Medicaid

Joyce Russell/IPR

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.  

British Red Cross / Flickr

Pat Giorgio anticipated some problems with the transition of state-run Medicaid to three private management companies, but she didn't quite anticipate the breadth and depth of the woes the transition would cause for Evergreen Estates, residential communities she founded to serve the elderly in Cedar Rapids.

"Because I heard that it might be a difficult transition, I got a line of credit with my bankers of $100,000. I'm billing roughly $40-50,000 a month to Home and Community Based Services, and I've used up that $100,000 in my line of credit."

Joyce Russell/IPR

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.

The issues include  delayed payments for providers, and claims denied for services.

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.

Joyce Russell/IPR

After months of negotiations, statehouse Democrats and Republicans have reached agreement on how to keep an eye on the new privatized Medicaid system. Since April 1, health care for more than half a million Iowans has been managed by for-profit companies. 

Rep. Linda Miller (R-Bettendorf) says under the compromise more consumers will be added to a key Medicaid advisory council.

“We’ve told the governor he has to get the consumers on there,” Miller said, “at least ten consumers on there, I think, by July 1st.”

Iowa Department of Human Services officials say Iowa’s Medicaid system has transitioned into private management with no major systematic problems. But members of the Senate Human Resources Committee say they’re hearing about serious issues from their constituents.

Senate Democrat Bill Dotzler of Waterloo says these problems stem from a lack of consistency among the companies now managing Medicaid. 

"You're not hearing what we're hearing, it's not all roses," says Dotzler. "It is systemic and it's across our districts from senator to senator." 

John Pemble

Here’s what to know going into the week at the Iowa legislature.

Iowa Public Radio / Sarah Boden

At midnight this morning, Iowa's Medicaid system transitioned into the hands of three for-profit corporations. Gov. Terry Branstad says the move will contain costs, but critics say privatization leaves many patients without services. 

At the McDonough home in Cedar Rapids, shower day for seven-year-old Carson can be tricky.  That's because he breathes through a tracheal tube.

The three healthcare companies taking over Iowa’s Medicaid system next week each say they are ready and that their network contains the vast majority of providers who have been serving Iowa’s Medicaid recipients.

"We have a very comprehensive network across the state and across all types of services," says Cheryl Harding of AmeriHealth Caritas.

Network adequacy was one reason the federal government delayed Iowa's implementation of privatized Medicaid. There were concerns that not enough providers had agreed to continue serving Medicaid recipients. 

FLICKR / JENNIFER MORROW

Medicaid officials from the Iowa Department of Human Services shared with state senators on Wednesday how the department plans to make sure Medicaid recipients are safe and receive necessary services, once the Iowa's Medicaid system is privatized on April 1.

Iowa Public Radio / John Pemble

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. 

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. 

Healthcare companies WellCare and Meridian have both thrown in the towel in their fight for a piece of Iowa’s $4.2 billion Medicaid system. Their decisions follow a ruling by Polk County District Court Judge Robert Blink, which struck down appeals from both companies.

WellCare argued the state was wrong to terminate its contract to manage Iowa's Medicaid system. In November, an administrative judge found WellCare violated the bid process, and the Branstad administration sided with that decision.

John Pemble / Iowa Public Radio

Even though lawmakers in the Iowa Senate voted to stop privatization of the state's Medicaid program last week, the measure is unlikely to pass in the Iowa House. The system is still slated to switch to private management on March 1 unless the federal government steps in. 

Iowa Public Radio / Joyce Russell

Three State Senate Republicans crossed party lines in voting to pass a bill that would stop the privatization of Iowa's Medicaid system. 

State Sen. David Johnson of Osceola County is the ranking Republican on the Human Services Committee. He says Iowa is trying to do too much too fast and, as a result, healthcare providers and vulnerable people are getting dumped on.

“We need to put a dagger in this,” says Johnson. “It’s moving too fast, and we can come up with a better plan. I’m absolutely convinced of that."

William Patrick Butler/Flickr

Former Democratic Gov. Chet Culver is now in the struggle surrounding the current Governor, Republican Terry Branstad’s plan for converting Iowa’s Medicaid program to private management. Culver is conducting several public forums this month.  In Coralville Tuesday, he listened for two hours to the fears of parents and others receiving Medicaid services about the move away from state management of the program.  He told the roughly 30 people attending the forum that privatizing Medicaid isn’t a partisan political issue.

Save Medicaid Action

Democrats in the Iowa Senate today ratcheted up their challenge to Governor Branstad’s plan to privatize Medicaid, the state’s health care program for the low-income and disabled.  

They introduced a bill to repeal the initiative, but Republicans are standing by the Governor’s proposal.  

Democrats say privatizing Medicaid will disrupt long-standing relations between patients and providers and compromise patient care.   Their bill would cancel the contracts with three for-profit, out of state companies chosen to manage the program.     

Healthcare companies WellCare and Meridian are continuing their fights to manage a piece of Iowa’s $4.2 billion Medicaid system.

WellCare was one of four companies selected to privatize Medicaid. But its contract was terminated after Administrative Law Judge Christie Scase determined it had violated rules of the bid process. 

FLICKR / WILLIAM PATRICK BUTLER

As Iowa gears up for transitioning its Medicaid system into private management by three for-profit companies, lawmakers are grappling with how many ombudsmen are needed to give recipients assistance and objective information.

Flickr / Jennifer Morrow

With six weeks to go before Iowa’s Medicaid program is tentatively scheduled to become privately managed, Medicaid Director Mikki Stier says she's "very confident" Iowa will be ready. The federal government delayed the state's plans to privatize Medicaid on New Year's Day, despite Gov. Terry Branstad and Iowa's Department of Human Services insisting the state was ready to make the switch.  

FLICKR / WILLIAM PATRICK BUTLER

About 20 lawyers representing six healthcare companies and the state of Iowa crowded into a small Polk County courtroom Thursday.

All want Judge Robert Blink to issue or reject various stays, or orders, relating to the upcoming privatization of Iowa's $4.2 billion Medicaid system. All also argued a ruling in their favor prioritizes the healthcare of Iowa's 560,000 Medicaid recipients. 

John Pemble/IPR file photo

Gov. Terry Branstad says the budget he’ll present tomorrow along with the annual Condition of the State Address is “very tight," but he adds lawmakers shouldn’t be caught off-guard by want he’s proposing this legislative session. 

"There's no surprise," says Branstad. "I think I've done a pretty good job of visiting with legislators about the tough decisions we have to make." 

Flickr / IowaPolitics.com

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."

Kids on Hawk-I, Iowa’s Medicaid program for low income children, are receiving new insurance cards in the mail. But they might not put them to much use, since Iowa’s Medicaid program is scheduled to go into privatized management on March 1.

Initially the transition to privatization was scheduled for New Year’s Day. In anticipation of this date, insurer Wellmark scaled back its Hawk-I resources; but now the transition is scheduled for March so Wellmark’s Hawk-I contracts need a new home.

Joyce Russell/IPR file photo

Certainly, Iowa’s role in the 2016 presidential race has been one of the top news stories in our state this year. There are also many others - including the privatization of the state's Medicaid program. 

"This is coming from a guy who covers politics and is looking forward to the caucuses, but I would argue that this is the most important Iowa-specific story this year," explains Clay Masters, Iowa Public Radio Morning Edition host and political reporter. 

Iowa Public Radio

This week, federal administrators ordered Iowa to wait at least 60 days before shifting its Medicaid program to private management. On this News Buzz edition of River to River, Ben Kieffer asks Brian Kaskie, associate professor of health management and policy at the University of Iowa, four questions about the order.

Was this expected?

John Pemble/IPR file photo

Federal officials have told Iowa the state is not ready to transition management of its Medicaid system to private companies.  The Centers for Medicare and Medicaid Services has told Iowa in a letter today it may transition to private management on March 1st instead of January 1st, 2016, as long as the state makes sufficient progress toward readiness by that time.  

The agency says, “a transition on January 1st would risk serious disruption in the care for Iowa Medicaid beneficiaries.”

Flickr / William Patrick Butler

The Centers for Medicare and Medicaid Services is in Iowa this week accessing the state’s readiness to transition the management of Iowa’s Medicaid program into the hands of four private companies on Jan. 1. Critics say the process has been unorganized and rushed, and many Medicaid recipients complain they don’t have enough information to determine which, if any, of the Managed Care Organizations best fits their coverage needs.

Flickr / Consumerist Dot Com Follow

Iowa’s Department of Human Services says United Healthcare has signed the most Medicaid providers of the four private Managed Care Organizations that are slated to take over management of the state’s Medicaid system on Jan. 1. United Healthcare has signed almost 66 percent of the state’s nearly 30,000 Medicaid providers, Amerigroup has signed 57 percent, WellCare 50 percent, and AmeriHealth Caritas 43 percent.

Iowa Public Radio / Sarah Boden

The Department of Human Services says it is not sure exactly how many of the nearly 30,000 Medicaid providers in Iowa have signed with at least one of the four for-profit companies that will take over Iowa’s Medicaid management on Jan. 1. This lack of information was one of the points Democrats used in a failed effort to delay the transition during Monday's Health Policy Oversight Committee meeting.

"I'm a little disappointed in the numbers you're giving me," says Rep. John Forbes of Urbandale. "Twenty-five days before this goes live. I have some concerns about that." 

Flickr / Tyler

At the Iowa Taxpayers Association's annual symposium on Friday, elected officials discussed Medicaid and the program's transition into management by four private, for-profit companies. The change is scheduled for January 1st, but many say this is a rushed deadline. 

State Senate Majority Leader Mike Gronstal, a Democrat from Council Bluffs, says he anticipates that during the next legislative session, a lot of focus will be devoted to resolving Medicaid-related issues. 

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