I’ll never understand why some public officials insist everything is OK when there is evidence to the contrary. Where is the wisdom in denying obvious truths? Unfortunately, that’s exactly where we find ourselves with Iowa’s Medicaid managed care program. It’s time to face the truth and take corrective action.
I’m the parent and legal guardian of a 36-year-old woman with an intellectual disability and a mental illness. She is a delightful woman, and I’m proud her. She is, however, dependent upon daily life-support services funded with Medicaid dollars. As a senior citizen who knows full well that I won’t be around forever to care for my daughter, I am more than a little fearful about the direction Iowa is moving with its Medicaid managed care program. Services have been reduced, and the day-to-day well-being of many people with intellectual and physical disabilities is being threatened. I know this from my own experience and by listening to the anguished stories of other parents who belong to a support group called Iowa Parents For People, all of whom have sons and daughters receiving services from Iowa’s managed care program.
In 2016, the Iowa Department of Human Services (DHS) entered into contracts with national, for-profit insurance companies called managed care organizations (MCOs) to manage Medicaid-funded services. The primary goal was to reduce expenditures. About 608,000 Iowans are served by Iowa’s MCOs. Of that total, 37,400 Iowans — about 6 percent — require lifelong services and supports because of physical or intellectual disability. It is these 37,400 Iowans who are being negatively and unnecessarily impacted by Iowa’s flawed managed care program.
As parents, we know intimately about the overwhelming problems our sons and daughters have experienced. Here are two examples that typify our collective experiences:
• “Robert” is nonverbal and his anxiety is exhibited in extreme physical aggression. In 2007, his behaviors were significant enough that his family and teachers were not safe. No agency in Iowa would admit him. He was enrolled in a private facility out of state. Six years ago, he came back to Iowa in crisis and was placed at the Woodward State institution at a cost of $360,000 per year. In 2012, Robert moved into a community-based home at one-third the cost. He lived in his hometown close to family for six years with relative success. Beginning in 2017, Robert’s Medicaid funding was reduced by the DHS and the MCO to a level insufficient to maintain services. The new funding level allows direct support staff to be paid about $9 an hour — not enough to compensate someone with the skills needed to support Robert. At present, Robert’s mom has no long-term solution to help care for her son.
• “Mary” and “Mike” each have an intellectual disability and a mental illness. Neither one can manage their daily routine without 24/7 staff support. With the advent of MCOs, the local nonprofit agency that provides services for Mary and Mike experienced a $1.3 million reduction in annual Medicaid funding, with no corresponding reduction in the needs of their clients. The reduced funding doubled the number of clients in the community-based home, reduced staffing, and increased the amount of “alone time” that each client is expected to endure.
Most “well” people receiving Medicaid-funded health services — and that’s most of the 608,000 Iowans receiving Medicaid services today — can be served successfully via MCOs. But the 37,400 people with disabilities cannot be served well when funding and program decisions are made by an MCO with little or no understanding of the complex and nonstandardized needs of the individuals they are supposed to serve.
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Leaders at DHS are unwavering in their conviction that Iowa’s Medicaid managed care is the best approach to serving people with disabilities, and they downplay or reject outright the litany of service complaints and failures as an indication of a fundamental problem. They understandably are concerned about rising Medicaid expenditures. Yet there has been no conclusive financial analysis, much less an official audit that demonstrates MCOs are saving money for the taxpayer without also making excessive cuts in services.
On Aug. 24, DHS announced that the state will pay Iowa’s contracted MCOs an additional $344.2 million in 2019, which represents an 8.4 percent increase over the previous year and brings the total annual payments for MCOs to $4.1 billion. It’s hard to see how MCOs are saving the state money with increases of this magnitude.
Those running for state elected office this November should be asked to explain whether and how they intend to fix Iowa’s Medicaid-funded services for people with disabilities. And Iowans need to vote for those candidates who demonstrate a strong commitment to fix Iowa’s Medicaid management system.
• Richard Clark, founder of Iowa Parents For People, and his daughter live in the Des Moines area. Clark retired as Des Moines city manager in 2014.