Wait for Medicaid waivers in Iowa is unacceptable

A report in Sunday’s Gazette by Emily Andersen is both heartbreaking and jaw-dropping.

Andersen tells the story of Gauri McClure, an 11th-grader diagnosed with focal dermal hypoplasia. The genetic disorder affects her eyes and other organs and causes developmental delays that make it hard for her to stay organized and on time without help.

Guari’s mom, Karen McClure, a special-education teacher at Linn-Mar, needs a Medicaid waiver to cover the cost of respite care. Such waivers pay for services and equipment for people with disabilities private policies don’t cover.

But it’s been more than two years since Karen McClure applied for a waiver. She’s been told she’ll have to wait five years to get one. Long waitlists are now common for Iowans in need waivers for health and disability, intellectual disability, brain injuries and other conditions.

Yes, that’s five years. And it’s unacceptable to make Iowans in need wait years for the money to cover the services they need.

A lack of funding is the main culprit due to budget cuts. Theresa Lewis, executive director of The Arc of East Central Iowa told Andersen she believes the conversion of Iowa’s Medicaid program to private managed care in 2016, is a key factor in budget cuts.

“Prior to that, providers got regular increases that mostly kept up with the cost to provide the service,” Lewis told Andersen. Adding that managed care “made things difficult for a lot of providers, The Arc being one, Lewis said.

There were warnings this would happen when the Branstad administration unilaterally decided to switch to managed care, with little or no input from Iowans affected. The move was supposed to save money, but none of managed care’s supporters revealed savings would come at the expense of families with disabled kids.

Low funding also hurts efforts by providers to attract and retain staff. If families lose the services of a provider, they risk losing their waiver. Some who cleared the waiver waitlist are in other waitlists for services. And while families wait, disabilities can become more severe and can send them to the hospital for care.

The state is rolling out a new program intended to address waitlists. The HOPE program would reduce the number of waiver categories. That way, requests for waivers can be consolidated potentially improving chances of getting one sooner.

We hope the new initiative will work. But it remains astounding that thousands of Iowans are waiting years for care. Lawmakers should use their oversight authority to ask questions on behalf of their constituents and craft any legislation needed. It’s an issue too important to ignore.

(319) 398-8262; editorial@thegazette.com