Branstad touts shift to privately managed Medicaid

Culver says switch lacks oversight, questions governor's judgment

Iowa Gov. Terry Branstad
Iowa Gov. Terry Branstad

JOHNSTON — Gov. Terry Branstad expressed confidence Friday that Iowa is moving ahead April 1 with a federally approved plan to deliver privately managed care to Medicaid recipients that will provide a better health system and be more sustainable for taxpayers.

“I believe that this is the modern way to deliver medical care,” Branstad said during the taping of Iowa Public Television’s “Iowa Press.”

Officials with the federal Centers for Medicare and Medicaid Services delayed the switch to managed care, originally set for Jan. 1, until April 1 because they thought the state wasn’t ready to turn over a program serving 560,000 Iowans to three private companies.

Legislative Democrats have pushed for more oversight aimed at protecting children and the program’s elderly, disabled and low-income clients,

“Managed care is oversight,” the governor said. “The old Medicaid system was a fee for services where you went to a provider and then the state Medicaid program just paid those providers. There was no management or oversight of it.”

By joining 39 other states with privately managed Medicaid programs, Branstad said he expects better coordination of services by the three private companies. And while some government oversight will be needed, “you don’t need to have an army of 100 people to oversee the overseers.”

Branstad said the fee-for-service approach that Iowa is moving away from was too expensive and duplicative, but he understands that hospitals and some providers don’t like the oversight that managed care provides and, unfortunately, “have tried to scare their patients” as implementation approaches.


Branstad also complained that “all of a sudden, the Democrats decided they wanted to make this a partisan issue,” and he questioned the motives of his 2010 gubernatorial opponent, former Gov. Chet Culver, for actively working in opposition to the Medicaid changeover.

“I’d like to know who is paying Chet Culver to attack what we’re doing,” Branstad said. “He left the state in a mess with a $550 million shortfall in Medicaid because he used one-time money.”

Culver, in an interview, said he is not being paid by anyone but has become engaged because vulnerable Iowans are at risk by placing Medicaid in the hands of private for-profit companies without proper openness, transparency and accountability as to how taxpayers’ money will be spent.

“It says a lot about Terry Branstad to question my motive instead of questioning his own judgment,” said Culver, who called it inaccurate, dishonest and misleading to say 39 other states are doing what Iowa is doing when only five other states have privatized their entire Medicaid system.

“We’re seeing the problems because it is a monumental task to try to shift to a whole new paradigm,” added Culver, who led a Statehouse rally earlier in the week where dozens of Iowans, many of them speaking through tears, pleaded, implored and demanded state lawmakers provide additional oversight of the $5 billion Medicaid program.

“There isn’t any oversight right now. We have a new policy in place, but we don’t have any built-in accountability,” said Culver, who was Iowa’s Democratic governor from 2007 to 2011.

Branstad, he said, “doesn’t understand. Managed care is not the oversight. Oversight has to do with holding the managed care organization accountable. Typically, the way you get those things is by having an oversight mechanism in place the day the policy goes into effect. That has not happened.”

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