Branstad touts shift to privately managed Medicaid

JOHNSTON — Gov. Terry Branstad expressed confidence Friday 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 Friday's taping of Iowa Public Television's 'Iowa Press' show.

Officials with the federal Centers for Medicare and Medicaid Services (CMS) initially delayed Iowa's Jan. 1 implementation out of concerns the state wasn't ready to turn over a program serving 560,000 to three private companies that have contracted with the state to manage the program. CMS officials this week gave the green light for Iowa to move ahead with the transition April 1 but with stipulations and progress report requirements as privatization advances.

Legislative Democrats have pushed for more oversight aimed at protecting vulnerable children, elderly, disabled and low-income clients served by the three private managed care organizations, but Branstad said those provisions already are in place as lawmakers have an oversight structure as well.

'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 there will be 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.'

The six-term Republican 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 full 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 Medicaid modernization.

'I guess my feeling is, some people in the Legislature just want to torpedo this and they don't want to move forward with a modern managed care system. We've heard the politics of that. They even hired, I'd like to know who is paying Chet Culver to attack what we're doing. He left the state in a mess with a $550 million shortfall in Medicaid because he used one-time money,' Branstad said during the taping.

'I'd just like to know who is paying for him. He's not doing this for nothing. But this is the politics of it. And my concern is we need to work together and focus on the health of Iowans and improving their health,' he added.

Culver led a Statehouse rally earlier in the week where dozens of Iowans, many of them speaking through tearful sobs, pleaded, implored and demanded state lawmakers provide additional oversight of the state's pending shift to private management of its $5 billion Medicaid program.

Democrats in the Iowa Senate are moving forward with legislation that would add some layers of oversight of the three health-care companies that starting April 1 will manage the vast majority of Iowa Medicaid patients. Under the proposal, the state would create a stakeholder work group designed to make recommendations to the governor and state lawmakers, create a Medicaid savings fund and expand the duties of the state ombudsman, among other provisions.

Earlier this month 29 senators — 26 Democrats and three Republicans — approved a bill seeking to halt Branstad's plan to privatize the Medicaid service delivery system, saying the transition is too rushed and needs refining. Backers cited concerns from constituents and providers over many unresolved issues and uncertainty.

See also: Timeline of major developments in Iowa's Medicaid managed-care transition

Leaders in the Republican-controlled Iowa House have been hesitant to embrace additional oversight of the state's Medicaid program, and some Republicans have joined Branstad in decrying Democrats' effort to stop the managed Medicaid program as playing politics.

Senate President Jochum, D-Dubuque, who has an adult developmentally disabled daughter enrolled in Medicaid, said she her concerns come from the perspective of a parent not as a partisan and she believes the CMS decision to delay implementation one more month 'tells me that something still is not quite up to speed.'

'This whole plan was done behind closed doors and just dropped on everybody,' Jochum said in an interview this week.

'I am offended by a governor who suggests that this was something about partisan politics,' added Jochum. 'I've said over and over again this has nothing to do with partisan politics. It has everything to do with the care of children and adults with disabilities and this governor obviously really doesn't care a whole lot about them or he wouldn't be pursuing this.

'If I believed that this was a good thing I would have been a cheerleader,' she added.