Emotional Iowans plead for Medicaid oversight

DES MOINES - Dozens of Iowans, many of them speaking through tearful sobs, implored legislators Wednesday to provide more oversight of the state's pending shift from public to private management of its $5 billion Medicaid program.

Lawmakers held a hearing at the Capitol on legislation that would add some layers of state oversight of the three out-of-state health care companies that - starting April 1 - will manage the vast majority of Iowa Medicaid patients.

Thirty residents spoke at the legislative hearing and dozens attended a rally nearby in the Capitol rotunda.

'The people of Iowa, 560,000 (Medicaid recipients), are pleading for some kind of oversight,” said one of them, Kelly Ramus.

Tuesday, the federal government approved the state's managed Medicaid program, which was proposed roughly a year ago by Gov. Terry Branstad as a way of saving tens of millions of dollars, to start in April - three months later than what the governor initially wanted.

The federal Centers for Medicare and Medicaid Services said Iowa had made significant progress on the transition to improve its call center and provide information to beneficiaries.

'Because of this progress, CMS is approving an April 1 start date for the state's transition to managed care,” the federal agency said Tuesday. 'CMS's primary focus is on protecting the quality of care delivered to beneficiaries, and we will continue to closely monitor the state's progress.”

Under the bill that was the subject of Wednesday's hearing, the state would create a stakeholder work group designed to make recommendations to the governor and lawmakers, create a Medicaid savings fund and expand the duties of the state ombudsman, among other provisions.

Medicaid 'is one of the top two expenditures in the state,” said Rhonda Shouse, an advocate from Marion who helped organize a group of more than 60 Iowans who traveled to the Capitol. 'If it is that important and that large, it warrants a stand-alone oversight committee.”

For roughly 90 minutes, Iowans on Medicaid or who have family members who receive Medicaid services spoke about their fears of what is coming under private management.

They expressed concerns they will lose their doctors if those doctors do not contract with one of the three managed care organizations, or they will lose services as the result of cost-saving measures.

Anna Whittle said her niece, who receives Medicaid services, has been unable to find a doctor for two months and she has witnessed some providers ceasing to accept Medicaid patients.

'This is just one small problem in a sea of issues, and the program has not even started yet,” Whittle said. 'We need an individual oversight committee that deals with nothing but the issues that this Medicaid privatization is causing and will cause in the future.”

Many of the speakers said they wished the state was not moving to private Medicaid management, but because it is, they hoped for strong oversight. Some suggested the proposed legislation is not strong enough.

The legislation already has passed a Senate committee with unanimous support. Wednesday's hearing was an opportunity for more people to testify.

Lawmakers said the legislation may be debated by the full Senate as early as next week. Upon its likely passage there, the bill will move to the House.

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

Jeff Edberg of Iowa City said Iowans' concerns with the new program have nothing to do with politics. Edberg said his son has profound disabilities and is on Medicaid.

'This is not Republicans and Democrats. This is not Congress and the Senate and the administration,” Edberg said. 'This is people. Important people.”