Health

New Iowa Medicaid director open to changes in state program

DHS director confident Michael Randol can bring improvement

New Iowa Medicaid director Michael Randol during an interview in the Hoover Office Building in Des Moines, Iowa, on Monday, Jan. 8, 2018.(Jim Slosiarek/The Gazette)
New Iowa Medicaid director Michael Randol during an interview in the Hoover Office Building in Des Moines, Iowa, on Monday, Jan. 8, 2018.(Jim Slosiarek/The Gazette)

DES MOINES — Iowa’s new Medicaid head said he would not close the door to adding a fourth managed-care organization to the state’s program. But he made it clear he did not want the state to continue to care for the Iowa’s most complex cases, who already have been moved from one insurance company to Iowa’s fee-for-service program.

With just more than a month under his belt as the new director of Iowa’s $5 billion Medicaid program that oversees coverage for 600,000 Iowans each year, Michael Randol told The Gazette Monday during one of his first public interviews that Iowa is on track to find a third private managed-care organization.

Randol, who started Dec. 4, said the Department of Human Services has extended the request-for-proposal by 60 days for potential bidders to fill that third slot, which would begin administering coverage to recipients on July 1, 2019.

Iowa’s Medicaid system has been handled by two managed-care organizations — Amerigroup Iowa and UnitedHealthcare of the River Valley — since AmeriHealth Caritas exited the program at the end of last year.

Randol said Iowa Medicaid Enterprises is “looking to add one or two” organizations to administer the system.

“It may be one, it could potentially be two, but we want to make sure whatever we select and whomever we select, they go through the appropriate process as far as readiness reviews and they have their policies and procedures,” Randol said.

The state initially had four managed-care organizations lined up to administer Medicaid, but WellCare had its contract terminated before Iowa’s managed-care program was rolled out in April 2016.

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Department of Human Services Director Jerry Foxhoven told The Gazette Monday in a separate interview he would support Randol’s judgment on possibly adding a fourth insurer to the program. But he anticipates that won’t be a conversation until after July 2019.

“I’m not sure if it’s in the planning right now,” Foxhoven said. “I consider him to be the expert in managed care, and if he told me tomorrow he thinks we should, we’d probably be doing it.”

The new director also plans to hold a roundtable for interested bidders in Des Moines on Jan. 17.

After AmeriHealth exited the state late last year and Amerigroup said it did not have capacity to take on any new members, about 10,000 Iowans were transferred to the state-run fee-for-service system.

State officials have been working with Amerigroup to build up the company’s capacity — a move in line with Randol’s belief that “managed care in Medicaid is the appropriate delivery model,” that and complex cases should not be handled by the state.

Foxhoven agreed, and said there’s value to managed care for the most complex cases in Iowa.

“Frankly, that’s what these companies do for a living,” Foxhoven said. “It’s not what the state of Iowa does for a living.”

Randol’s salary is at $145,953.60 annually, according to records obtained by The Gazette.

The new Medicaid director holds a Master of Business Administration degree from William Woods University with an emphasis in finance and a Bachelor of Science degree in accounting from University of the State of New York.

Randol previously had led Kansas’s privately managed Medicaid program for five years, beginning in 2012, before he was hired for the director position in Iowa.

Randol’s experience in Kansas while the state privatized its system was a major determining factor that led to his hire, Foxhoven said Monday.

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“We’re hoping to keep him for his whole career,” Foxhoven said. “I think we’re going to have managed care for a long time and it can be effective. It (Iowa’s program) has been effective, but we can continue to improve it and I think he’s got some great ideas to help us improve that and make it better.”

In her weekly news conference Monday, Gov. Kim Reynolds said Randol “has a reputation of really turning a system around.”

“Randol, who has the expertise, the knowledge and the financial background is someone from the outside coming in take a look at the system and make sure we are looking at it accurately, make sure we are comparing apples to apples,” Reynolds said.

Kansas’s $3.2 billion managed-care Medicaid program — called KanCare — covers more than 400,000 recipients. But after its launch in 2012, the program became a source of criticism from health care providers, Medicaid enrollees and state leaders, according to the Kansas Health Institute.

Early on, providers complained of late payments and trouble obtaining authorizations for services from the three insurance companies that administered KanCare. These managed-care organizations lost $110 million in the first year.

In 2016, a federal evaluation of the program found that the state’s oversight was inadequate, stating KanCare was “substantively out of compliance with federal statutes and regulations, as well as its Medicaid State Plan,” according to the Kansas City Star.

The federal Centers for Medicaid and Medicare and CHIP Services granted the state a 12-month extension of the Medicaid program in October, giving state officials time to implement a corrective plan and to create a new version of the program.

“Iowans have heard only bad news about the Medicaid privatization experiment in Kansas,” Amanda Ragan, D-Mason City, said last week. “It’s hard to imagine how someone coming from Kansas will help Iowa escape the Medicaid mess in Iowa that has resulted in bad services for Medicaid recipients, delayed and reduced reimbursements for health care providers and higher costs for Iowa taxpayers.”

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State Democratic leaders released a letter last month, calling on Gov. Kim Reynolds and Republican lawmakers to “end Iowa’s failed Medicaid privatization experiment” and switch back to a state-run program.

Although happenings in Kansas’s program — and that it happened during Randol’s leadership — make some Iowa leaders uncertain, Rep. Dave Heaton, R-Mount Pleasant, said he believes Randol could be the one to fix Iowa’s managed-care issues.

“I think he’s very qualified who’s going to be the person that’s going to make our improvements in our system,” Heaton said.

l Comments: (319) 368-8536; michaela.ramm@thegazette.com

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