Senators voice frustration over Iowa Medicaid transition

Iowa Medicaid Director Mikki Stier told senators Wednesday afternoon that the state is working quickly to answer Medicaid recipient and provider questions after the April 1 transition to managed care, adding the state 'continues to see no major systemic issues.”

Once again, she was met with serious doubts and even an outburst.

'You're not hearing what we're hearing,” said Sen. Bill Dotzler, D-Waterloo, who told a story of a woman in his district who was recently denied a medication that helps ease her seizures and was told she would need to try alternative medications. 'It's not all roses. It's systemic and across all of our districts from senator to senator.”

Stier, along with the heads of the three managed-care organizations contracting with Iowa to handle its $5 billion Medicaid program, met with senators of the Human Resources Committee for the second week in a row to discuss the transition.

A handful of senators read emails from both providers and beneficiaries detailing snags and problems regarding medical care since the April 1 transition. Problems ranged from a disabled adult being dropped off at the wrong place by a cab company contracted to take him to and from a medical appointment to rehabilitation therapy agencies given misinformation regarding a fee cap on services.

Sen. David Johnson, R-Ocheyedan, recounted a story a hospital administrator in northwest Iowa told him regarding an unresponsive Medicaid patient brought into the emergency department

'The MCO denied an inpatient stay,” he said.

Instead, the hospital was granted a lower reimbursed observation stay - which is meant to be a shorter hospital stay in which the hospital determines if a patient needs longer inpatient care.

'We want real answer to these questions, and I don't think we're getting them,” he said.

A majority of senators who spoke up during the meeting were in agreement that additional meetings were needed over the summer and fall, after session has ended, to continues to address some of these issues.

Senators were particularly frustrated with a news release Gov. Terry Branstad's office sent out Wednesday morning touting five success stories, including a Medicaid enrollee who no longer has to pay a $15 copay on medications and a Medicaid member with multiple chronic conditions who was able to work with a care manager on health goals.

Branstad said in the release that the stories highlight how the managed-care organizations are connecting patients with services to live healthier, happier lives.

'Medicaid patients are getting access to better care, seeing greater flexibility to deliver that care, and ultimately better health outcomes under Medicaid modernization,” he said.

However, the senators did not think the news releases reflected reality.

'Has the governor become so disconnected with the world?” said Sen. Joe Bolkcom, D-Iowa City. 'It's disheartening to see these rosy news releases saying that everything is going wonderfully. It is not selling out there.”

'With all due respect,” said Sen. Liz Mathis, D-Cedar Rapids, 'this is what you're paid to do. You are contractually obligated” to offer these services. 'This is what you are supposed to do.”

Waterloo Sen. Dotzler said after the meeting that the governor's attitude over the transition has made senators and beneficiaries more upset.

'You hear this thing that they can put lipstick on a pig. But they're doing more that, they're giving them face-lifts, but it's still a pig,” he said. 'It's a frustration level that I've never really had before.”

Des Moines Bureau reporter Rod Boshart contributed to this article.