listener: Iowa’s privatized Medicaid illegally denies care | Health Info

By DAVID PITT, Associated Press

DES MOINES, Iowa (AP) – Iowa’s privatized Medicaid system has illegally denied service or care to program beneficiaries, and the two private insurance companies running the system have violated the terms of their contracts with the State, according to a state audit released Wednesday.

Auditor Rob Sand released a report on his investigation spanning a six-year period from 2013 to 2019. He said his investigators had seen a massive increase in denials of illegal care by managed care organizations, or MCOs. , as part of the privatization of Medicaid.

“What this means is that privatized Medicaid is less likely to treat the people of Iowa according to the law. It means the Medicaid MCOs we have contracted with are not living up to their end of the bargain.” Sand said.

The Iowa Medicaid program manager responded within minutes of the audit being published, dismissing his findings and saying Sand was making an “apples-to-oranges comparison” that misrepresented the current program.

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Former Republican Governor Terry Branstad in 2016 abruptly transferred the Iowa Medicaid program from management by the Iowa Department of Social Services to private insurers. His successor, current GOP Governor Kim Reynolds, continued to support privatization amid complaints that the service suffered, payments to service providers were sometimes delayed and the promised savings never materialized.

Such privatization became a popular idea among GOP politicians, who argued that private companies would run Medicaid more effectively than a state government agency. Currently, private Medicaid managers provide health care to over 781,000 poor and disabled Iowans.

Sand said that after privatization there was an 891% increase in the number of cases in which a judge restored services to a Medicaid participant, concluding that services were illegally denied by private insurers running the program.

After being elected in 2018, he pledged he would write a Medicaid compliance report after service providers and beneficiaries complained that the new system did not provide comparable care and payments.

“It’s been a long time coming. It took a lot of work. We have looked at tens of thousands of documents and at the end of the day this is a statement of facts, ”Sand said. “It tells the people of Iowa what’s going on in the state. the people.”

Sand also reported that the two companies running the Medicaid program, Amerigroup and Centene Corp., operating as Iowa Total Care, violated the terms of the contract with DHS.

He said Amerigroup breached one provision of the contract and ITC failed to honor many provisions of the contract. For example, in several documented cases, the two companies failed to comply with the clause in the contract requiring home and community service providers to continue providing services to a member moving from one provider to another.

“This resulted in members depriving themselves of services, such as bathing and wound care, thus violating the contract and state and federal laws, while the company still receives payment for their care,” Sand said in the report.

In her statement in response to the report, Medicaid Director Elizabeth Matney called the audit “an incorrect and flawed report.”

Matney said the report inaccurately compares the old “fee-for-service” system with a managed care approach in which appeals can be resolved without going through an administrative law judge. These judges can then focus on more complex cases.

“We worked with the Auditor of State team to explain why this was an apples-to-oranges comparison,” said Matney. “The process is not the same, so making a comparison without taking into account the improvements we made to the MCO appeals process before ever seeing an administrative judge is just plain wrong.

She said much more information would be needed to substantiate the allegations in the auditor’s report.

She said the department is looking into the allegations of contract breaches and offered to meet with Sand to discuss in more detail, agreeing that “contract fulfillment is something that requires diligent monitoring.”

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