# Chuck Palmer

Privatized Medicaid makes no sense for people with disabilities

Who could have guessed that privatizing Medicaid would lead to for-profit companies cutting essential services to Iowans with disabilities? Aside from anyone who spent five minutes reading how the same approach had played out in Kansas?

When Iowa Democratic lawmakers sounded the alarm two and a half years ago, Governor Terry Branstad and his aides dismissed the warnings as “Washington D.C.-style partisan attacks.” They insisted privatization would allow Iowa patients to “enjoy the increased quality of service and care that comes with modern plans administering Medicaid.”

Instead, thousands received less in-home care or had trouble accessing medications and services after private insurance companies began managing their cases. The state now faces a class action lawsuit on behalf of 15,000 Iowans with disabilities.

Iowa Department of Human Services Director Jerry Foxhoven admitted yesterday what should have been obvious from the start: letting for-profit companies control access to health care for people with disabilities makes no sense.

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Will Kim Reynolds change DHS policy, or just directors?

Iowa Department of Human Services Director Chuck Palmer is retiring effective June 16, Governor Kim Reynolds announced today. Critics including Democratic State Senator Matt McCoy have called on Palmer to resign for months, charging that inadequate staffing at DHS facilitated more suffering and premature deaths among abused children. The department’s handling of Medicaid privatization has also drawn criticism. Despite Palmer’s promises to hold the line, the DHS agreed to pay private insurance companies more for managing Medicaid. In addition, DHS officials have downplayed numerous, ongoing reports of those companies cutting back on health care services and failing to reimburse providers promptly or adequately.

In keeping with Governor Terry Branstad’s playbook when Teresa Wahlert ended her disastrous tenure at Iowa Workforce Development, Reynolds didn’t acknowledge any problems with Palmer’s management of the DHS today. On the contrary, she and acting Lieutenant Governor Adam Gregg praised Palmer’s work in the official press release, enclosed in full below.

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Cash-strapped Iowa DHS agrees to pay private Medicaid managers more

No matter how strained Iowa’s fiscal condition may be, count on Governor Terry Branstad to lend a sympathetic ear to corporations asking for more handouts. Tony Leys brought the latest example to light in a late Friday scoop for the Des Moines Register. The Iowa Department of Human Services will “help private Medicaid management companies shoulder huge losses they’ve suffered in covering more than 500,000 poor or disabled Iowans.” DHS officials estimate the deal struck in February will cost the state about $10 million, “which would be paid more than a year from now.”

The Branstad administration agreed last fall to transfer an extra $33.2 million to the three private firms picked to manage the state’s Medicaid program. It wasn’t enough to satisfy Amerigroup, UnitedHealthcare and AmeriHealth Caritas. They soon asked for much higher payments from the state, saying they were losing money under their contracts. Documents indicate each company lost at least $100 million during the first year of managing care for Iowans on Medicaid, Chelsea Keenan reported earlier this month for the Cedar Rapids Gazette.

One salient fact from Keenan’s story: administrative costs for the insurers totaled 6.8 percent, 11.6 percent, and 11.9 percent of expenditures. Before Branstad unwisely rushed to privatize Medicaid, our state-run program was only spending about 4 percent on administrative costs.

DHS Director Chuck Palmer told reporters in January that the state would not offer the Medicaid managed-care providers more money for the 15-month period running through the 2017 fiscal year. Only weeks later, officials amended the current-year contracts with “risk-corridor agreements” calling for the DHS “to shoulder the management companies’ financial losses if they grow beyond a certain point.”

Federal officials “have signed off on the contract amendments,” but no one informed key legislators about the development. Republican State Representative Dave Heaton, who co-chairs the Health and Human Services Appropriations Subcommittee, found out from Leys.

Speaking of appropriations, where will Iowa find extra money to pay the Medicaid managers? Around the time DHS leaders signed the contract amendments last month, the department was forced to absorb $25.5 million in spending cuts before June 30.

State lawmakers have not yet set fiscal year 2018 budget targets, but money will surely be tight following a recent downward revision to revenue projections. Mid-year budget cuts can’t be ruled out for next year either.

Meanwhile, Medicaid recipients are getting less care than before privatization or having to fight insurance companies over denied claims. Managed-care companies have slashed in-home services for Iowans with disabilities. About a quarter of the Iowans on Medicaid cannot access a program providing transportation to and from medical appointments. AmeriHealth Caritas is cutting payments to agencies that serve people with disabilities, leaving some caseworkers out of a job. Reimbursement problems drove some providers out of business last year.

Given Branstad’s track record of doing whatever big business asks of him, it wasn’t hard to predict that the DHS would end up shoveling more money to the Medicaid managers. The governor’s imminent departure creates an opportunity for Lieutenant Governor Kim Reynolds to learn from her predecessor’s mistakes. Here’s hoping she will demonstrate her capacity for independent thinking by pulling the plug on Iowa’s failed Medicaid privatization.

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17 Iowa politics predictions for 2017

Two weeks late and humbled by the results from previous efforts to foretell the future, I offer seventeen Iowa politics predictions for the new year.

I struggled to compile this list, in part because it’s harder to come up with things to predict during a non-election year. I didn’t want to stack the deck with obvious statements, such as “the GOP-controlled Iowa House and Senate will shred collective bargaining rights.” The most consequential new laws coming down the pike under unified Republican control of state government are utterly predictable. I needed time to look up some cases pending before the Iowa Supreme Court. Also, I kept changing my mind about whether to go for number 17. (No guts, no glory.)

I want to mention one prediction that isn’t on this list, because I don’t expect it to happen this year or next. I am convinced that if the GOP holds the governor’s office and both chambers of the Iowa legislature in 2018, they will do away with non-partisan redistricting before the 2020 census. I don’t care what anyone says about our system being a model for the country or too well-established for politicians to discard. Everywhere Republicans have had a trifecta during the last decade, they have gerrymandered. Iowa will be no exception. So if Democrats don’t want to be stuck with permanent minority status in the state legislature, we must win the governor’s race next year. You heard it here first.

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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.

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Well-placed allies couldn't save WellCare's Iowa Medicaid contract

They were so close. Florida-based WellCare played the game almost perfectly to win a contract for its Iowa subsidiary to manage care for Medicaid recipients, which could have been worth hundreds of millions of dollars over the next three years.

The first sign that WellCare’s ambitions might come to nothing attracted little notice, appearing just before the long Thanksgiving weekend. More bad tidings for WellCare arrived yesterday in a late Friday afternoon dump, the classic way for government officials to bury news. Reading Jason Clayworth’s report for the Des Moines Register, it’s easy to see why the Branstad administration sought minimal attention for fixing an embarrassing oversight.

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