Heading into the second year since privatization, Iowa’s Medicaid program clarified its financial standing — but did so under the glare of enrollees and health care providers alike.
More than 617,000 Iowans were enrolled in the $5 billion managed-care program, according to state data, which has been managed by private insurers. A third insurer — Iowa Total Care, a subsidiary of Centene Corp — will join the program in 2019.
According to Iowa Medicaid Enterprises officials, the state saved $140.9 million in fiscal year 2018 by switching to managed care from the former state-run system.
In public meetings in June, Iowa Medicaid Enterprises Director Michael Randol explained his methodology. The nearly $141 million estimate was calculated by comparing actual Medicaid costs for fiscal 2015 — which was the last full year under the previous system — with the projected basic expenditures for fiscal 2018.
But the nearly $141 million estimate did not jibe with previous savings figures released by the state, prompting an outcry from lawmakers and health care providers involved in the program, including the Iowa Hospital Association.
That prompted Iowa State Auditor Mary Mosiman to conduct an audit of Iowa Medicaid’s cost savings, which, in a November report, she concluded to be largely accurate. However, with up-to-date information, Mosiman determined Iowa saved $126 million in fiscal year 2018.
Incoming State Auditor Rob Sand said he intends to review the state audit, and some health care providers and enrollees remain displeased with the program, saying managed-care organizations save costs by denying reimbursements.
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Virginia Gay Hospital, a 25-bed facility in Vinton, filed a lawsuit against the insurers — first in Benton County, then the suit was moved to federal court — earlier this year. The suit claims the companies “illegally recouped” patient revenue from emergency room visits between 2016 and 2017.
In addition, Black Hawk County is considering a similar lawsuit against UnitedHealthcare for denied reimbursements to a county-operated nursing home unit that total to as much as $584,000.
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