Iowans deserve clear picture of Medicaid switch

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If Gov. Terry Branstad and the Department of Human Services truly want us to believe handing Iowa’s Medicaid program over to private insurers was a wise, beneficial move, they need to offer us more than political spin and paltry data.

We all want effective and cost-efficient management of Iowa’s Medicaid program. All Iowans clearly benefit from a system that delivers quality services at the lowest cost to the more than 600,000 Iowans covered by Medicaid.

What is less clear is whether private Medicaid is delivering — whether it is meeting the needs of Medicaid patients, is paying providers for legitimate claims and is achieving responsible budget savings.

Over the last two weeks, we’ve heard from the governor that privatized management by three managed care organizations is rooting out “fraud and abuse.” The governor’s office also used a speculative report filed last November in an attempt to prove the new system is cutting payment errors. Neither the governor nor his staff have produced any specific examples nor evidence.

The DHS issued a quarterly report filled with broad-brush statistics and data that painted a rosy facade with little or no detail to back it up. It reports the state has saved $22 million with managed care compared to the old government-run system, but, again, gave no explanation for how those savings were realized.

It proclaimed that 99 percent of “clean claims” from providers had been paid within 21 days, without explaining how often these “clean claims” amount to only partial payments.

Two managed care companies have reported significant losses.

Has the new system delivered on Branstad’s promise that clients would not see a reduction in services? The data provides no clear answer.

On the other hand, there is a mountain of anecdotal evidence from scores of clients and providers that the new system is foundering. We’ve heard of health care providers burning through reserves and contingency funds as they wait for managed care companies to pay legitimate claims, including some preapproved charges. Some providers have had to seek extended lines of credit. Others have been pushed to the brink of closure.

We’ve heard from clients facing long waits for services and supplies, even simple necessities such as catheters.

Branstad has chalked up criticism to partisan politics or fear of change. But the truth is, his administration’s pronouncements don’t match realities on the ground. Its numbers don’t paint a full picture.

That has to change. Transparency is essential. Health coverage for hundreds of thousands of Iowans and their providers is at stake.

Allowing red tape or minor errors to delay payments and put providers out of business is unacceptable. The state must do far more to make sure that doesn’t happen. Program savings, for example, could be used to head off closures until payments are approved.

And Iowans deserve to know far more about how their $5 billion Medicaid program is being managed, and in far greater detail. Quarterly reporting must include much more information on how, exactly, managed care companies are slicing Medicaid spending. If fraud is being fought and errors are being corrected, show us specifics.

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