Guest Columnists

Problems with Iowa's Medicaid transition

In response to Iowa Medicaid Enterprise Director Mikki Stier’s guest column concerning Iowa’s Medicaid Modernization (“Iowa’s Medicaid modernization transition,” April 24):

If the Iowa Medicaid Enterprise’s intent was to make it more difficult for Medicaid beneficiaries to get much-needed items such as catheters, diapers, medication, and transportation to medical appointments, then Medicaid Modernization has been a huge success. These were not obstacles under the old Medicaid system.

In IA Health Link’s first month, the bulk of the problems point to Iowa Department of Human Services and IME’s failure to adequately provide the managed care companies with accurate information. It is likely due to the unrealistic time frame that was established. Most states that have moved to a managed care approach have moved only portions of their beneficiaries at a time and done so over a two- to five-year period.

It is unfortunate that Gov. Terry Branstad, DHS, and IME have for more than a year misinformed Iowans about how their tax dollars will be spent and how services will be delivered to 560,000 Iowans.

Iowa’s program has brought about several unprecedented actions.

• CMS held five conference calls last fall due to the public outcry by beneficiaries, their family members, and providers.

• CMS delayed the start of Iowa’s program twice.

• Beneficiaries, family members, and providers went to the State Capitol on two bus trips, testified in multiple legislative hearings, and conducted a rally to protest the handling of Iowa’s Medicaid Modernization. Jamila Michener, a professor at Cornell University in New York, has studied Medicaid nationwide for more than three years and is writing a book on the topic said she hasn’t seen anything like what advocates are doing in Iowa.

We’ve heard repeatedly from IME that the transition is going smoothly. This is not the case. New programs of this scope and complexity will have “bumps.” Advocates don’t dispute that. We do dispute that the transition has gone smoothly and several other of Stier’s assertions.

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IME’s Member Services call center does answer calls quickly now. However, getting actual answers is difficult. It’s not uncommon for people to be told a supervisor will call them back within three business days to answer a question. Then the call never comes or doesn’t come until much later.

The state implies there are more providers than there really are. If one doctor sees patients in five locations, that does not make him five doctors. He still is one doctor but has signed five contracts, one for each location, according to Stier’s testimony in Senate hearings. The state is trying to convince the public that this is five doctors. If a child did math this way in school they’d surely receiving a failing grade.

Stier said 39 other states have Medicaid Managed Care. True, but according to the Robert Wood Johnson Foundation, less than five have transferred as many Medicaid beneficiaries to managed care as Iowa has, and the states that have actually seen cost savings are those that had above-average reimbursement rates already. Iowa ranked in the low 40s of all states going into this program.

As an administration for the Facebook group MCO Watchdog, I hear daily from Medicaid beneficiaries, family members, and providers who do not consider the following items “minor bumps:”

• Being unable to get the medications or durable medical equipment you need now, as was available under the old Medicaid system, not weeks down the road.

• Guardians who have for years acted upon behalf of their loved ones not being able to make necessary medical decisions because they suddenly no longer appear in IME and/or their MCO’s computer system.

• Quadriplegics who can’t find home health aides to help with daily living functions such as going to the bathroom, eating, and showering because of low reimbursement rates.

• Mental health patients who can’t access medication in a timely fashion without getting the media involved.

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• Medicaid beneficiaries walking home from the emergency room in the middle of the night because the hospital was told they are no longer eligible for transportation because they do not have a MCO.

• An “added value” of having 24/7 nurse lines through the MCOs, but it operates as an on-call line instead with beneficiaries being told a nurse will call back within 75 minutes. Then they don’t call back within that time frame.

• Needing to travel more than 50 miles to see a new doctor because the MCOs haven’t been able to sign contracts with all Medicaid providers.

The list goes on and on.

Maybe to Stier, DHS Director Chuck Palmer, and Gov. Terry Branstad these seem like minor “bumps.” Perhaps they don’t have serious illnesses or disabilities that require immediate attention. Maybe they don’t need to go to the bathroom or eat on a daily basis or are OK walking home in the middle of the night after visiting an emergency room. Or, perhaps, they aren’t the guardian of a loved one who is non-verbal but are told that their non-verbal ward must get on the phone and give permission for a representative to speak with them.

Medicaid Managed Care may help Iowans achieve healthier outcomes. That remains to be seen. In other states that have switched to managed care, people on a large scale have been denied services, which then leads to the question how is that healthier outcomes.

Iowans have heard repeatedly since last September by state officials that IA Health Link doesn’t change the member benefits available through Medicaid. The reality is different.

This is not the picture of a smooth transition by any means. If this were a private company, the shareholders would be calling for those in charge to lose their jobs. Yet, as Iowans the probability of recalling the governor is non-existent. Therefore, as a Medicaid beneficiary, Iowa resident for more than 25 years, and a longtime taxpayer I am publicly calling for DHS Director Chuck Palmer and IME Director Mikki Stier to lose their jobs for the botched implementation of IA Health Link.

• Rhonda Shouse is a Medicaid beneficiary & advocate and a member of Iowa’s Mental Health Planning Council. Comments: rhonda_shouse@yahoo.com

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