Fully fund Medicaid in Iowa

A majority of states across the country, including here in Iowa, currently use managed care for at least some portion of their Medicaid program. This approach attempts to identify and address an individual’s current and even potential health care issues before they become chronic, severe, and costly. For example, regular physicals and other health care screenings can help with early detection of diabetes, heart issues, cancer and more. Fundamentally, this type of approach is about actual “health” care where people access medical services to live healthier lives rather than a “sick” care system where they go to the doctor only when they become ill.

In Iowa, we have nearly 800,000 people who are enrolled in the Medicaid system. With those types of numbers, it stands to reason most Iowans know someone who is a Medicaid member, whether that is a friend, extended family member, or neighbor. Within this population, there are approximately 417,000 children who receive health care through Medicaid, which makes it all the more important that the program is fully funded and delivering the full range of services the state has promised.

More than six years ago, the state of Iowa, under the leadership of then Gov. Terry Branstad and current Gov. Kim Reynolds, made the decision to shift Medicaid to managed care. I believe this was the right decision. For Medicaid members, it means better health care outcomes. For policymakers and taxpayers, it provided a mechanism to bring more stability to our state budget and in doing so helped avoid the skyrocketing health care cost increases that would have forced cuts in other areas like education and infrastructure.

That’s not to say, however, that there haven’t been challenges along the way. For health care providers across the state, there have been issues transitioning from an entirely state-run program to a privately managed system. This has caused headaches when it comes to billing and payments, which have the potential to create financial strains for providers of all sizes. A couple managed care organizations who had been selected to administer the program chose to leave the state citing a disparity between the services they were required to cover and the funding allocated to provide them.

Additionally, I believe there is room for improvement in Iowa’s Medicaid reimbursement rates, particularly for dentists such as myself. As you may know, Iowa’s Medicaid program only reimburses twenty cents on the dollar for dental services. This has caused many dentists throughout the state to stop accepting Medicaid members as patients. Even more have been forced to restrict the number of Medicaid patients they take on. This limits the care options for low-income Iowans, who may not have the ability to travel long distances to find dental care.

Fortunately, the state of Iowa has established a process to collect data so they can regularly evaluate the Medicaid program in a comprehensive and meaningful way. This allows the governor’s office, the Iowa Department of Human Services, other members of the legislature, and more to make any necessary changes. Thankfully, this is largely what they have done in the six years since managed care was initiated. This commitment is to their credit and my hope is they continue that approach now.

Today, the state of Iowa has a billion-dollar budget surplus. That is first of all a reflection of sound budgeting practices and a continual commitment to fiscal responsibility. But it’s also an indication that the state has the resources available to fully fund our Medicaid program. Taking this important step will ensure that the nearly 800,000 Iowans, including 400,000 plus children, who rely on this program are receiving the health care services they have been promised and ensure the managed care model of health care is best positioned to succeed. Simply put, managed care has worked well in Iowa and can continue to do so if we are willing to make the appropriate and necessary investments today.

Dr. Steven Bradley is a Republican state representative from Maquoketa.