State Auditor: Medicaid Companies Violating Contracts In Treatment Of Two Iowa Patients

Jun 26, 2019

State Auditor Rob Sand, a Democrat, said Wednesday the private insurance companies managing Iowa’s Medicaid program violated their contracts with the state in their treatment of two paralyzed patients.

Sand sent a letter to the Iowa Department of Human Services, which oversees Medicaid, describing the patients’ experience.

He stated both patients were notified by their in-home care provider that they’d stop receiving care in 30 days. Sand said the insurance companies, known as managed care organizations (MCOs) tried to push them into nursing homes rather than find new providers. That resulted in service gaps.

“What I want people to take away from this if they’re on Medicaid is that someone is looking at this and trying to figure out at the very least if the MCOs are doing the bare minimum they’re supposed to for Iowans,” Sand said.

Department of Human Services spokesman Matt Highland said the department received Sand’s letter “and will look into the issues he’s raised.”

Sand said he is forming a plan for a broader review of these issues.

“The goal of it is to figure out how big of a problem this is,” Sand said. “Once we know how big of a problem non-compliance is in the state of Iowa, at that point the state of Iowa has a lot of decisions to make.”

The state can withhold some payment or sever contracts if the companies violate certain terms. Sand said these issues may also be a violation of federal regulations.

Some Democrats have called for a reversal of Medicaid privatization, but Republican officials support continuing the policy.