State’s move to managed care could cut Linn County jobs

CEDAR RAPIDS — Some 80 Linn County social service employees with union wages and benefits who provide care to the intellectually and developmentally disabled could see their jobs vanish as Iowa shifts from a state-administered Medicaid program to a private system.

Four of the five Linn County supervisors, all four of whom are Democrats, expressed frustration at their meeting Monday with the state's move to managed care. They said they had little or no ability to weigh in on the changes even though the county and its employees have played a key role in the delivery of services for this at-need part of the state's population.

'This is what counties do,' said Supervisor Brent Oleson of the role counties long have played in social services.

Oleson said the push by Gov. Terry Branstad, a Republican, to contract with four private-sector companies to take over administration of the $4 billion Medicaid program in Iowa has come with a promise to save significant dollars for the state — Branstad estimated more than $51 million in the first six months.

Oleson, who has just changed his political party affiliation from Republican to Democratic, said some of the cost savings will result from a shift from public employees represented by unions to private-sector employees without union support and lower wages.

Sue Novak, financial management director for Linn County Community Services, told the supervisors that 38 county employees could lose their jobs come July 1 if the managed care organizations decide to handle the work themselves or hire other providers to handle the management of cases of mental health and developmental disability.

The organizations will continue to work with two other Linn County programs, Options and Home Health, but could move to other providers by 2018, for those programs, Novak said.

She said Options has about 50 county employees who continue to work with the developmentally disabled, while Home Health has a couple of employees.

Oleson and Supervisor Linda Langston said they were concerned about the programs' clients.

Novak said Linn County's case managers coordinate care for about 30 clients each, and she said the ratio of managers to clients could become much larger.

The move to transfer the care of people from public-sector social service employees to private or non-profit sectors is something Linn County has seen before.

Two years ago, the Abbe Center for Community Care closed, in part, to better integrate the 75 clients into smaller community settings. In the process, though, 60 full-time, union positions were eliminated.

Likewise, the county's Options program is in the process of closing its sheltered workshop program, with some of the 50 county jobs expected to be eliminated as some of the clients move to other providers and not to Options' adult day care program, Novak said.

Oleson said the 38 county employees in case management who may be the latest to lose their jobs are employees who have been in long-term relationships with clients 'at the lowest rung of society with problems.'

Supervisor Ben Rogers said he was worried that clients may sign on with one organization to continue in a program but discover their doctor is not in that network.

Novak pointed out that the state still has not secured approval of the federal Centers for Medicare and Medicaid Services to move to a managed care operation, and so the state has not yet signed contracts with the companies it selected to take over.

Langston said supervisors would write letters to the federal agency, to Iowa's congressional delegation and to lawmakers to express supervisors' concerns about confusion and the speed of the transition.

Oleson questioned if Renee Schulte, a former lawmaker from Cedar Rapids and now a mental health consultant, provided enough information while working under contract with the officials in Linn County and the eight other counties that comprise the East Central Iowa regional board for mental health and developmentally disabled services.

Schulte has been hired by one of the four companies picked by the state to take over management of the Medicaid program in Iowa, Oleson said.

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