How Many Ombudsmen Will Be Needed Under Privatized Medicaid In Iowa?

Jan 28, 2016

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.

To aid legislators, The Health Consumer Ombudsman Alliance Final Report was penned by officials from multiple state and consumer advocate agencies. It proposes adding 154 additional ombudsmen, or one advocate for every 3,500 Medicaid recipients. Thus far, only two new staff have been hired. 

The report’s recommendations come with a $17 million price tag. Gov. Terry Branstad says the suggestions are “overkill.”

State Long-term Care Ombudsman Deanna Clingan-Fischer currently investigates complaints regarding nursing and residential care facilities, assisted living programs, and elder group homes. She says the committee based its suggestions on the estimated number of grievances that would be received once Medicaid is privatized, though Clingan-Fischer admits Iowa has no way of knowing how many ombudsmen will actually be needed.

“Do we know this is the right amount? No. We have no way of knowing," says Clingan-Fischer. "We are utilizing other states' best practices to create something in Iowa that we have not done before." 

In addition to ombudsmen, the report also says Iowa needs to expand the current legal assistance network. Medicaid recipients are legally entitled to appeal decisions made by the managed care organizations that will oversee their healthcare.

These appeals will likely arise if recipients disagree with a company’s decision to reduce or terminate services. A concern healthcare advocates have of Medicaid privatization is MCOs will deny needed benefits for the sake of profit.

"Only if the state has an effective oversight and advocacy system will Iowans be getting the right care at the right time in the right setting," says Jane Hudson, executive director of Disability Rights Iowa, one of the organizations providing legal aid to Medicaid patients.

Since Medicaid is currently a fee-for-service program, the only complaints investigated come from the 57,000 recipients who are on Medicaid waivers, or for those who receive institutional care. Once Medicaid is fully privatized, 560,000 will be calling on the state for advocacy and guidance.