Guest Columnist

Frustrating to watch Medicaid managed care from afar

Iowa Medicaid Director Mike Randol speaks at a meeting of the Council on Human Services at the Hoover State Office Building in Des Moines on Wednesday, June 13, 2018, about the cost discrepancies in DHS’s reporting of the state’s Medicaid managed care plans. (Rebecca F. Miller/The Gazette)
Iowa Medicaid Director Mike Randol speaks at a meeting of the Council on Human Services at the Hoover State Office Building in Des Moines on Wednesday, June 13, 2018, about the cost discrepancies in DHS’s reporting of the state’s Medicaid managed care plans. (Rebecca F. Miller/The Gazette)

It was without surprise that I read Gov. Kim Reynolds’ administration had agreed to give Iowa Medicaid managed care insurers a 7.5 percent increase.

With Medicaid managed care, once you’re in for a dime, you’re in for a dollar.

In studying “managed long-term services and supports” (MLTSS) for a law review article, I was struck by the lack of accountability and cost overruns that have accompanied placing the administration of a vital safety net, dating to 1965, into the hands of insurance companies.

The Dallas Morning News ran a poignant investigative series entitled “Pain & Profit” about the shortcomings of Medicaid managed care in Texas. They shared stories like that of Heather Powell, a 38-year-old paralyzed from the neck down and effectively trapped in her bed upon an insurer taking over her Medicaid care — she didn’t receive the necessary durable medical equipment, and her care hours were cut from 12 hours a day to seven.

The Morning News noted, “Texans with complex medical needs are now the most profitable, on a per-person basis, for the companies in Medicaid managed care, financial data shows.”

Yet, also as the Morning News reported, Texas Gov. Greg Abbott has effectively dismissed as “fake news” the findings of the paper’s yearlong, in-depth reporting: “Abbott is a vocal defender of managed care whose top advisers have connections to health care companies.

In New Hampshire, we used the examples of Iowa and Kansas to argue, successfully, the state should negate its statutorily-required transition to MLTSS. Kansas has reportedly gone without an inspector general for KanCare since 2014, effectively allowing managed care insurers to do whatever they want.

To quote a Topeka Capital-Journal editorial last month: “Nothing but problems. That’s been the theme of the state’s transition to a privatized Medicaid program that closed regional offices and failed to deliver on promises of efficiency and cost savings.”

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Yet, instead of holding accountable a company that “had only a 40 percent accuracy rate in making financial payments,” outgoing Gov. Jeff Colyer has agreed to pay it more money.

Sound familiar, Iowa?

Of course, Mike Randol, the person who initiated the debacle that has been KanCare found refuge ... in Iowa as its Medicaid director.

In contrast to the resources Gov. Reynolds has been willing to lavish upon out-of-state insurers, Iowa’s average nursing home rates, effective July 1, 2018, were only — at $160.96 per patient, per day — $2.41 higher than they were on July 1, 2016. And that was over two years. Not quite a 7.5 percent increase, was it?

One can only imagine the newfound largesse upon which insurers will be feasting will not be spread to care providers or their vulnerable charges. The $25.3 million the CEO of Centene reportedly made last year suggests this expected new entrant into Iowa’s managed care market also will be a very, very hungry mouth to feed.

As a former Iowan, it is frustrating to watch, from afar, such shortsightedness.

• Brendan Williams is the president/CEO of the New Hampshire Health Care Association, and a former Iowa City resident.

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