Medicaid

Natalie Krebs/IPR

This month about 420,000 Iowans on Medicaid are preparing to transition to a new managed care organization when UnitedHealthcare leaves the state on June 30. This includes nearly 30,000 special Medicaid patients that require long term-services and supports and their families. Though they make up just 6 percent of Medicaid recipients, they require a much higher level of specialized care than the general population, and this upcoming transition has left many of these people feeling anxious.

Natalie Krebs/IPR

This year has been a political roller coaster for the state’s transgender population. A March state Supreme Court decision overturned a ban on using state Medicaid dollars for transition-related surgery. Then lawmakers enacted a provision that would alter the Civil Rights Act so Medicaid could once again opt out of paying.

Courtesy of the ACLU

The ACLU of Iowa has filed a lawsuit seeking to overturn a law that denies transgender Iowans on Medicaid coverage for gender-affirming surgery.

John Pemble / Iowa Public Radio

State Auditor Rob Sand announced Thursday he will investigate prescription drug industry middlemen to find out if they are overcharging Iowa’s Medicaid program.

The Iowa House of Representatives in April unanimously approved a provision directing the Iowa Department of Human Services to look into pharmacy benefit managers’ billing practices in Iowa Medicaid. But the Senate rejected that proposal before lawmakers left the statehouse for the year.

governor reynolds
Katarina Sostaric / IPR

Gov. Kim Reynolds said Wednesday she is confident Iowa will have two insurance companies ready to take on 425,000 poor and disabled Iowans after the state’s biggest Medicaid management company leaves.

Reynolds said she has “every indication” that Amerigroup will stay in the state and that Iowa Total Care will start up July 1 as planned. Contracts for the next fiscal year have not yet been signed. 

“They’re committed to Iowa. They’re committed to continuing to provide the services, and we’re going to get it done,” Reynolds said.

John Pemble / IPR file

As negotiations with an Iowa Medicaid insurer break down, the state’s senior U.S. Senator says he’s supporting the governor. Sen. Chuck Grassley says the privatization of the Iowa’s Medicaid system is "an entirely state decision". 

jerry foxhoven
Katarina Sostaric / IPR

State officials responded Monday to the recently announced departure of one of the two private companies that manage the government-run health insurance program for poor and disabled Iowans.

Democrats in the Iowa Legislature said the departure of UnitedHealthcare, which manages the care of about 425,000 Iowans, shows privatized management of Medicaid does not work. It’s the second such company to leave the state since privatization began in 2016.

jason schultz
John Pemble / IPR

Republicans in the Iowa Senate passed a bill Tuesday that would require some Medicaid recipients to report they are working or volunteering at least 20 hours a week in order to receive the government-funded health benefits.

Sen. Jason Schultz, R-Schleswig, said it will give people a “better chance at life.”

“If there’s nothing holding you back except your own decision not to move forward, we’re going to bump you forward,” Schultz said.

ACLU of Iowa

The Iowa Supreme Court on Friday struck down the state’s policy excluding transgender people from using Medicaid coverage for transition-related surgical care.

iowa capitol
John Pemble/IPR

Iowa lawmakers are considering three bills that would change eligibility requirements for public assistance programs like Medicaid and the Supplemental Nutrition Assistance Program, formerly known as food stamps. 

Jack Reardon, who grew up in Des Moines in a single parent household says that there isn't a need to increase oversight for the program, but that there is a need to expand programs like SNAP. 

senate subcommittee meeting
Katarina Sostaric / IPR

Republican senators advanced three proposals and tabled one this week that would change eligibility requirements for public assistance programs.

Sen. Jason Schultz (R-Schleswig) chaired the three-member subcommittee meetings on each of the bills. The Opportunity Solutions Project, which is associated with a conservative think tank based in Florida, submitted the proposals.

“A lot of these bills are focused on the public general perception that there is a large fraud problem,” Schultz said. “But I’ve looked into it—I’m not sure there is.”

Joyce Russell/IPR file

Iowa’s outgoing state auditor says the Department of Human Services is correctly calculating the savings from having private companies manage Iowa Medicaid. But the lawmaker who asked for an audit says the report doesn’t provide good answers.

The management of Iowa Medicaid was handed over to private companies in 2016. Auditor Mary Mosiman, a Republican, says the state’s estimate of $126 million in savings this year, as of early November, is accurate.  In May, the state projected $141 million in savings, nearly triple last December’s projection of $47 million.

John Pemble / Iowa Public Radio

Iowa’s incoming state auditor says his first priority when he takes office in January is to look at where things are in a state audit of Medicaid. That’s the government health insurance program for low-income and disabled Iowans. The privatization of Medicaid’s management was a dominant issue in the governor’s race. Rob Sand was the only Democrat elected in a statewide race to replace a Republican incumbent. He says he doesn’t know the status of the audit but will meet with the current auditor after the Thanksgiving holiday.

reynolds and hubbell
John Pemble/IPR file

Ads are flooding screens and mailboxes in Iowa calling the state’s move to privately-managed Medicaid a failure and a health care crisis. Some feature Tucker Cassidy, a quadriplegic man from Waterloo, who says the program forced him to move to a nursing home.

“Three days before Christmas, I get an email from my health care agency saying, ‘We are not going to be able to provide you anymore services. Happy Holidays,’” Cassidy says in a video ad.

Roey Ahram via flickr creative commons / https://www.flickr.com/photos/roeyahram/

Some public health advocates say Iowa’s Medicaid program is illegally denying treatment for certain hepatitis c patients. With drugs that can cure 98 percent of patients, care for the potentially deadly disease is incredibly effective, but also incredibly expensive.

mike randol
Katarina Sostaric / IPR

Iowa’s Medicaid director said Tuesday he doesn’t know what is driving a recent increase in what the state is paying per Medicaid member.

Kim Spading, a member of the council that oversees the Iowa Department of Human Services, asked during a budget presentation why the per-member cost shot up in the past two years.

“This is the opposite of what we would’ve hoped for,” Spading said.

John Pemble/IPR file

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 file

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.

kim reynolds
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.

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