s guardianship paperwork continues to be lost in the company’s system.
Branstad OKs Medicaid oversight, issues vetoes
Source: William Petroski and Jason Noble. Des Moines Register, May 27, 2016
Gov. Terry Branstad approved plans Friday to require increased accountability for Iowa’s newly privatized Medicaid health care program while taking final action on 30 bills and the state’s $7.35 billion general fund budget for the upcoming fiscal year. The Republican governor vetoed portions of a broader health and human services budget bill. But he left intact all the oversight requirements placed on private companies contracted to manage Iowa’s $4.2 billion Medicaid health insurance program, which helps 560,000 low-income and disabled Iowans. …
Over 300,000 Iowa Medicaid claims paid since April 1 privatization switch
Source: Rod Boshart, The Gazette, May 11, 2016
The three privately run managed care organizations now administering Iowa’s Medicaid system have received, processed and paid more than 300,000 claims since taking over the state’s duties April 1, the state’s Medicaid director said Wednesday. … Contacts with the state Department of Human Services’ call centers set up to handle problems from Iowa’s 580,000 Medicaid recipients during the managed care transition have dropped from 3,000 daily to about 1,500 each day, and up to 97 percent of Iowa’s providers have signed up with at least one managed care organizations, while three of our four providers had registered with all three as of mid-April, Stier added. ..
An Iowa alert: Take note of Medicaid failures elsewhere
Source: Jason Clayworth, The Des Moines Register, May 9, 2016
Medicaid managed by corporations has failed in two states, leaving advocates for the poor and disabled to warn Iowa: Don’t get hooked by flashy promises, unverifiable data and staunch ideologies. Their advice surrounding Iowa’s new Medicaid management system is for public and state officials to aggressively monitor results, insist on transparency and don’t be afraid to fire the for-profit networks if standards aren’t met. … The Legislature on April 29 passed House File 2460, a bill that Heaton says would put into place the most comprehensive oversight of those companies in the nation, and, if signed into law by Gov. Terry Branstad, would protect Iowans from an undesirable outcome, Heaton says. Branstad has not indicated how he is leaning on the measure. … Toubman recommended that Iowa closely monitor denial rates; payments to medical providers as a way to make sure they are not being underpaid, which can encourage them to stop serving the program; and close accounting of how much money is spent on actual medical care. He also says a “secret shopper” policy is necessary to truly assess whether the services work as promised.
Iowa senators say they’re hearing about Medicaid problems
Source: Barbara Rodriguez, Associated Press, April 20, 2016
State senators said Wednesday that they have heard complaints about Iowa’s Medicaid program under private management and that state officials providing information on the new system should stop telling the public the transition has been smooth. Members of the Senate Human Resources Committee said they have received emails and heard in person from Medicaid service providers and program recipients about problems, including questions over rejected claims and confusion about coverage. Members of the committee in the Democratic-majority Senate challenged a report at the start of the meeting from a state official that there are no systemic issues. …
Medicaid leaders tell skeptics privatization going well
Source: Tony Leys, Des Moines Register, April 13, 2016
Leaders of Iowa’s Medicaid program tried to convince skeptical state legislators Wednesday that the first two weeks of private management have gone well. … Stier touted improvements in her agency’s call center, which is helping Iowa Medicaid members figure out the new system. She said the call center’s beefed-up staff has cut waiting times to an average of 20 seconds for the more than 18,000 consumers who have called since April 1. Several senators said they’re already hearing about problems in the new Iowa Health Link program. Sen. Janet Petersen, D-Des Moines, mocked the department’s use of the phrase “warm transfer” to describe how patients have been shifted to the new managers. “I’m still getting letters from people who call it anything but a warm transfer,” she said.
OUR OPINION: Medicaid privatization needs proper state oversight
Source: Sioux City Journal, April 13, 2016
As we have said before in this space, we support Iowa’s transition to privatization as a means by which to rein in the state’s Medicaid costs. Those costs have risen by 73 percent since 2003, resulting in an increasingly smaller piece of the state budget pie for everything else. … However, privatization of Iowa’s $5 billion Medicaid program, which began April 1, shouldn’t mean the state embraces an entirely hands-off approach. Proper oversight of state contracts with the three private managed-care organizations remains essential. … Within the spirit of making sure privatized management of Medicaid in Iowa meets the goals of saving money and providing quality care for the state’s 580,000 Medicaid recipients, we urge the two chambers to redouble efforts at finding common ground on oversight language and cost in the Department of Health and Human Services budget.
House GOP unveils its oversight plan for privately-run Medicaid program
Source: O. Kay Henderson, Radio Iowa, April 7, 2016
House Republicans say already-existing committees in state government have the “expertise” to monitor the three private companies that now manage Iowa’s Medicaid program. Senate Democrats have proposed a new “working group” to oversee the switch, but Republican Representative Linda Miller of Davenport says given the “intricacies” of Medicaid, that’s not the best approach. … The proposal from House Republicans also calls for letting the public see much of the performance data from companies that began managing care for 560,000 Iowa Medicaid patients on April 1. It also calls for annual reports to the legislature to summarize that data. … Senate Democrats say they haven’t reviewed the details of the GOP proposal and they don’t want to “negotiate in public.” But Senate Democratic Leader Mike Gronstal predicts action of some kind is likely on this topic.
Privatized Medicaid Switch ‘Seamless’ for Iowa Home Care
Source: Stephanie Moore, WHO TV, April 6, 2016
The state officially switched more than 550,000 Iowans to a privatized Medicaid system on April 1. Instead of the state running the Medicaid program, it is now run by three separate managed care organizations referred to as MCOs. Officials at Iowa Home Care said the switch is going smoothly. The company is one of the state’s largest privately owned home health care companies and serves 1,400 Iowans. It’s working with all three MCOs which will make the switch a smooth one for clients. … The biggest change for Iowa Home Care is in its accounting department. The company now bills to each MCO instead of billing through the state.
Branstad: Medicaid changeover a smooth transition
Source: Rod Boshart, Globe Gazette, April 5, 2016
Gov. Terry Branstad said Monday the state’s transition to privately managed Medicaid services is off to a smooth start and should improve health outcomes for the program’s enrollees while saving taxpayers money. On Friday, Iowa joined 39 other states and the District of Columbia by switching from a government-run, fee-for-service approach to delivering health care services to more than 580,000 Iowans to a network operated by three private managed care organizations (MCOs) — Amerigroup Iowa Inc., Amerihealth Caritas Iowa Inc. and UnitedHealthCare Plan of the River Valley, Inc. … That view was not held by every one in the Statehouse on Monday. “It was not very smooth,” said Senate President Pam Jochum, D-Dubuque. “I can tell you that we got phone calls over the weekend from people that weren’t on beneficiary list for the MCOs, they couldn’t get their prescriptions filled — it was not a very smooth rollout.” … McCoy said the state hired seven new employees and about 20 state employees are dedicated to oversight efforts. Other workers handling calls or other duties are contract employees. Overall, she said the projected $110 million in savings will come from efficiencies and coordination of services, not from a reduction in force of state full-time workers.
Medicaid Privatization Starts Today
Source: Sarah Boden, Iowa Public Radio, April 1, 2016
Gov. Branstad says Medicaid costs are eating up the state’s budget, and private healthcare companies, called managed care organizations, claim they do a better job coordinating patient care, which saves money. Additionally, some say the old Medicaid delivery model of fee-for-service was dysfunctional and wasteful. … UnitedHealthcare along with AmeriHealth Caritas and AmeriGroup are the three companies now in charge of Iowa Medicaid. Each MCO says it’s committed to providing Iowans with high quality care, while also being good stewards of taxpayer money. But critics say MCOs don’t so much manage care, but rather find ways to deny it. This may be a flat out refusal, or a systematic squeezing out of providers, which is what the McDonoughs say happened to their old nursing provider, CarePro. … Other states that have privatized their Medicaid systems have produced varying results. Experts say ultimately it comes down the quality of oversight. So far Iowa’s House and Senate can’t agree what should look like.
Opinion: Managed care affects 560,000 Iowans, needs oversight
Source: Iowa State Senator Tony Bisignano, Des Moines Register, March 31, 2016
Despite our repeated efforts to stop or delay it, Gov. Branstad’s ill-conceived plan to turn over management of Medicaid to three out-of-state companies is now a reality for 560,000 Iowans. Medicaid recipients, health care providers and advocates are worried and frustrated about how this major shake-up will impact our elderly and Iowans with disabilities. Senate Democrats will continue fighting for them by pushing for tough oversight and accountability to keep Iowa’s health care safety net strong.
Privatized Medicaid might not be ready in Iowa
Source: Jim Niedelman, Our Quad Cities, March 27, 2016
Rep. Cindy Winckler, (D) Davenport, discussed the progress during an appearance on 4 the Record. Winckler says the insurance companies aren’t ready. Her concern is that many people still don’t know who their service provider is or what their services will be. Although the state met the requirements of CMS, she says they have not met the full extent of the implementation. Winckler says it will essentially be halfway implemented and many will still be in need.
Editorial: Connecticut abandoned privatized Medicaid
Source: Des Moines Register, March 22, 2016
Now Iowa is on track to experience the same pain felt in other states that have extensively privatized Medicaid management: namely, denied claims, delayed payments, loss of providers, little transparency and for-profit insurers who demand more and more public money. After Florida implemented state-wide managed care, insurers almost immediately asked for higher state reimbursements. In Kansas, two of the companies Iowa picked to manage our program face new accusations of padding their profits by systematically denying payments to health providers. However, the story of Connecticut, recently detailed in a Wall Street Journal article, may be of greatest interest to Iowans. Connecticut is no stranger to Medicaid managed care, with its experience dating back to the mid-1990s. Year after year, the complaints rolled in. Patient advocates said insurers would not cover services. Providers waited and waited for reimbursements. The companies refused to share data with the state. A 2009 audit found Connecticut was overpaying insurers by nearly $50 million annually. … In 2012 Connecticut fired the remaining managed care companies and began transitioning back to the traditional “fee for service” model in which the state reimburses hospitals and doctors directly. What happened next? The monthly cost of care per patient dropped from $718 in mid-2012 to $670 last year, the Journal reported. The number of doctors willing to accept Medicaid patients increased 7 percent. Administrative costs — money not spent on actual health care for people — dropped from 12 percent to 5 percent.
Senate Democrats have revived two bills aimed at oversight of Medicaid privatization and boarding schools in Iowa, but the legislation could undergo some changes in the Republican-controlled House
Source: Barbara Rodriguez, Associated Press, March 17, 2016
Senate Democrats revived an effort Thursday to expand state oversight of Medicaid and boarding schools in Iowa, and House Republicans said they support some aspects of the proposals but would introduce their own versions. The five-member Senate Government Oversight Committee voted to advance legislation that would add oversight to Iowa’s $4.2 billion Medicaid program as well as to private facilities that offer residential services to minors. The bills now head to the Democratic-majority Senate, which approved nearly identical legislation earlier this session when they were brought up by separate policy committees. Those bills did not survive a legislative deadline, and their placement on the oversight committee was a maneuver to revive them this year. The committee can introduce bills that are not subject to such deadlines.
Iowa Poll: Majority prefer state-run Medicaid
Source: Tony Leys, Des Moines Register, March 8, 2016
Iowans are more likely to trust state government than private companies to run Medicaid, a new Des Moines Register/Mediacom Iowa Poll shows. Fifty-five percent of poll participants say they would have more faith in the state government to run a program such as Medicaid, which covers health care for 560,000 poor or disabled Iowans. Thirty-six percent say they would have more faith in a private company to run it. Nine percent are unsure.
Medicaid Oversight Bill Passes Senate With Bipartisan Support
Source: Sarah Boden, Iowa Public Radio, March 2, 2016
A bill supporters say makes it harder for managed care companies to prioritize profits over the healthcare of Medicaid recipients passed the Iowa Senate Wednesday. Every Senate Democrat and six Republicans voted for the legislation. Medicaid enters privatized management next month, and critics of the transition are eager to install safeguards. The bill, penned by the Senate’s Human Resources Committee, includes provisions for consumer protections, making sure networks have enough providers, methods to determine reimbursement rates, and outcome expectations.
Iowa Senate, Branstad clash over Medicaid oversight
Source: Rod Boshart, The Courier, March 2, 2016
Iowa senators launched an effort Tuesday to require more government oversight of private companies managing Medicaid for 560,000 Iowans effective April 1. A bill, which cleared a Senate committee with bipartisan support, would enhance the responsibilities of the Health Policy Oversight Committee, review program integrity and finance improvements and support for recipients, Sen. Amanda Ragan, D-Mason City, said. … Branstad maintains his administration and the Legislature already have authority to monitor Medicaid. He says privatization will move the program from a fee-for-service model to a system that rewards improvements.
Problems With Medicaid Privatization Plague Other States Ahead of Iowa’s Switch
Source: KCRG, February 29, 2016
Three years after privatizing its Medicaid system, lawmakers, disability advocates, and providers across the state of Kansas cite several problems with the system. Those problems include a lack of meaningful oversight, confusing reimbursement requirements from the three managed care organizations, or MCOs, who are contracted with the state, and cuts to care. The privatization of Medicaid in Kansas is similar to the system that will roll out for nearly 600,000 Iowans on April 1. Both states will have a high percentage of Medicaid patients under managed care – about 92 percent of Medicaid recipients will move to managed care in Iowa, while Kansas moved 95 percent of patients. …
Corporate-owned Medicaid clinics come to Iowa
Source: Jason Clayworth, Des Moines Register, February 27, 2016
The three corporations hired to manage Iowa’s Medicaid program each plan to open their own medical clinics, senior facilities or “wellness” centers, raising questions about the dual role of companies that reap the financial benefits as both insurance and medical providers. … The new information raises yet more concerns in the plan to privatize Iowa’s $4.2 billion Medicaid program. Previous Register reporting has revealed those companies’ histories of fraud and mismanagement in other states, along with patterns of campaign contributions to elected officials involved in the process. Federal administrators delayed the planned Jan. 1 implementation date until April 1 over concerns that the companies and the state weren’t ready.
Iowans Plead For Medicaid Oversight
Source: Sarah Boden, Iowa Public Radio, February 25, 2016
Dozens of Iowans begged members of the Iowa Senate Human Resources Committee Wednesday to make sure the state provides extensive oversight of the three healthcare management companies that will soon manage Iowa’s Medicaid system. The federal government says privatization can begin April 1. … A key criticism of privatization is that without oversight from the state, companies will implement unfairly low reimbursement rates and create excessive administrative burdens that will drive providers out of business, or cause them to drop Medicaid clients. They also say companies will prioritize profits above client care.
Iowa Medicaid Privatization Begins April 1st
Source: Matt Hamill, CBS2, February 23, 2016
The state of Iowa has the green light to begin its controversial privatized Medicaid plan starting April 1st. The Centers for Medicare and Medicaid Services notified Governor Terry Branstad Tuesday afternoon. It is the second delay for the program, but the CMS notes significant improvements in Iowa provider networks….
Editorial: DHS holds private talks on matters of public interest
Source: Des Moines Register, February 22, 2016
Unfortunately, DHS never provided CMS with a written response or summary of its actions. Instead, it opted to communicate that information to CMS orally — with no one putting pen to paper. Amazingly, CMS went along with this approach. You might wonder what possible benefit could be derived from troubleshooting the state’s extraordinarily complex, multi-tiered effort to privatize a $4.2 billion program in this fashion, with nothing committed to writing. The potential for miscommunication would, after all, be enormous, and the health care of 560,000 Iowans hangs in the balance. This appears to be an attempt by DHS to push the privatization plan forward without creating a paper trail that would document any potential problems.
CarePro Health Services closes two divisions due to Medicaid privatization
Source: Kristin Rogers, KWWL, February 21, 2016
CarePro Health Services says they recently closed two of their in-home nursing divisions in large part due to the privatization of Medicaid. The local and employee owned company says unknowns about what is going to happen with the transition lead them to the closures. … One reason is that CarePro was using the particular in-home nursing divisions to help seven patients. Jensen says there are unknowns about navigating the new Managed Care Organizations (MCOs) and it seems it would be a challenging for divisions that are not serving a large population. Another reason for the closure of these two divisions Jensen said, is financial. She says right now the nurses get paid for the hours they work inside of the home only. The company then pays for other hours such as staff meetings or training. At the end of the year CarePro is able to fill out a cost report and they get paid the difference through Medicaid allowing them to break even. Jensen says it is their understanding in the transition the MCOs will be eliminating the cost reports, which would cause them financial issues for the two divisions.
Former Governor speaks out against Iowa Medicaid privatization
Source: Sarah Greene, Our Quad Cities, February 18, 2016
Former Iowa Governor Chet Culver stopped in Davenport Thursday. He hosted a town hall meeting to share his concerns about Governor Terry Branstad’s plan to privatize Medicaid. The change is supposed to take effect March 1st. That’s when Medicaid would be managed by three private companies out of state. Culver talked to dozens of people who will be directly affected by the change, many say they’re concerned the new plan will leave them with fewer options and poorer care.
Is Medicaid ready for March 1 private management shift?
Source: Tony Leys, Des Moines Register, February 16, 2016
Iowa Medicaid leaders told skeptical lawmakers Tuesday that they’re confident they will be able to shift the program to private management on March 1. … State administrators, speaking to legislators Tuesday, offered reports showing that roughly twice as many health care providers have signed managed-care contracts as had signed them in mid-December. … Officials from the Centers for Medicare and Medicaid Services advised Iowa in December that it would like to review the state’s actions in preparing for privatized Medicaid in writing no later than Feb. 15. But, on Tuesday, Iowa Department of Human Services spokeswoman Amy McCoy said there is no such document exists because Iowa is instead communicating with the federal officials in other ways, largely via telephone.
2 companies end fight to halt Iowa Medicaid privatization
Source: Associated Press, February 17, 2016
A WellCare executive says the company has ended legal actions to regain its contract to manage Iowa’s Medicaid program. The contract was terminated by Iowa in December after WellCare was disqualified for unfair bidding practices, an allegation that WellCare denied. WellCare later joined a lawsuit that alleged the bidding was deeply flawed and should be reopened.
Iowa Senate votes to stop Medicaid privatization
Source: Mike Donahey, Times-Republican, February 12, 2016 (Subscription Required)
The Democratic-controlled Senate passed legislation Thursday in an effort to halt Gov. Terry Branstad’s proposal to privatize Iowa’s $4.2 billion Medicaid program, though the bill isn’t expected to advance in the divided Legislature.
OPINION: Bill to stop Medicaid privatization stands no chance
Source: Sioux City Journal Editorial Board, February 11, 2016
Our question: Because the bill stands little to no chance of passage in the Republican-controlled House and absolutely no chance of signature by Gov. Terry Branstad, what’s the point? In our view, work on the bill represents a waste of time and effort. … We understand Democrats don’t support privatization, but dogged pursuit of a bill to stop this transition ignores realities. We would prefer opponents, including Democratic state lawmakers, read the handwriting on the wall, accept the inevitability of privatization and spend their time and talents working with, not against the administration so this new approach to Medicaid will work to the benefit of all Iowans.
Former Gov. Culver convenes Medicaid privatization meetings
Source: KWWL, February 5, 2016
Former Iowa Gov. Chet Culver, often rumored a possible Congressional candidate, has scheduled town meetings next week to talk to Iowans affected by the state’s plan to hire three private companies to run the Medicaid program. The public meetings will highlight the impact of the proposal on Iowa’s 560,000 people who rely on Medicaid for their health care needs. Culver, a Democrat, says Iowa’s swift move toward privatization is putting peoples’ health at risk.
Democrats seeking stop to Medicaid privatization
Source: O. Kay Henderson, Radio Iowa, February 5, 2016
Democrats in the Iowa Senate plan to pass a bill that would stop Governor Branstad’s plan to move the 560,000 Medicaid patients in Iowa into private managed care plans. … The Branstad Administration originally planned to start the switch on January 1, but federal officials who oversee the Medicaid program ordered a 60-day delay. Senate Democratic Leader Mike Gronstal of Council Bluffs says many Iowa Medicaid patients can’t figure out if their doctor has signed up with one of the three managed care companies or if they’ll be forced to switch to a new doctor. … Republicans are defending the new system and making clear the effort by Democrats to stop the switch will go nowhere in the Iowa House where Republicans have a majority of votes. House Speaker Linda Upmeyer, a Republican from Clear Lake, suggests Democrats are stoking the chaos.
IA Senate to vote on bill to end Medicaid privatization
Source: CBS2/Fox28, February 4, 2016
Some lawmakers in the Iowa Senate are pushing to end the Governor’s plan to privatize the state’s Medicaid system. On Monday, they are set to vote on a new bill that would stop Governor Branstad’s plan and put Medicaid back in the hands of the state and “continue to make the public management of Medicaid more efficient. ”
Ragan continues efforts to stop Medicaid privatization
Source: John Skipper, Globe Gazette, February 1, 2016
State Sen. Amanda Ragan, an outspoken critic of Gov. Terry Branstad’s plan to privatize the state’s Medicaid program, is appealing to President Obama and other federal officials to prevent it. Branstad says putting Medicaid under the direction of private providers will save the state millions of dollars in the years to come.
Democrats to Obama: Sink Medicaid privatization plan
Source: Jason Clayworth, Des Moines Register, January 27, 2016
Every Democratic member of the Iowa Senate signed a letter sent to President Obama Wednesday asking that a plan to privatize the state’s Medicaid management be denied. … “Since the CMS letter was released nearly 40 days ago, we have seen no evidence that the Iowa Medicaid Enterprise and the out-of-state companies picked to help privatize Medicaid have taken the steps necessary to ensure the safety and well-being of Iowa’s most vulnerable citizens,” the letter to Obama says.
Rocky Medicaid privatization rollout looms as political issue in Iowa
Source: Harris Meyer, Modern Healthcare, January 26, 2016
But in Iowa, many healthcare providers, patients and public officials are more immediately concerned about Branstad’s Medicaid privatization effort, which he says will save money and improve care. They note that other states have implemented their Medicaid managed-care programs much more gradually, moving disabled people into MCOs only after the programs have been well established. Now some Democrats are making it a political issue, with Hillary Clinton warning Branstad’s plan could mean cuts in services. … Tim Charles, CEO of MercyCare Service Corp., which operates the independent Mercy Medical Center, said his fear is that the governor’s stated plan to save $51 million in the first six months of the program will translate into provider rate cuts and reduced access to care for beneficiaries. … Sabra Rosener, vice president of government relations at UnityPoint Health, which operates St. Luke’s Hospital in Cedar Rapids, said she’s worried about the utilization-management methods the Medicaid plans will use, based on what she’s seen in other states. Additionally, the plans have hired a massive number of nurses to handle care management, adding to the state’s nurse-staffing squeeze, she said.
Judge declines to further halt Iowa Medicaid privatization
Source: KWWL, January 22, 2016
A judge has declined to halt Iowa’s efforts to turn over management of its Medicaid program to private insurers. Two companies failing to win bids to help administer the program sued seeking to halt the transition to managed care which is now expected to begin in March. Aetna Better Health and Meridian Health Plan claimed the bidding process was rigged and the state should do it over again. They were joined by WellCare, which initially won a contract but was disqualified in December for unfair bidding practices.
Senate Leader: Iowa still not ready for privatized Medicaid care
Source: Rod Boshart, Quad-City Times, January 21, 2016
A top Senate Democrat said Thursday she does not think Iowa will have the safeguards in place by March 1 to proceed with the change to privately managed Medicaid services, and she hopes federal regulators again will delay implementation of Gov. Terry Branstad’s modernization effort. … But Jochum said she has concerns vulnerable Iowans may get shortchanged without proper oversight in place to head off problems regarding access to improved service and reimbursement reductions to local providers that cropped up in other states that privatized Medicaid service delivery. She also challenged the savings projections Branstad administration officials have attached to privatization.
Editorial: Medicaid savings: Pick a number. Any number
Source: The Des Moines Register, January 21, 2016
Will Iowa really need to find an extra $100 million if the Obama administration rightly denies the governor’s divisive and already delayed plan? Boy, that is worrisome. But before accepting the governor’s proposition to tackle the state budget, the editorial board figured it better first confirm the $102 million figure. Quite frankly, it is difficult to trust Medicaid savings estimates quoted by this administration. After repeatedly claiming last year that privatization would save $51 million in the first six months of implementation, it could not produce any documents or names of experts it consulted to arrive at the figure. … The bottom line: While the governor’s plan disrupts this state’s entire health care system, its net impact on the state budget remains a mystery. Iowans may be starting to wonder whether the state is going to save anything. Perhaps it could cost more.
New estimate: Iowa Medicaid savings below projections
Source: Jason Clayworth, The Des Moines Register, January 20, 2016
Gov. Terry Branstad’s plan to privatize Medicaid will save the state millions of dollars less than the figure on which lawmakers based this year’s budget, documents obtained by The Des Moines Register show. The revised estimate shows a savings of $36.6 million in the first six months. That’s nearly $15 million less than was previously projected. … The new document was prepared by Milliman, a Seattle-based actuarial firm the state regularly uses to calculate projected costs and savings. It was provided to the Register after Branstad mentioned it during his meeting with the newspaper’s editorial board earlier this month, saying the savings would top $102 million a year.
Opinion: Governor perpetuates myths about Medicaid privatization
Source: Kirk Norris, The Des Moines Register, January 20, 2016
As Iowa’s 118 community hospitals and 71,000 hospital employees work daily to bring healing and wellness to all Iowans, the state’s reckless rush toward privatization of the Medicaid program has been a source of extreme concern. Most concerning are the myths about privatization perpetuated by our own governor, including during his interview with the Des Moines Register editorial board, as he tries to promote what is simply a bad idea for Iowa and, especially, for 560,000 vulnerable Iowans who depend on Medicaid. On behalf of those Iowans and the health care professionals who care for them, it’s time that all of Iowa sees these myths for what they are: misleading half-truths that cannot hide the failures of this ill-conceived plan.
Editorial: Are federal officials playing politics with Medicaid?
Source: The Des Moines Register, January 16, 2016
In meeting with the Register’s editorial board last week, the governor was either unwilling or unable to explain why he so vigorously pursued a Jan. 1 launch date for privatization at a time when the state’s help line for Medicaid beneficiaries had a call-abandonment rate of 49 percent and Iowa doctors were openly stating that they intended to refuse or delay patient care. As late as mid-December, not one of the state’s managed care organizations had been able to secure contracts with more than 34 percent of Iowa’s critical access hospitals, but the governor refused to delay implementation. When asked about the federal Centers for Medicare and Medicaid Services citing these issues as reasons to delay privatization until at least March 1, the governor said dismissively, “We disagree with some of those conclusions they made.” Disagree? The numbers relied upon by CMS came from the Branstad administration itself.
Report: Iowa Medicaid oversight to cost $17 million
Source: Jason Clayworth, Des Moines Register, January 15, 2016
Iowa would need to hire 134 additional workers and spend as much as $17 million more a year to properly expand ombudsman oversight of Gov. Terry Branstad’s plan to privatize Iowa’s Medicaid management, a new multi-agency workgroup report shows. The report mandated by the Legislature includes several key findings behind the privatization plan that has already been delayed once by federal officials because of the state’s unpreparedness … The recommendation that Iowa hire scores of additional patient advocates would cost just over $16.9 million, according to the report from the state’s long-term care ombudsman and about a dozen other state agencies and offices, including Iowa’s departments of Public Health and Veterans Affairs and its Civil Rights Commission. … Iowa Department of Human Services spokeswoman Amy McCoy last week described Iowa’s planned oversight as “unprecedented.” But when The Register noted that its plans are — at least structurally — nearly identical to those outlined online by Kansas, she was unable to immediately say what made Iowa’s oversight superior. She said she was unable to touch base with office executives on that question.
Court arguments: Iowa’s Medicaid plan a ‘cancer’
Source: Jason Clayworth, Des Moines Register, January 14, 2016
Three companies on Thursday asked a judge to suspend or terminate Iowa’s plan to privatize Medicaid management, one saying Gov. Terry Branstad’s plan is so ill-conceived it should be treated like a “cancer.” The comments came in response to revelations that WellCare, one of three companies selected to manage Iowa’s $4.2 billion Medicaid program, hired former House Speaker Christopher Rants and former Rep. Renee Schulte to help them win the contract.
Will Iowa’s poor face Kansan fate of Medicaid denials?
Source: Jason Clayworth, Des Moines Register, January 10, 2015
Two of the corporations Iowa has picked to manage its Medicaid program face new accusations of trying to pad their profits by systematically denying payments to medical providers serving poor and disabled people in Kansas. Similar allegations of denied payments and unjust delays hounded both companies for years in other states. … But the new accusations in Kansas are particularly relevant to Iowa because the model used by Gov. Terry Branstad’s administration for privatized Medicaid management is similar to the Kansas plan in many ways, critics contend. …
Opinion: Medicaid privatization offers no upsides for Iowa
Kirk Norris, Sioux City Journal, January 8, 2015
With results like these already occurring, why is the state looking to eliminate successful programs for an unsuccessful, unnecessary privatized model? And why is The Journal’s editorial board endorsing this plan, especially given the well-reported legal and ethical misdeeds of these companies as well as their botched rollout of the Iowa plan, which has been so poorly managed that the federal government was forced to step in and delay it? There is no reliable evidence that Medicaid privatization reduces costs, improves quality or increases access to care. This is why Iowa’s hospitals encourage The Journal to reconsider its position and look beyond the claims and promises of companies that have no stake in Iowa, but simply seek to make money off of vulnerable Iowans.
Senate Democrats Want Medicaid Oversight
Source: Sarah Boden, Iowa Public Radio, January 5, 2016
Iowa’s Senate Majority Leader says there will be legislation that provides oversight of the transition of Iowa’s Medicaid program into management by private companies. “The rollout of this managed care has been messy and we’re going to standup for the patients and for providers out there that need to understand the rules of the game,” says Democrat Mike Gronstal of Council Bluffs, who has been a vocal critic of Medicaid privatization. “We don’t think there are enough protections right now in that process, so we’re going to keep working on that.”
Branstad: Remaining 3 companies will offer Medicaid services
Source: Barbara Rodriguez, Capital Gazette, December 21, 2015
Gov. Terry Branstad on Monday said Medicaid recipients enrolled with a private company that had its state contract terminated can be covered by one of three remaining companies set to take over Iowa’s $4.2 billion Medicaid program. Branstad said three is an adequate number of companies providing managed care of Medicaid services in the state. He said he can’t predict the outcome of an expected legal challenge from WellCare of Iowa, the company whose services were formally dropped on Friday. … The Iowa Department of Human Services will reassign about 140,000 people tentatively enrolled in WellCare among the remaining three companies, according to spokeswoman Amy Lorentzen McCoy. She said the process for such a reassignment among the companies — Amerigroup Iowa, AmeriHealth Caritas Iowa and UnitedHealthcare Plan of the River Valley — will happen over the next several weeks.
Feds tell Iowa: Delay Medicaid privatization by 60 days
Source: Tony Leys, Des Moines Register, December 18, 2015
Federal administrators have ordered Iowa to wait at least 60 days before shifting its Medicaid program to private management. The delay, announced Thursday, will affect 560,000 poor or disabled Iowans who receive health care under the $4 billion program. Gov. Terry Branstad has been pushing to transfer Medicaid management to national, for-profit companies on Jan. 1. … Branstad needs federal permission to make the switch, because the federal government pays more than half the cost of Medicaid. The Centers for Medicare and Medicaid Services administrators made their position known Thursday in a letter to the state’s Medicaid director, Mikki Stier.
Medicaid Privatization Gets Messy in Iowa
Source: John Tozzi, Bloomberg, December 17, 2015
Nationally, the shift to Medicaid managed care hasn’t been proved to save money, and the approach has a mixed record on how patients fare, according to a 2012 review by the Robert Wood Johnson Foundation. Another study, published this year by authors at the Urban Institute, a liberal think tank, found that for nondisabled adults, managed care is associated with increased likelihood of emergency room visits, trouble seeing specialists, and difficulty getting prescription drugs. “We don’t have as much evidence on what works and what doesn’t work as we would like to have,” says Julia Paradise, associate director at the Kaiser Commission on Medicaid and the Uninsured, a bipartisan policy group convened by the Kaiser Family Foundation.
Iowa lowers projected savings for privatizing Medicaid
Source: Barbara Rodriguez, Washington Times, December 16, 2015
Iowa health officials on Wednesday lowered the state’s projected savings for switching its $4.2 billion Medicaid program to private care, saying its initial estimate was released a year ago. Iowa Department of Human Services Director Chuck Palmer told lawmakers on the Fiscal Committee that the department now estimates it will save about $47 million in the first six months of 2016 with the move to privatization on Jan. 1. That’s a slight decrease from the $51 million that’s been publically used for months. It’s also what the Legislature used to approve its current state budget.
Opinion: Iowa’s radical privatization of Medicaid is already struggling
Dana Milbank, Washington Post, December 11, 2015
The Iowa rollout has been hampered by delays, and some beneficiaries of the program are only now getting their enrollment packets, though the deadline for signing up is Dec. 17. Health-care providers complain that they are being forced to sign incomplete contracts or face a penalty, and they complain that some contracts don’t cover services that had been covered under the existing Medicaid program. … Now, as the nation’s attention turns to the Iowa caucuses, Iowans will likely be witnessing either a fight between Branstad and President Obama (if the federal government forces a delay in the Iowa program) or chaos (if the program is allowed to proceed). Other states, such as Kansas and Kentucky, have tried similar experiments, but they either moved more deliberately or didn’t extend the private program to vulnerable populations such as the disabled.
People travel to Des Moines to share Medicaid privatization concerns with lawmakers
Source: KCRG, December 7, 2015
Dozens of people from around the state asked Iowa lawmakers to slow down the rush to privatize the state’s Medicaid system on Monday. … That committee, on a motion by Sen. Joe Bolkcom (D-Iowa City), took a vote on whether to delayed the implementation by six months from the current January 1st date. That motion failed on a 5-5 tie vote. Medicaid privatization would impact about 560,000 Iowans receiving those services. Medicaid in Iowa is an approximately $5-billion program a year to provide medical care for the disabled.
Iowa asks out-of-staters to tout benefits of privatized Medicaid
Jason Clayworth, Des Moines Register, December 7, 2015
The Iowa Department of Human Services tried to put a positive face on Medicaid privatization Monday, asking each of the companies it has contracted with to bring out-of-state residents to tout their experiences to Iowa lawmakers. … It was unclear how many of the preselected out-of-state residents were in the audience during Monday’s hearing or part of the speaker roster. At least seven speakers said they were from other states and associated in some way with one of the four companies hired by the state of Iowa. …
Three large hospital systems sign Medicaid contracts
Source: Tony Leys, Des Moines Register, December 3, 2015
Three of Iowa’s biggest hospital-and-clinic systems have signed contracts to provide care to patients who will be enrolled in new Medicaid managed-care programs, Gov. Terry Branstad’s office announced Thursday. UnityPoint Health, the University of Iowa Hospitals and Clinics and Genesis Health System all have signed such contracts, Branstad said. The news comes amid concern that Medicaid patients would have few choices of health care providers when the new system is to take effect Jan. 1.
Despite Ruling, Branstad Says Medicaid Privatization Still Set for January 1st
Source: Sarah Boden, Iowa Public Radio, November 30, 2015
Gov. Terry Branstad says the state will move forward as planned with the January 1st deadline for Medicaid privatization in Iowa. That’s despite last week’s recommendation from Administrative Law Judge Christie Scase that the state dismiss one of four contracts it awarded to for-profit companies to manage Iowa’s Medicaid programs. The ruling found that Tampa, Florida-based WellCare had improper communications with the governor’s chief healthcare advisor during the bid process, and that the company should have disclosed information about a false-claims settlement. Regardless of WellCare’s fate, the governor says there is no reason to delay Iowa’s transition to privately managed Medicaid.
Branstad: No reason to delay Medicaid privatization
Source: Brianne Pfannensteil, Des Moines Register, November 30, 2015
Iowa Gov. Terry Branstad said Monday that an administrative law judge’s recommendation to throw out one of the state’s four managed care contracts is no reason to slow the move to Medicaid privatization. He said he has appointed Iowa Department of Administrative Services Director Janet Phipps to decide whether to follow the judge’s recommendation or to move forward as planned. “There’s a lot of evidence to review, and I have every confidence that she will do that in a very thoughtful and methodical way,” Branstad said.
Iowa’s Medicaid providers plead: Delay switch
Source: Jason Clayworth, Des Moines Register, November 21, 2015
Dozens of Iowa’s health care providers voiced warnings to federal officials in meetings last week about Gov. Terry Branstad’s plan to privatize Medicaid management, one calling it an upcoming “catastrophe of monumental proportions.” … The complaints and concerns were aired during a series of five public forums hosted this month by the Centers for Medicare and Medicaid Services. The feedback received is important because it could help determine whether the federal agency will allow the planned launch of Branstad’s effort to privatize management of the $4.2 billion program.
Branstad touts Medicaid contracts, but few hospitals signed
Source: Tony Leys, The Des Moines Register, November 19, 2015
Gov. Terry Branstad, who is pushing to shift management of the state’s Medicaid program to private companies on Jan. 1, said Thursday that the firms have signed more than 12,000 contracts with pharmacies, doctors and other health care providers. But most Iowa hospitals and physicians have not signed contracts to participate in the new system, according to the Department of Human Services. The issue is important, because the managed-care companies are supposed to show they have broad networks of health care providers willing to care for the new plans’ members. … DHS released to The Des Moines Register on Thursday numbers showing that few hospitals have signed such contracts, however. None of the four managed-care companies reported signing more than 17 of the 118 Iowa hospitals now participating in Medicaid. One of the companies, WellCare of Iowa, said it hadn’t signed up any hospitals. Another, AmeriHealth, said it had signed up just two. The managed-care companies reported signing contracts with from 200 to 1,116 physicians out of 6,685 who now provide care to Iowa Medicaid patients.
Iowa senators seek to halt Medicaid privatization in DC trip
Source: KWWL, November 17, 2015
Three Iowa Senate Democrats plan to meet with federal officials in Washington on Wednesday in hopes of stopping implementation of Gov. Terry Branstad’s proposed privatization of the state’s Medicaid program. Senate President Pam Jochum of Dubuque and Sens. Amanda Ragan of Mason City and Liz Mathis of Robins say the privatization plan is disorganized and leaves too many major questions unanswered to be implemented on Jan. 1.
Branstad decries Medicaid privatization “scare” tactics
Source: Rod Boshart, WCF Courier, November 16, 2015
Gov. Terry Branstad expressed concern Monday that some health care providers are using “scare tactics” and misinformation to undermine his administration’s effort to begin the transition to a privately managed Medicaid service delivery system beginning Jan. 1. Some providers in mental health, assisted living and other service areas that rely on Medicaid for treatment have expressed concerns that the state’s plan to privatize Medicaid services includes a new payment system that could cut their reimbursements enough that it could force smaller organizations to close. …
Service providers fear fee cuts under Medicaid privatization
Source: Associated Press, November 15, 2015
The state government’s plan to privatize Medicaid services includes a new payment system that organizations helping people with physical, mental or developmental disabilities say cuts their reimbursements enough that it could force smaller organizations to close and leave people they serve scrambling to find needed services. The providers include mental health centers and organizations that serve the most vulnerable adults and children in Iowa who rely on Medicaid for treatment, assisted living, behavioral programming and improving day-to-day living skills. These services are often used by people with brain injuries or those born with physical or intellectual disabilities. “We figure we’ll lose somewhere in the neighborhood of $150,000,” said Pete Brantner, executive director of Crossroads Behavioral Health Services, a community mental health center serving six counties in southwest Iowa for nearly 40 years. That’s 7.5 percent of his annual budget of just over $2 million.
Medicaid bids include misleading or unverifiable data
Source: Jason Clayworth, The Des Moines Register, November 7, 2015
Some of the claims made by the for-profit corporations chosen to manage Iowa’s $4.2 billion annual Medicaid program contain unverifiable data, misleading statements or half-truths, a Des Moines Register investigation has found. The questionable information was provided to Iowa officials in public bid documents used to help the companies edge out competitors to win the lucrative contracts. The Register could find nothing to suggest that the Iowa Department of Human Services, the agency that oversaw the selection process, did its own fact-checking of claims included in the winning bids. …
Federal officials express concern over Iowa’s timetable to privatize Medicaid services
Source: Associated Press, November 6, 2015
Federal officials reviewing Iowa’s plans to switch its $4.2 billion Medicaid program to private care have concerns about the state’s timetable for implementing the changes, according to a letter sent Friday to an Iowa official. … “CMS has significant concerns that the implementation timeframes for the transition to managed care may place access, continuity of care, and quality of care for beneficiaries at risk,” reads the letter from Hill, who is deputy director of the Center for Medicaid and Children’s Health Insurance Program Services. The agency also said it has concerns about the extent to which managed care organizations, providers, and Medicaid recipients are prepared for the transition. …
Medicaid Privatization Scrutinized
Source: Joyce Russell, Iowa Public Radio, November 4, 2015
A statehouse committee spent the day Tuesday hearing about what’s being called a massive change in how health care in Iowa is delivered to the poor and disabled. Private companies are scheduled to take over management of the state-federal health care program known as Medicaid which serves more than 560-thousand Iowans. … The companies say they’ll work with current case managers and phase the program in slowly. And they say they’ll follow the guideline to use 88% of the money the state pays them for direct care of patients. Senator Bolkcom offered a motion to delay the program’s implementation until July. That motion failed on a partisan vote.
Health care providers ask state to slow Medicaid management transition
Source: Erin Murphy, Globe Gazette, November 3, 2015
Health care providers want the state to pump the brakes on its plan to privatize management of the health care program that serves roughly 560,000 disabled and low-income residents. But the state and the four health care companies that will manage Medicaid in Iowa starting next year insist they will be ready. Several health care providers on Tuesday told a panel of state lawmakers they have serious concerns with the state’s timeline for privatizing management of its Medicaid system, which includes about 1 in 6 Iowans.
Will Medicaid ‘oversight’ ignore past issues?
Source: Jason Clayworth, Des Moines Register, November 2, 2015
Legislators will meet Tuesday to launch a watchdog effort behind Iowa’s plan to privatize Medicaid, but it is uncertain whether some of the biggest controversies that have surrounded the effort will be the subject of the group’s review. … House Chairman Dave Heaton, R-Mount Pleasant, said Monday that he doesn’t expect issues about nepotism, unfair bidding practices, fraud convictions or hundreds of millions of dollars in past fines or settlements against four companies with contracts to manage Iowa’s Medicaid program to be part of his panel’s review. …
Hearing on challenges to Medicaid privatization bid process concludes
Source: Rod Boshart, Sioux City Journal, October 30, 2015
Former Iowa House Speaker turned paid lobbyist Christopher Rants testified Friday that he spoke with state executive and legislative officials about Iowa’s privatization of Medicaid services for one of the bidders but balked at suggestions he and others tried to improperly influence the procurement outcome. … Friday marked the final day of testimony in a weeklong hearing before a state administrative law judge who is considering appeals by three private companies that contend their bids were passed over in a “tainted” process in favor of four competitors chosen in the largest procurement in state history. … During more than three hours of testimony Friday, Rants, a WellCare lobbyist who previously served 18 years in the Iowa House, four as speaker, confirmed he had up to five conversations with Bousselot during the so-called “blackout” period but did not deem them improper because none dealt with the bidding process. The discussions in the governor’s office were about the proposed privatization program’s workability, rate structure and financial projections rather than specifics of the bidding process, Rants said.
Did politics taint Iowa Medicaid bid process?
Source: Jason Clayworth, The Des Moines Register, October 29, 2015
A private company that ultimately won a contract to help manage Iowa’s $4.2 billion Medicaid program asked two former state lawmakers for assistance in determining who was on the committee that would be evaluating the bids and how it might influence their decisions, according to evidence presented in court on Thursday. That company, WellCare, also sought information and received a response from a key member of Gov. Terry Branstad’s staff during a so-called “blackout” period when bidders were prohibited from making contact with state employees about the project, the documents show. The evidence was submitted as part of a legal challenge from three companies — Aetna, Meridian and Iowa Total … If successful in their lawsuit, Iowa’s plan to privatize Medicaid management by Jan. 1 could be derailed. ….
Editorial: Branstad’s Medicaid privatization is a reckless gamble
Source: The Des Moines Register, October 28, 2015
In his blind, headlong rush to privatize Medicaid and hand billions of public dollars over to a group of for-profit corporations, Gov. Terry Branstad has tripped over his own feet every step of the way. His initial mistake was in failing to secure the necessary federal approval for privatization. In fact, the feds have yet to approve of the arrangement, despite the fact that full implementation is just nine weeks away. Then he pushed ahead with his plan to issue the largest set of publicly bid government contracts in the state’s history without telling legislators what he was up to. Given the fact that Iowa Medicaid is a $4.2 billion program, his lack of communication can’t be attributed to mere indifference. This was a deliberate, carefully orchestrated effort to keep Iowa’s elected lawmakers in the dark until privatization could be presented as a fait accompli.
Iowa DHS: Medicaid director’s private email ‘improper’
Source: Jason Clayworth, The Des Moines Register, October 27, 2015
Iowa’s Medicaid director had improper communications with an insurance company consultant and former lawmaker during a critical review period that ended with the for-profit company being selected to help privatize the state’s $4.2 billion annual Medicaid program, the state acknowledged in court Monday. … But the three companies challenging the state’s selection — Aetna, Meridian and Iowa Total Care — say it’s just one of many examples of nepotism, improper review and even illegal actions taken by the state in a flawed and “haphazard” process. They are asking Administrative Law Judge Christine Scase to rule against the state’s process, which could force Iowa to start the privatization process over. … Schulte, a Cedar Rapids Republican, worked as a paid consultant for Iowa’s Department of Human Services starting in January of 2013, soon after she lost re-election. She terminated her nearly $100,000-a-year contract with the state on Feb. 20, four days after Gov. Terry Branstad announced Iowa was seeking competitive bids to contract with private companies to manage its Medicaid program. Days later, she began working for WellCare.
In bid to privatize, governor shortchanges vulnerable
Source: Rekha Basu, The Des Moines Register, October 24, 2015
Let’s start with the fact that there was no compelling reason to turn the state’s health insurance program for the poor over to the private sector when Gov. Terry Branstad suddenly acknowledged in January that he would. He gave no substantial case against the $4.2 billion federal and state program that covers the health care of 560,000 low income and disabled people, and by various accounts works well — only that costs were growing too fast. … Most Iowans — all but 22 percent, according to a poll of 1,200 people — oppose Medicaid privatization. But unfortunately for them — for us — it fits Branstad’s ideological agenda of getting government out of direct service to the public. That hasn’t worked out so well so far.
Medicaid privatization undermines innovation, access
Source: Kirk Norris, President and CEO of Iowa Hospital Association, October 21, 2015
The Iowa Hospital Association opposes the state’s plan because it seeks to reduce Medicaid costs by restricting access to health care services and reducing reimbursement to providers through claims denials and requirements for prior authorization. Merely copying what 40 other states have pursued unsuccessfully is not new or innovative. It simply hands the reins of Iowa’s second largest insurance program to four out-of-state companies, along with a half a billion dollars of Iowa taxpayer funding. … The current administration and Iowa hospitals agree that Iowa has been an innovator in its management of Medicaid. Just this year, the federal Centers for Medicare & Medicaid Services approved a $40 million implementation grant for Iowa to continue work on the State Innovation Model initiative, a multi-payer Accountable Care Organization model that resulted from an 18-month collaborative plan design phase. The plan was approved by CMS and envisioned a long-term goal of advancing the significant progress made after the state expanded Medicaid to create the Iowa Health and Wellness Plan, which provided health insurance to more than 150,000 newly eligible Iowans.
Hillary Clinton slams Branstad’s Medicaid privatization plan
Source: Tony Leys, The Des Moines Register, October 20, 2015
Hillary Clinton is wading into the controversy over Gov. Terry Branstad’s decision to hand over management of Iowa’s Medicaid program to private corporations. The Democratic presidential candidate has routinely drawn applause on the campaign trail for denouncing the Republican governor’s earlier decision to close two state mental institutions. On Tuesday, she ripped his plan to hire four national corporations to run the Medicaid program, which provides health coverage for more than 500,000 poor or disabled Iowans.
Iowa board overseeing children’s health insurance program seeks information over privatization
Source: The Associated Press, October 19, 2015
A board that oversees a children’s health insurance program in Iowa says it’s waiting for more information from state officials over the board’s legal authority as the program’s services are switched to private care. … The hawk-i program provides health insurance to more than 37,000 children from low-income families. Plans to switch the program to managed care have been questioned by board members, who say they weren’t consulted.
Editorial: Slow down on Medicaid privatization
Source: Globe Gazette, October 18, 2015
At least one North Iowan has died while waiting for an appeals process to play out in the Elderly Waiver program — a hint for Iowans wanting to see the impact of private companies managing public health programs. Despite what state officials say, that’s not a process that’s working. … Branstad’s office can’t say how it came up with the $51 million in savings it pitched to the Legislature, only that it was “prudent and was arrived at with careful consideration.” … We know the governor isn’t likely to backtrack on policy he is pushing. But we must not have any more cases slip through cracks. No more deaths while waiting for appeals. No lack of service for those with disabilities.
Editorial: Who can save $50 million in Medicaid? State employees
Source: The Des Moines Register, October 16, 2015
… What the Branstad administration is not talking about: State-managed Medicaid saved nearly $47 million last year “through program integrity cost avoidance or recoveries while maintaining essential healthcare services and provider rates,” according to a recent report from DHS. A few dozen state employees — who do not earn multi-million-dollar salaries and are not beholden to stockholders — accomplished this. Not huge, for-profit insurers.
Lawmaker says Medicaid privatization could hurt kids program
Source: Associated Press, October 15, 2015
A state lawmaker is questioning whether a children’s health insurance program should be included in a plan to privatize Medicaid in Iowa. Sen. Janet Petersen, a Democrat from Des Moines, is raising her concerns regarding the hawk-i program in a letter to Gov. Terry Branstad. In the letter sent Wednesday, Petersen says the transition will cause “disruption and turmoil” for families. Petersen also questions whether management of the program — which provides insurance to over 36,000 children — can be changed without consulting the hawk-i Board.
Iowa can’t show the math of Medicaid savings estimate
Source: Jason Clayworth, The Des Moines Register, October 15, 2015
A state agency says it has no documents or even a list of experts consulted to support its claim that a controversial plan to hire private companies to manage its Medicaid program would save taxpayers $51 million during its first six months. The absence of any public data behind the estimate is significant because the Legislature relied on the projection when it approved the budget for the current fiscal year, which began July 1. Some lawmakers now say they have doubts about whether the Department of Human Services’ estimate is accurate and how Gov. Terry Branstad’s administration came up with the number. “They can’t show the math. It’s a completely bogus, made-up number,” said state Sen. Janet Petersen, a Des Moines Democrat who had previously asked the federal government to halt Iowa’s effort to privatize Medicaid management. …
North Iowans question Branstad about Medicaid changes
Source: John Skipper, Globe Gazette, October 14, 2015
Branstad obviously anticipated questions about it on Wednesday. With him in Mason City was Amy McCoy, public information officer for the Iowa Department of Human Services, to help answer questions. … Branstad was also asked about the Elderly Waiver program in Iowa. DHS recently rejected a request from the Franklin County Board of Health to resume services to patients who lost benefits in the program, which is a part of Medicaid. In-home assistance was discontinued last year because of a discrepancy in how eligibility and service levels were applied. DHS was able to work through an appeals process to get many of the elderly reinstated.
Iowa signs Medicaid contracts with private managers
Source: Tony Leys, The Des Moines Register, October 9, 2015
Iowa officials announced Friday that they have signed contracts with four national companies to manage the state’s massive Medicaid program. Gov. Terry Branstad’s administration announced in August that the Department of Human Services had chosen the four companies, Amerigroup Iowa, AmeriHealth Caritas Iowa, UnitedHealthcare Plan of the River Valley and WellCare of Iowa. …
Time running out for Iowa’s Medicaid privatization transition?
Source: William Garbe, Telegraph-Herald, October 9, 2015
Gov. Terry Branstad insists the four out-of-state, for-profit managed-care organizations selected to handle Iowa’s $4.2 billion Medicaid program will be ready for members by Jan. 1, but local health care providers say they’ve lost nearly a month to prepare for the transition due to a delay in MCOs receiving state contracts. … But approval of the transition will require the federal Centers for Medicare & Medicaid Services to see the provider network is ready to operate by Jan. 1. To have an adequate provider network, MCOs will need finalized contracts with local health care providers as soon as possible. During a meeting Thursday in Dubuque, representatives for DHS and the four MCOs told more than 50 parents, Medicaid recipients, providers and two state lawmakers they were preparing to meet the demands of the transition.
Editorial: Medicaid savings are increasingly suspect
Source: The Des Moines Register, October 8, 2015
But there’s still that $51 million in first-year savings privatization is supposed to yield, right? Though state workers have never explained how that will be achieved, they can’t just make that up, can they? Well, last week a state official testified in a court hearing that number is not based on a specific analysis of Iowa’s program, but is the midpoint of estimates from unidentified “experts.” At least one of those estimates projected the state would save nothing. Zero. Not a dollar. … The governor received nearly $40,000 in campaign donations from managed care companies over the past few years. Shortly after being reelected last November, he announced his administration would seek bids from private companies to administer Medicaid beginning Jan. 1, 2016….
Testimony calls into question Medicaid savings estimate
Source: Jason Clayworth, Des Moines Register, October 7, 2015
The $51 million in savings that Iowa has cited as a key reason to privatize its Medicaid program is a midpoint of wide-ranging estimates from unidentified experts, some of whom predict no savings, a state official has acknowledged in court testimony. … Jean Slaybaugh, a fiscal manager for the Iowa Department of Human Services, testified last week that experts have predicted that privatizing management of Iowa’s annual $4.2 billion Medicaid program could save anywhere from nothing up to 15 percent. At DHS Director Chuck Palmer’s request in August 2014, Slaybaugh selected a midpoint of the estimates, which is around 7.5 percent or roughly $51.3 million in the first six months of privatized Medicaid management, she testified. That’s the number that was factored into the state budget approved by the Legislature before it adjourned in June.
Privatizing Medicaid Savings Estimated
Source: Associated Press, KGAN, October 7, 2015
A state official says $51 million in savings cited by Iowa as a reason for privatizing its Medicaid program is a midpoint of wide-ranging estimates from experts. … The $51 million estimate was factored into the state budget passed by the Legislature earlier this year. The state plans to sign contracts with four companies Friday that would privatize Medicaid management on Jan. 1.
State’s move to managed care could cut Linn County jobs
Source: Rick Smith, The Gazette, September 28, 2015
Some 80 Linn County social service employees with union wages and benefits who provide care to the intellectually and developmentally disabled could see their jobs vanish as Iowa shifts from a state-administered Medicaid program to a private system. …Sue Novak, financial management director for Linn County Community Services, told the supervisors that 38 county employees could lose their jobs come July 1 if the managed care organizations decide to handle the work themselves or hire other providers to handle the management of cases of mental health and developmental disability. The organizations will continue to work with two other Linn County programs, Options and Home Health, but could move to other providers by 2018, for those programs, Novak said. She said Options has about 50 county employees who continue to work with the developmentally disabled, while Home Health has a couple of employees. …
Serious service errors plague Medicaid companies
Source: Jason Clayworth, The Des Moines Register, September 20, 2015
The corporations poised to take over management of Iowa’s Medicaid program have each been held accountable in other states for serious service and administrative errors, including some that wrongly delayed or denied medical services to poor residents, a Des Moines Register investigation shows. Yet a review committee that scored the corporations’ bids gave the highest scores — and a piece of the annual $4.2 billion in contracts — to some of the companies with the most egregious problems. In total, more than 1,500 individual regulatory sanctions resulting in more than $10.2 million in fines have been imposed against the four companies in the past five years, according to information contained in public bid documents. …
Democrats ask feds to block Medicaid privatization
Source: Tony Leys, The Des Moines Register, September 17, 2015
Two leading Democratic legislators are asking federal administrators to block Gov. Terry Branstad’s plan to turn the state’s Medicaid program over to private companies. Sens. Amanda Ragan and Liz Mathis contend that Branstad is trying to make the shift too quickly and that he has not shown how it will save money and help poor Iowans. … Branstad did not require legislative approval to overhaul the Medicaid program. However, in responding to the Democratic senators Thursday, Branstad spokesman Jimmy Centers alluded to a Democratic budget bill that included possible savings from the project. …
State seeks federal waivers to implement Medicaid managed care
Source: Rod Boshart, Globe Gazette, September 11, 2015
Iowa officials have submitted waiver requests with the federal government as part of Gov. Terry Branstad’s plan to shift Medicaid to a privately run managed care system effective Jan. 1 — a change they expect will provide quality services while saving a projected $51.3 million in the first six months. … DHS officials say the goal of the new Iowa Health Link program is to improve quality and access, promote accountability for outcomes and create a more predictable and sustainable Medicaid budget for a program that has grown 73 percent since 2003 to more than $4.2 billion in the last fiscal year, including $1.39 billion in state general fund taxpayer dollars. … The private vendors initially selected in the request for proposals process were Amerigroup Iowa Inc.; AmeriHealth Caritas Iowa Inc.; UnitedHealthcare Plan of the River Valley Inc.; and WellCare of Iowa Inc.
Companies appeal Iowa’s Medicaid privatization bidding process
Source: Rod Boshart, Quad City Times, September 9, 2015
Three private companies seeking to be part of Iowa’s Medicaid modernization program when it launches next year have appealed their requests for reconsiderations that were turned down by the head of the state’s Department of Human Services. Attorneys representing Aetna Better Health, Iowa Total Care and Meridian Health Care Plan of Iowa have requested hearings before an administrative law judge to challenge the “fundamentally flawed” process DHS officials used to determine four winning bids among the 11 responses to the state’s request for proposals seeking private companies to manage Iowa’s $4.2 billion Medicaid program. … Three competing companies — Aetna, Iowa Total Care and Meridian — have challenged the selection process on a variety of grounds ranging from evaluator bias to scoring methodology deficiencies, process flaws and potential conflicts of interest. In appeals filed with the agency, attorneys say the DHS intent to award must be overturned and the department ordered to re-evaluate the bids using an independent, disinterested arbiter.
Our opinion: Privatizing Medicaid rife with problems
Source: Telegraph Herald, September 4, 2015
Privatizing Medicaid in Iowa is an attempt to fix what isn’t really broken. Compared to other states, Iowa’s Medicaid program has been operating quite effectively. The state-run program provides health insurance coverage to more than 560,000 Iowans in need with low administrative costs and little fraud. The cost per capita is lower than the national average and lower than most other states. … It’s hard to imagine that the four companies chosen will handle this new piece of business with the best interests of the clients foremost in their corporate minds. All four have been associated with instances of fraud or mismanagement in other states.
Chairwoman: Is Iowa’s Medicaid privatization legal?
Source: Jason Clayworth, The Des Moines Register, September 1, 2015
The chairwoman of a state program that provides health insurance to children of poor families is questioning whether Iowa has acted legally with efforts to privatize management of the system. At issue is a $111.3 million annual program known as hawk-i that provides health insurance for more than 37,000 children from low-income families in Iowa. … But Mary Mincer Hansen, the former director of Iowa’s health department and the chairwoman of hawk-i, has raised concerns about the legality of the move. In an Aug. 21 email to Chuck Palmer, the director of the Iowa Department of Human Services, Hansen cited state law that says her board is responsible for developing the criteria on which any administrative contractor would be selected. In the email, Hansen questioned Palmer’s legal authority to make decisions for the program without input and approval by the hawk-i board. … DHS spokeswoman Amy Lorentzen McCoy didn’t directly answer a question about whether the agency had the legal authority to move forward with the privatization efforts for hawk-i without the board’s approval. However, she said in a written statement that the department regularly enters into contracts and makes changes for the program.
Editorial: Feds should stop Medicaid privatization
Source: The Des Moines Register, August 26, 2015
About 550,000 low-income Iowans rely on Medicaid health insurance. The program, administered by the state, has low administrative costs. It has held down spending by reimbursing providers modestly, reducing fraud and giving seniors alternatives to expensive nursing homes. Medicaid in Iowa spends less per person than the majority of other states, while still providing comprehensive coverage. Unfortunately, Republicans have never met a government program they didn’t want to privatize. And Gov. Terry Branstad is a Republican. … Privatizing Iowa’s Medicaid program will increase administrative costs as much as 300 percent. That is money not spent on actual health care. The state has provided no evidence privatization will improve health care quality and access — likely because it cannot find any. Iowans have no assurances these private companies will be transparent or held accountable for problems.
Editorial: Privatizing Medicaid no cure for what ails it
Source: Des Moines Register, August 10, 2015
…That point is underscored in a new report from the DHHS Office of Inspector General. It shows that roughly 12 percent of the Medicaid-funded service providers who have been kicked out of their state-run Medicaid programs for fraud or quality issues are still able to participate in other states’ Medicaid programs. The inspector general found 295 providers who had been terminated from one state’s Medicaid program in 2011 and, three years later, were still providing services to Medicaid beneficiaries. Fifteen of the providers collected $100,000 or more from Medicaid and one received more than $1 million. … One of the main culprits is managed care, which should be of concern to Iowans since the state is now moving toward the privatization of Medicaid administration. The OIG found that 25 of the 41 states that use managed care to deliver Medicaid services don’t require providers to be enrolled with the state Medicaid agency. That’s a problem because the states cannot terminate providers, even for fraud, if they are not directly enrolled in the program — a critical deficiency that DHHS says it’s working to correct.
Patients In Iowa Worry About Private Management Of Medicaid
Source: Clay Masters, NPR, August 6, 2015
Medicaid serves a large population in Iowa. The state expanded Medicaid under the Affordable Care Act, and is now open to not only its traditional population — the poor and disabled — but also to adults who earn as much as about $16,000 a year for a single person, and as much as $32,000 for a family of four. … “Thirty-nine states are using some kind of managed care,” she says. “So other people have done this. We have models to look after, and we have companies who have experience.” But a lot of states, including Kansas and Kentucky, have not done so well, says Pam Jochum, president of the Iowa Senate and a Democrat. … Gov. Branstad did not need legislative approval when he announced the switch to managed care in January. … Eleven companies have submitted bids to manage most of the $4 billion program, and Iowa plans to announce later this month which insurers will win the bid.
Iowa’s Medicaid privatization draws scrutiny
Source: Catherine Lucey, Associated Press, April 19, 2015
Gov. Terry Branstad’s plan to privatize the state’s Medicaid program is moving forward, though critics are raising questions about how the shift will impact patients. Earlier this year, the state began an effort to shift Medicaid administration to two or more managed care organizations, to which Iowa will pay a fixed amount per enrollee to provide health coverage. State officials predict cost savings and say patients will still have access to quality health care. But Democratic Senate President Pam Jochum, of Dubuque, said this week that she is not convinced…. A total 39 states and the District of Columbia contract with managed care organizations, according to the nonpartisan Kaiser Family Foundation….
Iowa to hire private firms to help run Medicaid
Source: Tony Leys, Des Moines Register, January 20, 2015
Gov. Terry Branstad plans to hire a private managed-care company or companies to help run the state’s Medicaid program, legislators and administration officials said Tuesday. Details are scarce on how the plan would work, but Branstad projects it would save $51.3 million from January through June 2016, its first six months. Managed-care arrangements generally involve private companies that oversee large health care programs and that share savings they obtain by making care more efficient. Iowa already has two such contracts for some services under Medicaid. The new arrangement apparently would involve a broad array of services, legislators said. Medicaid is the huge health care program for the poor and disabled, which is jointly financed by the state and federal governments. It covers 564,000 Iowans, or 18 percent of the population, at an annual cost of $4.2 billion……