Auditor wants to measure quality of Iowa Medicaid services

Sand says recent audit doesn't answer enough questions

The State Capitol dome is illuminated by the sunset in Des Moines on Thursday, Feb. 16, 2017. (Rebecca F. Miller/The Gazette)
The State Capitol dome is illuminated by the sunset in Des Moines on Thursday, Feb. 16, 2017. (Rebecca F. Miller/The Gazette)

CEDAR RAPIDS — It’s not simply about adding and subtracting numbers, Rob Sand says about his new job as Iowa State Auditor.

So the newly elected Democrat plans to follow through on his campaign promise to audit the state’s privately managed Medicaid program even though his predecessor released an audit in late November that found $126 million in savings in 2018.

The audit by Republican Auditor Mary Mosiman, who lost her re-election bid to Sand, indicated that Gov. Kim Reynolds’ administration correctly estimated $141 million in savings, attributed to the state’s switch from fee-for-service to a privately managed Medicaid system.

Echoing Democratic state lawmakers, Sand said the audit does not answer questions about how much the managed care organizations, or the private insurers that administer Medicaid coverage to Iowans, still owe health care providers for services.

Since the managed care program was implemented, providers around the state say they have wrongly been denied payments for services provided to the roughly 618,000 Iowans in the program.

The audit also did not consider the services being provided or quality of those services, Sand said.

“You can’t just look at a price tag — you have to know what you’re getting in exchange, and we haven’t looked at that,” Sand told Iowa Public Television. “I think that’s really important. It doesn’t make any sense to say here’s the price without saying here’s what we’re getting.”

A week into his job, Sand said his office has an obligation “to figure out whether or not this program is meeting its goals. And one of its goals was said to be providing improved care.”


To do that, Sand said, his office will look at what he called “externalities.” His office will try to determine “if we’re failing to provide preventive medicine and it’s costing us more later on ... if we’re moving people from one form of health care to another and that’s making them unable to be productive citizens,” he said. “We can factor in those external costs.”

He thinks the Auditor’s Office staff of about 103, including 30 CPAs, can do that, but is willing to go outside state government if that’s necessary to get the most accurate answer.

“Somebody has got to try to measure it, and undoubtedly measuring it is a difficult thing to do, but we can’t just throw up our arms and say, ‘Gee, that’s too hard,’” Sand said.

The audit already is under discussion in his office, “but how long it will take, that’s another question,” he said.

“We want to make sure that we’re getting it done right,” Sand said.

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