WEST DES MOINES — Iowans who provide Medicaid services to patients with intellectual disabilities warned Tuesday of an impending “real life crisis” for the health-care industry, its workforce and clients if changes aren’t made to the privately run system managing care for vulnerable children and dependent adults.
Providers who participated in a roundtable discussion with Democratic gubernatorial candidate Fred Hubbell on the state’s privately managed Medicaid system said many are in survival mode as they seek to deliver quality care and get proper reimbursement for their efforts.
However, earlier in the day Republican Gov. Kim Reynolds told reporters many the initial problems associated with the April 2016 switch to a privately managed Medicaid system for about 680,000 low-income and dependent Iowans have been addressed and the revamped approach will ensure “sustainable services for the future.”
“I’m proud of what we’ve been able to do with managed care,” the governor said in defending a private-run approach that has “been able to bend the cost curve.”
She said she wanted to be able to “look parents in the eyes” and assure them a system is in place to meet Medicaid participant’s needs long term.
“We’ve taken a lot of steps the last year to ensure that,” she said.
However, providers assembled by the Hubbell campaign painted a different picture, expressing concern over former Gov. Terry Branstad’s decision to go “all in” from day one with a privatized system that Shelly Chandler, chief executive officer of the Iowa Association of Community Providers, said “has been extremely painful” for the thousands of Iowans her group assists.
“The system now is not person-centered anymore, it’s not friendly to the consumers. That it’s all about the paperwork, it’s all about how they can gain efficiencies for the MCOs,” said Steve Hodapp, chief executive officer of the Vodec provider group. “From the families, we’re hearing — and it truly saddens me — that it’s not person-centered anymore. It’s about the money.”
Hubbell expressed his desire to begin a transition away from privately managed Medicaid services if he succeeds in defeating Reynolds in Iowa’s general election this November, but Chandler said any return to a state-managed approach would have to be “a work in progress.”
“You can’t unring a bell,” Chandler said. “You can’t just ring another bell and say we’re starting over. It will take a lot of consideration.”
Kelsey Clark, a Madrid direct support professional for 15 years working with people with intellectual disabilities, warned many health-care businesses in Iowa that serve vulnerable populations “are getting to a precipice” of an economic and workforce crisis.
“They’re reaching a point where there may not be a point of return for some of them and the folks that they care for have to go somewhere. They have to have care to live,” Clark said. “We’ve seen deaths that have occurred because of denials of care. This is a real life crisis. It’s compounding crisis upon crisis.”
After the event, Hubbell said there is evidence the current system run by private managed care organizations is not working and is getting worse, given that previous administrative state costs that ranged between 4 percent and 5 percent are now costing 12 percent to 15 percent.
About 40,000 Iowans have had their benefits denied or reduced, and 14 providers “have been pushed out of business because they’re not being paid properly,” he said.
Since the current system was started by executive action, Hubbell said he believes he can issue an executive order when he takes office to begin transitioning to a system that would not go back to the fee-for-service approach the state previously had but rather would adopt approaches that have worked in other states to deliver services to various member populations and reimburse providers on a timely basis.
“I’m convinced that we can do it much smarter, much more effectively, pay the providers better and have more people get the kind of support that they need,” he said.
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Reynolds countered the state just negotiated a new MCO contract designed to address problems with providers not being paid in a timely manner, make certain that members’ “voices are being heard” and incorporate expanded mental-health services into the revised rates.
“We’ve identified where the problems were, and I think we’ve accounted for that in the rates that we just certified, and I want to make sure that I have a sustainable system,” she said, noting the private system has been in place for just over two years. “Now we have actual experiences that we can take a look at where some of the issues were at and how we can improve the system.”
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