Medicaid

foxhoven
John Pemble / Iowa Public Radio

Several days after the new fiscal year started July 1, Iowa has yet to finalize contracts with the companies that run its privatized Medicaid program.

This also happened last year. Department of Human Services Director Jerry Foxhoven told lawmakers in January negotiations would be completed in time for their budget process.

But lawmakers approved budgets more than two months ago without knowing how much the Medicaid program would cost.

mike randol
Katarina Sostaric / IPR

Iowa’s Medicaid director Wednesday told the Council on Human Services the state’s privatized Medicaid program is saving money for taxpayers, but his explanation left questions unanswered.

Medicaid Director Mike Randol said the state is projected to save $140.9 million in the fiscal year that ends June 30, compared to what the state would have spent before its health care program for low income and disabled people was turned over to for-profit companies.

“I think it’s important to understand that regardless of the methodology, there are savings,” Randol said.

ACLU of Iowa

A Polk County District Court judge this week ordered the Iowa Department of Human Services to cover the costs of sex reassignment surgery for two transgender women.  

The ACLU of Iowa says it’s the first court ruling recognizing the rights of transgender Iowans under the Iowa Constitution and the Iowa Civil Rights Act.    

In his ruling Chief District Judge Arthur Gamble ordered DHS to approve Medicaid coverage for what’s known as gender-affirming surgery for Carol Ann Beal of northwest Iowa and EerieAnna Good of the Quad Cities.   

John Pemble / IPR

After speaking with all of the Democratic and Libertarian candidates on Iowa's gubernatorial primary ballot, IPR's Clay Masters extended an invitation to Gov. Kim Reynolds to discuss her vision for the state. While Reynolds does not have an opponent in the June 5th GOP primary, the crowded gubernatorial field has criticized her handling of the privatization of Medicaid and funding for mental health care services. Masters spoke with Reynolds about those and other issues. What follows is a transcript of the conversation.

John Pemble/IPR

  

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.

John Pemble/IPR

A bill that aims to correct some of the problems in Iowa’s privatized Medicaid system advanced in the Republican-controlled Iowa House this week.  

The bill comes as complaints continue from patients not getting services and providers not getting paid. 

A House committee approved HF2483 on Tuesday, one day after the state ombudsman released a scathing report on the privatized program, including services for the elderly and disabled.

John Pemble/IPR

A key member of the Kim Reynolds administration faces a confirmation vote in the Iowa Senate, and at least one Democrat says it is not a done deal.   

Jerry Foxhoven has directed the Department of Human Services since June, while complaints have continued to pour in about Iowa’s new privatized Medicaid system, including denial of care for patients, and delayed payments to doctors and hospitals.      

At her weekly news conference, Gov. Reynolds said Foxhoven has done a great job in his short time in office.

John Pemble / IPR

There was a spirit of optimism in the air as state lawmakers gaveled in the 2018 session. Opening day often brings talk of bipartisanship and cooperation, but that spirit never seems to last, especially in an election year.

Nevertheless, state Senator Pam Jochum, a Dubuque Democrat, struck a hopeful tone about the coming session, although her party is in the minority in a Senate controlled by Republicans 29 to 20. She says last session they made their voices heard.  

legislative leaders
Clay Masters / IPR

Iowa House Speaker Linda Upmeyer, R-Clear Lake, says the state’s privatized Medicaid system needs to be "in a better position" before the end of the upcoming legislative session.

Iowa’s handover of its Medicaid system to private companies in 2016 has led to patients losing services and providers losing payment.

Joyce Russell/IPR

State legislators of both parties Monday grilled representatives of the for-profit companies who manage Iowa’s health care program for the poor and disabled, after a report was released about how many patients are losing health care services.  

The director of the Managed Care Ombudsman Program presented the report to the legislature’s Health Policy Oversight Committee.

It showed that denial, reduction, or termination of services is the number one complaint of Medicaid recipients under the privatized program.

John Pemble / IPR

This week Republican Gov. Kim Reynolds says she’s not backing down from yet another big change to Iowa’s privatized Medicaid.

“I’ve never said it was perfect," Gov. Reynolds said on Tuesday. "I’m willing to put the time and the effort into making sure that Iowans get the care that they deserve in a managed and coordinated and more modern delivery system.”

She says she’s “not going back” on how Iowa’s Medicaid is managed.

Joyce Russell/IPR

Gov. Reynolds today expressed confidence in Iowa’s privately-managed health care program for the poor and disabled, even as thousands of Medicaid patients are being pulled out of the new system.     

One of three for-profit companies managing the program, AmeriHealth Caritas, has dropped out.   Another company, AmeriGroup, can’t absorb some of AmeriHealth’s 215,000 patients.

As a result, at least 9,000 patients are going back to the traditional state-run Medicaid program, at least until AmeriGroup can build up capacity. 

doctors office
Jennifer Morrow / flickr

Iowa’s largest health system is considering ending its contract with one of the two remaining companies that insure Medicaid patients in the state.

UnityPoint Health announced Wednesday it will end its contract with Amerigroup if "contract issues" are not resolved by the end of the year. Amerigroup is one of the two remaining companies that participate in Iowa’s privatized Medicaid program.

Joyce Russell/IPR

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.    

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.

Joyce Russell/IPR

Nearly a quarter of a million patients covered by Medicaid, Iowa’s health care program for the poor, disabled, and elderly, are advised to watch the mail for a new insurance card.  

One of the three for-profit companies who have been managing the program since last year is pulling out.  

The Department of Human Services has been negotiating for months with the companies trying to agree on rates and terms for this year.      

They include Amerigroup Iowa, UnitedHealthcare Plan of the River Valley, and AmeriHealth Caritas.   

Sarah Boden/IPR

Gov. Kim Reynolds says she hasn’t received any indication from the White House that it opposes Iowa’s attempt to lower premium rates for health insurance policies on the Obamacare exchange.

Clay Masters / Iowa Public Radio

Iowa is one of 38 states that radically changed the way it runs Medicaid over the past few years. The state moved about 600,000 people on the government-run health program into care that is managed by for-profit insurance companies.

The idea is that the private companies would save the state money, but it has been a rocky transition in Iowa, especially for people like Neal Siegel.

Joyce Russell/IPR

A statehouse committee was briefed today on a controversial Republican proposal to save the state millions of dollars in health care costs for indigent, disabled, and elderly people.   

Under the plan, needy patients could no longer get care paid for right away, while waiting to be approved for government help.  

Currently, Medicaid will pay for three months of retroactive coverage.   

DHS Administrator Wendy Rickman briefed the legislature’s Administrative Rules Review Committee on the proposal.  

FLICKR / WILLIAM PATRICK BUTLER

Opponents of the privatization of Iowa’s Medicaid system say recent revelations show the program should not be run by for-profit companies. A Des Moines Register report this week revealed the three companies in charge of Iowa Medicaid say they are facing dramatic losses.

When private companies took over Iowa’s Medicaid system in April, many wondered if they could make a profit. The companies claimed profits would come as a result of better management, but now they say underfunding is threatening the program’s stability and that state payments are insufficient.

FLICKR / JENNIFER MORROW

All three of the for-profit healthcare companies that have been managing Iowa’s Medicaid system are falling short of a contract requirement intended to protect segments of the Medicaid population from having to travel out-of-county for services. 

LinkedIn

Iowa’s Insurance Commissioner Nick Gerhart is stepping down on the 23rd of this month. He’s served as state insurance commissioner since February 2013, overseeing the state’s Medicaid transition, as well as the implementation of the Affordable Care Act. During this River to River interview, he talks with host Ben Kieffer. 

Gerhart says that policy makers need to step back and take a look at the entire healthcare ecosystem, not just the insurance piece. 

FLICKR / JENNIFER MORROW

The State of Iowa is increasing the amount of money it pays to the three private companies managing Iowa’s Medicaid system by $33.2 million. Gov. Terry Branstad says the increase is largely due to pharmaceutical costs, which are higher than anticipated since April when the state privatized its Medicaid system.

"We're dealing with healthcare costs," says Branstad. "It's not something that's going to be perfect." 

FLICKR / JENNIFER MORROW

Medicaid providers and recipients criticized the privatized management of Iowa's Medicaid system at the state capitol Monday.

Governor Terry Branstad says there is less waste, fraud and abuse when Medicaid is run by private companies. But critics contend that poor administration of the program by three for-profit Managed Care Organizations or MCOs is harming the quality of life of low-income and disabled Iowans.

Iowa Public Radio/Sarah Boden

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.      

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.

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