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Neighbors Growing Together | Sep 18, 2018

Legislative Democrats seek to end privately managed Medicaid

They ask for return to state-run program
By Rod Boshart, Gazette Des Moines Bureau | Dec 18, 2017

DES MOINES — Minority legislative Democrats on Friday called upon Gov. Kim Reynolds and Republicans who control the Iowa Legislature to work together during the upcoming 2018 session to end the state’s experiment with privately managed care and “put Iowans back in control of the Medicaid system.”

In a letter from 20 Senate Democrats and 40 House Democrats, the minority-party legislators expressed concern that Iowa’s privately managed Medicaid system is “collapsing” with the withdrawal of one of the three managed care organizations that contracted with the state in April 2016.

“For the past 20 months, constituents of all ages have been bombarding Gov. Reynolds and Republican and Democratic legislators with real problems caused by Medicaid privatization,” legislative Democrats wrote.

“There is clear evidence that Iowans have died as a result of life-sustaining services being cut off to extremely vulnerable individuals.”

The letter also cited what the Democrats’ called the “financial jeopardy” that Medicaid privatization has imposed on hospitals, nursing homes and other Iowa health care providers — especially in Iowa’s small towns and rural areas.

They also challenged contentions the privately managed Medicaid approach is saving money for taxpayers or resulting in healthier participants.

“Under Medicaid privatization, the state of Iowa keeps giving the private, out-of-state companies more and more money, while giving Iowa taxpayers less and less,” they wrote.

Top GOP legislators declined to comment on Friday’s letter, but Reynolds’ spokeswoman Brenna Smith issued a statement indicating the governor is committed to improving quality and access to care, promoting accountability for patient outcomes and creating a more predictable and sustainable Medicaid budget.

Smith noted than more than 55 million Medicaid patients are enrolled in managed care health plans in 39 states and Washington, D.C., and that Democratic governors from across the country have credited Medicaid managed care in their states for improving patient quality and accountability.


Medicaid modernization ‘patient-centered’ approach

“Medicaid modernization is a proactive, patient-centered approach to modernizing Iowa’s Medicaid program. Recently, JD Power ranked Iowa's Medicaid program as second highest in the nation in patient satisfaction,” she added.

Last month Reynolds told reporters she is committed to a privately managed Medicaid system despite recent system upheavals and calls from Democratic rivals to dump the approach.

One of three companies initially hired to manage the program exited after it and the state did not agree to terms for a new contract.

Iowa has signed new contracts with its remaining two Medicaid insurers — Amerigroup and UnitedHealthcare of the River Valley — and will seek a third company to replace AmeriHealth Caritas Iowa.

The departure of AmeriHealth has caused some missteps and confusion during the transition period that the governor acknowledged has not been “perfect.”

“I’m willing to put the time and the effort into making sure that Iowans get the care that they deserve in a managed and coordinated and more modern delivery system. I’m not going back,” Reynolds stated.

However, Democrats, in their joint letter, called for working in a bipartisan fashion to expand access to affordable health care for Iowa’s most vulnerable citizens by using a different approach for administering a Medicaid “safety net” that is funded through a federal-state partnership.

“When Connecticut realized its privatized Medicaid was not working, state leaders made the decision to go back to a publicly managed Medicaid system. Connecticut is now seeing much better results with their new model. They are saving money and improving care,” they wrote.



“More than ever before, we all know that privatized Medicaid is not working for Iowa. For the health and safety of so many, will you work with us to put Iowans back in control of Medicaid?” the letter asked. “We can and should do better for Iowans. Watching our health care system collapse is not an option.”

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