Bitter Debate Over Shift in Care for Severely Disabled Iowans

Nov 7, 2017

Advocates for Iowa’s most severely disabled patients spoke out Tuesday about recent changes in the state’s privately-managed Medicaid program now in its second year. 

One of the for-profit companies managing the program has pulled out, and critics say the neediest patients may be harmed by having to change case managers and providers over a period of one month.    

It's been a scramble for us. -DHS Dir. Jerry Foxhoven

Senator Joe Bolkcom (D-Iowa City) is a leading critic of Medicaid privatization.  He grilled Department of Human Services Director Jerry Foxhoven at a meeting of the Medical Assistance Advisory Council.

"You're flippantly telling me it's no big deal they've left the state,” Bolkcom said, referring to the exit of AmeriHealth from the program.     “I have no confidence in your ability to manage anything at this point." 

"I'm not flippant about this, Senator,” Foxhoven replied.  “We’re doing everything we can to make sure these people get their care."

Sen. Joe Bolkcom (D-Iowa City)
Credit Joyce Russell/IPR

Two hundred and fifteen thousand patients are being reassigned to United HealthCare.     As many as 18-thousand require long-term intensive services including daily feeding and bathing. 

"It's been a scramble for us,” Foxhoven said.  “We're going to make it work and I think United is really committed well to doing it."

"I would describe it as reckless," Bolkcom replied.

Foxhoven told the council that AmeriHealth wanted Iowa to provide $150 million more in  reimbursement and negotiators determined that was too much.

Lori Allen of Ames serves on the council as a public member.

She also spoke on behalf of disabled Iowans on Medicaid.

It has real life consequences for the people. -Advisory Council member Lori Allen

“Though it may seem like paperwork and moving names and numbers from one computer program to another, it has real-life consequences for the people who have to change care providers,” Peters said. 

Foxhoven says a new company to replace AmeriHealth will not be brought on board until July of 2019.

“We've got to figure out a way to make that work so that the most vulnerable people don't have too  much shifting around,” Foxhoven said.

Six disabled Iowans are suing the state alleging that Medicaid managed care, as it is known, deprives thousands of Iowans with disabilities the right to live safely in their homes.

Earlier this year Foxhoven suggested that the intensely disabled population should not be part of the privatized program, but should be cared for instead through traditional Medicaid.