Senate votes to create Medicaid oversight body

DES MOINES — The Iowa Senate voted unanimously Wednesday to establish a new commission to oversee the transformation of Iowa's $4.2 billion Medicaid into a managed care system that will enlist private health care vendors to coordinate care and manage program spending.

Sen. Amanda Ragan, D-Mason City, urged a go-slow approach as Iowa moves to join nearly 40 other states in adopting a managed care approach, saying the policy change came as a surprise to many members of the split-control Legislature when Gov. Terry Branstad unveiled it as part of his budget proposal in January.

Senate File 452 calls for creation of a Medicaid transformation and oversight commission to provide legislative involvement and to ensure stakeholder input, consumer protection and quality assurances in moving to a managed care service delivery approach for a program that serves about 560,000 young, poor, disabled and elderly Iowans.

Earlier this month, the state Department of Human Services issued a request for bids from potential vendors to move to a risk-based Medicaid modernization initiative aimed at improving coordination and quality of care while providing predictability and sustainability for taxpayers in Medicaid spending. DHS officials said the objectives were to improve quality and access, promote accountability for outcomes and create a more predictable and sustainable Medicaid budget for a program that has grown 73 percent since 2003 with a cost last fiscal year of $1.5 billion to Iowa taxpayers.

'I'm alarmed at the speed that this is advancing,' Ragan said during Wednesday's Senate floor debate.

'If Iowa moves forward at the pace proposed by DHS, Iowa will have made the transition faster than any other state. Not only do the plans move us along faster than all other states, the proposal is more comprehensive than most other states,' she noted.

'When you research managed care, you learn quickly that the first lesson is to be methodical, be inclusive of stakeholders and Medicaid members, and take your time to make sure you do it right. Iowa Medicaid is, after all, Iowa's second largest insurance company,' Ragan added, 'and we're talking about the largest procurement in state history at about $4.2 billion.'

Sen. David Johnson, R-Ocheyedan, said he supported the bill, but expressed concern that some of the Senate Democrats who spoke on the bill appeared to be knocking the Branstad administration when bipartisan cooperation was needed to work toward a positive result.

S.F. would create a Legislative Medicaid Transformation and Oversight Commission that will monitor the transition to managed care and make recommendations for improvement annually by Jan. 15. The focus of the Commission's work will be defining and monitoring outcomes, reviewing DHS' contract oversight, and ensuring that members are able to access appropriate, high quality health care services.

'I think a change of this magnitude requires legislative debate and robust oversight,' said Ragan. 'It's critical that we have a voice in this because the people we represent don't have a voice in this.'

The bill now goes to the Iowa House for consideration.