DES MOINES — The head of Iowa’s Department of Human Services rejected a “back to the future” notion Wednesday that the state could abandon its privately managed Medicaid system in favor of returning to a fee-for-service approach that, he said, would create more chaos for 600,000 program participants.
DHS Director Jerry Foxhoven spent an hour with the Senate Human Resources Committee defending his agency’s case workers and the department’s handling of the Medicaid system. He admitted there have been shortcomings in the changeover while offering optimism for the future.
“I’m never satisfied with where we are. We can always do better,” Foxhoven told legislators, but added, “I think we’re turning the corner. I think we’ve got better days ahead. But I think we’ve had good days, you just haven’t heard about them.”
A challenge his agency always faces, Foxhoven said, is that thousands of dedicated staff spend countless hours working “to do the right thing” in providing a safety net for disadvantaged Iowans and a ladder to success — but it’s the failures and shortcomings that result in “a kick in the pants.”
“It’s not news to save a life today or to put a family back together today or for people to get the services that they need. The news is when it doesn’t work as well as it should,” the DHS director said, “if one thing goes wrong, that’s what everybody notices.”
DHS officials have taken heat for the privatized Medicaid rollout beginning in April 2016 that Gov. Kim Reynolds admits has been fraught with mistakes and missteps. But Foxhoven — who has been on the job for seven months — said the transition since one of Iowa’s three managed care organizations quit has been “remarkable” given that 200,000 Medicaid members were put through tremendous change.
However, Sen. Liz Mathis, D-Hiawatha, said she continues to receive complaints about services delayed or denied, providers not getting paid and problems associated with the changeover.
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“I’m not so optimistic,” she said “It keeps going around in a circle. We keep talking about the same things.”
Before the Legislature reconvened Jan. 8, minority legislative Democrats called on Reynolds and majority Republicans to work together this session to end the state’s experiment with privately managed care and “put Iowans back in control of the Medicaid system” with a state-run approach.
Iowa’s Medicaid system has been handled by two MCOs — Amerigroup Iowa and UnitedHealthcare of the River Valley — since AmeriHealth Caritas exited the program at the end of last year.
Under questioning from Sen. Julian Garrett, R-Indianola, about the plausibility of going back to a fee-for-service approach, Foxhoven said DHS no longer has the infrastructure it had to run a cost-effective program. He said Medicaid members just went through “tremendous change” when AmeriHealth Caritas quit and switching to a new system would inject more trauma into the Medicaid structure.
“I think it would be incredibly unfair to the patients to say and now we’re going to take that system and change it again,” he said. “It’s been remarkable that we are where we are in 20 months. It would be another 20 months of really some chaos that would be really hard on our patients if we went back.”
After the committee meeting, Foxhoven told reporters that the national shift is to privately managed Medicaid.
“It’s like we’re not going to go back to rotary phones. Everybody is moving in that direction, not away from it but towards it because it’s the only way you make it sustainable in the long term,” he said.
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