Transparency needed on Medicaid spending

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By Dean Lerner


Kudos to Des Moines Register reporter Clark Kauffman for attending and writing about the Iowa Legislature’s Administrative Rules Review Committee meeting concerning the Iowa Department of Human Service’s proposed nursing home Medicaid Cost Report payment rules (“DHS silent on transparency issue,” July 10 story.”)

These rules allow nursing home trade associations, private nursing home lawyers and others to continue to receive untold sums of taxpayer Medicaid money. The trade associations are powerful industry lobbyists. Their agenda is, always, more money and less regulation.

Annually, one of them, the Iowa Health Care Association, tours the state presenting at nursing home legislative forums, Power Point in hand. Their message is predictable (yes, you guessed it, more ____, less _____). And they contribute, generously, to the governor and legislators’ political campaigns.

It was noted in Kauffman’s article that the nursing home associations consulted with DHS regarding these rules, so it is no surprise the rules well account for their special interests. Neither is it a surprise that the IHCA consultant/accountant, Jeff Steggerda, told legislators “the various fees (being discussed) total $18 million annually in Iowa,” and that it’s “a relatively small amount.”

His presentation to legislators during their committee meeting helped to clarify how the $18 million was divided up between association dues and private lawyer fees.

However, by so doing, Steggerda unwittingly became the poster child of the problem. Indeed, he knows all about the $18 million, and his nursing home industry also is well-informed. Unfortunately, the Legislature doesn’t know, DHS doesn’t know and, worse yet, DHS apparently doesn’t care.

Here’s the bigger rub: We taxpayers are funding the nursing home associations with Medicaid money, in unknown amounts, instead of spending these limited Medicaid dollars caring for our loved ones.

We don’t know when the last time it was that the IHCA executive director, whose salary and benefits in 2011 was reported to be over $317,000, answered a nursing home call light, or assisted a resident to the bathroom, or helped to feed those who couldn’t feed themselves.

Likewise, we don’t know how much Medicaid money helped to buy IHCA’s West Des Moines land and building and equipment, reflected on its 2011 Form 990 Tax Return as having a “cost or other basis” of $2.3 million.

Transparency. Accountability. Priorities. These are nice words our governor and legislators love to toss about. But when it comes to taking money out of their contributor’s pockets, or even exposing where Medicaid dollars are spent, that’s a whole other story.

The Iowa DHS has accepted comments on these proposed rules, the Administrative Rules Review Committee has seen them. The next step in the process is consideration by the Council on Human Services.

We would all do well to express our views about how our governor and legislators intend to spend our taxpayer Medicaid money. When and if they still decide to give it away, there’s always the ballot box.

Dean Lerner of Des Moines served as director of the Iowa Department of Inspections and Appeals from 2007 until 2012, when Gov. Terry Branstad replaced him. Comments:

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