Four Questions on the Medicaid Privatization Delay

Dec 18, 2015

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?

I actually think this was to be expected. First, despite the suggestion that our state is simply following on what has happened in other states, what has been proposed here is actually quite comprehensive and complex. The Iowa Medicaid modernization involves a combination of several existing programs and services and the turnover of key personnel and management. And the actual application itself amounted to more than hundreds and hundreds of pages, each of which had to be reviewed by federal officials. So, given the scope and complexity of it all, the federal reviewers certainly were likely to identify points that required some corrective course of action. In fact, it probably would have been unprecedented if such a comprehensive, complex proposal was reviewed and approved without a delay.

Then, second, as you know, there’s been a considerable amount of concern expressed about this proposed change to the Medicaid program voiced by both the people who are enrolled in Medicaid and from the providers themselves, including hospital administrators, physicians, and care managers. So, with such a strong and diverse number of people who were concerned about moving this forward, it certainly would have been conspicuous if CMS reviewed and approved the proposal, as well.

Does this delay make sense to you as a public health expert?

Oh, yea. Like I said, what we’re doing here is really pushing our Medicaid system into a whole new area. And we’re also pushing it in a way that is not in line with what has happened in other states. What the governor is proposing is, like I said, very comprehensive and complex.

Why wouldn’t the governor delay it himself?

There's a window there that needs to be closed somehow. - Brian Kaskie

I don’t think anyone wants to elect a governor who’s not willing to take on such a leadership role and state something like “Well, you know, we’ll get this implemented when we get all the i’s dotted and t's crossed.” I think people look to governors to stake out leadership positions like this and say, “Hey, this is my vision and this is where I think we should go with this program and I’m putting all my efforts to get us there.” So, you know, whether it be our current governor or one of our previous governors, I would expect from a leader to take that front end of the boat, if you will, and push us forward.

How does this affect the Medicaid privatization process going forward, especially those 500,000+ enrolled in it?

Well, let’s remind ourselves that the state has effectively been moving towards this goal to modernize Medicaid for a few years now. So, two month delay certainly is not going to derail the effort. Still, since the state has maintained the position that the waiver would be approved and operations would begin in a few weeks on January 1, we are left to wonder what will happen in the next few months. So, some of the pragmatic concerns, for example, is that many of the on-the-ground providers who previously worked for companies that were offering Medicaid services have left those groups and signed contracts with managed care companies under the assumption that operations would begin January 1. Well, now that those companies can’t begin operations til March 1, there’s a window there that needs to be closed somehow. Will our Medicaid beneficiaries still receive services from the existing program providers, some of which have lost their staff to the MCOs or have shut down altogether? I don’t know at this time, but I do assume we will be hearing something pretty soon from Iowa Medicaid enterprise.