Iowa Medicaid Transition Not Smooth

Rhonda Shouse, a Medicaid recipient and member of Iowa’s Mental Health Planning and Advisory Council, is a leading advocate for Iowans affected by Medicaid privatization. She is an admin for the MCO Watchdog Facebook group and has previously shared resources to help people report problems with managed-care providers. The Cedar Rapids Gazette published a shorter version of this commentary last week. -promoted by desmoinesdem

Iowa Medicaid Enterprises (IME) Director Mikki Stier wrote a guest column on Iowa’s Medicaid Modernization which appeared in the Cedar Rapids Gazette, Fort Dodge Messenger, and Sioux City Journal in April. I am writing in response to Ms. Stier’s column.

If IME considers making it more difficult for Medicaid beneficiaries to get much needed items such as catheters, diapers, medication, transportation to medical appointments, and permission for guardians to represent their wards, then Iowa’s Medicaid Modernization is 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 directly to the Department of Human Resources and IME to adequately provide the MCOs with accurate information. It is likely due to the unrealistic time frame established by Governor Terry Branstad, or DHS, depending on who tells the story of who came up with the idea for Iowa’s Medicaid Managed Care program. 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 very unfortunate that Governor Branstad, DHS, and IME have been perpetrating a public relations campaign for more than a year now to misinform Iowans on how their tax dollars will be spent, who Medicaid beneficiaries are, and how services will be delivered to approximately half a million Iowa residents. Healthcare should not be a partisan political issue.

The Democratic-controlled Senate, with bipartisan support, has worked to create tough real oversight of the program given the three companies tasked with operating the program have all paid hefty fines for fraud in other states with similar programs. This is after one managed care company was kicked out following one of several court battles over the program. The Republican-controlled House of Representatives has refused to even allow the Senate bills related to Medicaid Managed Care make it out of committee to be discussed by all state representatives. The House Republican version of oversight is a plethora of reports the MCOs are already required to provide under the terms of their contract with the state. The truth is some state legislators are not listening to their constituents.

Iowa’s program has brought about several unprecedented actions.
• CMS [The federal Centers for Medicare and Medicaid Services] held five conference calls last fall because there was such a public outcry from Medicaid beneficiaries, their family members, and providers.
• CMS delayed the start of Iowa’s program two times.
• Medicaid beneficiaries, family members, and providers made two bus trips, testified in multiple legislative hearings, and conducted a rally at the State Capitol to protest the handling of Iowa’s Medicaid Modernization. A professor who has studied Medicaid nationwide for more than three years and is writing a book on the topic has said she has never seen anything like what advocates are doing in Iowa.

We’ve heard repeatedly from state officials that the transition is going smoothly and that DHS is quickly reaching out to beneficiaries and family members who have had problems that have been reported in the media. However, this is not the case. Any new program of this scope and complexity will have “bumps” and “kinks.” Advocates do not dispute that. We do dispute that the transition has gone smoothly, that IME “address questions and concerns to quickly meet the needs of our members and Iowa’s dedicated providers,” and several other of Stier’s assertions in her column.

IME’s Member Services call center does answer calls quickly now. However, getting actual answers is a different story. It is not uncommon for beneficiaries and family members still to be told they will need to have a supervisor call them back within 3 business days to answer a question but then the call never comes or doesn’t come until much later.

When calling to inform my MCO of who my family doctor is, the representative gave me the option of signing up with her at four different addresses. The problem is she only sees patients at one location. However, she is part of the Mercy Care Physicians group and each address the MCO representative listed is one of their offices. Getting the MCO to actually find her in their system took almost an entire month because of the time it took for them to process the contract the physicians group signed.

The state implying that there are more doctors and providers is an outright lie. If one doctor sees patients in five locations, that does NOT make him five doctors. He is still one doctor but has signed five contracts, one for each location. The state is trying to convince the public that this is five doctors in the figures they’re releasing. If a child did math this way in school they’d surely receiving a failing grade.

Stier, along with other state officials, have said 39 other states in the country have Medicaid Managed Care. Again, true, but with the caveat that less than five of those have transferred as much of their Medicaid population to managed care as Iowa has. Also omitted is the fact that the states that have actually seen cost savings are those that had an above average Medicaid reimbursement rate already. Iowa ranked in the low 40s of all states going into this program.

Medicaid beneficiaries, family members, and providers do not consider the following items “minor bumps:”

• Not having your doctors appear in the MCO computer systems 27 days into the program.
• Not being able 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 (This problem has been ongoing since December).
• Quadriplegics who can’t find home health aides to help them with daily basic living functions such as going to the bathroom, eating, and showering because of low reimbursement rates.
• Mental health patients who can’t access the medication they need in a timely fashion without getting the media involved.
• Having Medicaid beneficiaries walking home from the emergency room in the middle of the night because the hospital has been told they are no longer eligible for transportation because they do not have a MCO.
• Being told there is a perk of having 24/7 nurse lines through the MCOs in which some act more as an on-call line instead with beneficiaries being told a nurse will call back within 75 minutes. Then they still don’t call back within that time frame.
• Having to travel more than 50 miles to see a new doctor because the MCOs haven’t been able to sign contracts with all the Medicaid providers under the old program.

The list goes on and on. Maybe to Stier, DHS Director Chuck Palmer, and Governor Branstad these seem like minor “bumps.” Perhaps they don’t have serious or chronic 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 okay 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 nonverbal yet are told that the nonverbal ward they have legally been appointed to represent 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 Medicaid Managed Care, the results have been people on a large scale being denied services, which then leads to the question how that can be healthier outcomes.

Iowans have heard repeatedly since last September by state officials and Stier stated it again in her column, “This new program doesn’t change the member benefits available through Medicaid.” The reality of IA Health Link is very different from that mantra.

I am one of the administrators of a Facebook group called MCO Watchdog. It was created as a result of the Medicaid Managed Care plan that started being talked about publicly on a regular basis last August. Our membership has doubled since December to the current 1,661 members made up of beneficiaries, family members, providers, legislators, MCO and IME employees, and members of the media. The group is so diverse and we have become an advocacy force to pay attention to because we have been careful not to have an attitude of “the sky is falling” and we deal in facts. We provide information from official sources such as IME and the MCOs, media stories, and share the experiences people are having in reality with the system. The problematic experiences have become such a constant issue that a sister group, MCO Doghouse, was started this week to deal solely with these stories.

This is not the picture of a successful or 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 long-time taxpayer I am publicly calling for DHS Director Chuck Palmer and IME Director Mikki Stier who have led this transition to lose their jobs for the botched implementation of what is being spun as IA Health Link.

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