The Head of the Iowa Department of Human Services is defending the state’s privatized Medicaid system, after a scathing report last week by the state ombudsman.
The report said complaints from patients and providers jumped by 157% last year, making Medicaid one of the top targets of complaints from citizens reporting difficulties with the government.
Since April of 2016, for-profit companies have managed the program for 640,000 Iowans who are poor or disabled.
Jerry Foxhoven said the 225 complaints to the ombudsman last year amount to a tiny percentage of patients.
Some people are being paid for services that they shouldn't be paid for." DHS Dir. Jerry Foxhoven
“If you were an airline how many people call you and say my flight was on time and my luggage was there when I got there?” Foxhoven asked on Iowa Public Radio’s River to River program. “The people you hear from are the people whose luggage didn't get there on time or whose flight was delayed or canceled.
“A point-zero-zero-zero three percent complaint number is very, very, very small.”
The ombudsman report cited the cases of a 74-year-old woman with Lou Gehrig’s disease, a young woman with Down syndrome, and a man with a severe eating disorder. Families complained that the companies known as managed care organizations had made significant cuts to hours of care.
“In our view, this tactic by the MCOs amounted to strong-arming members into accepting reduced services against their better judgment,” the report read.
In another case, an elderly patient complained of being denied services despite winning an appeal.
“In our view, the MCO’s position on the matter was stubborn and absurd, and it makes a mockery of the fair-hearing appeal process,” the report read.
But Foxhoven said the DHS has overruled the MCO’s on appeal and fined the companies in some cases.
He said reducing services is a clinical decision made by doctors.
“Sometimes when we've come in and taken a look at the program there's some people who they need more services than they were allowed before and we try to make that change,” Foxhoven said. “But there’s some people who are being paid for services that they shouldn't be paid for.”
A billhas advanced in the Iowa House to increase DHS oversight of the Medicaid program to address some of the complaints.
“We are looking at making sure there that if there is a reduction of services the DHS is also required to look and give an eye to that to make sure the reduction is appropriate so it's not just left to the MCO to determine,” said Rep. Joel Fry (R-Osceola. “We want to make sure we have accountability to members, accountability to providers, as well as making sure we have the proper amount of oversight.”
