Legislator: 'We made a mistake' on policy changing Medicaid benefits

A bipartisan group of legislators expressed concern Tuesday over a new law that will reduce coverage for thousands of new Medicaid beneficiaries in Iowa.

The changes, which took effect Nov. 1, were tucked into a massive budget bill that was introduced and approved in the chaotic final weeks of the last legislative session. Some lawmakers said they wished they had spent more time reviewing the changes and are concerned about how deeply they may affect patients and providers.

"When we have these cost-containment items, we need to do a better due diligence on them and have more discussion on the floor, especially," said Rep. Dawn Pettengill, a Republican from Mount Auburn and chair of the Administrative Rules Review Committee, which considered the issue Tuesday. "... We'll definitely try to address this (during the next legislative session)."

The rules committee oversees the implementation of new laws, but it has little authority to overrule decisions made by the Legislature.

Pettengill and others expressed frustration with the law itself, but conceded the committee is poorly equipped to address it on its own.

"We may all regret what’s in code, but it’s not within the power of this ... committee to overturn the will of the Legislature," said Rep. Guy Vander Linden, R-Oskaloosa. He promised to join others in "taking another look at this once we reconvene" in January.

At issue is a process known as "retroactive eligibility" for Medicaid recipients. It provides payment to health care providers for services performed during the 90 days prior to when a patient formally is declared Medicaid-eligible. It's intended to ensure providers accept low-income patients who aren't yet covered by Medicaid — often those who are hit by unexpected health care crises.

Legislators passed a bill that eliminates that 90-day retroactive eligibility period as a cost-containment measure to help bring down the cost of Medicaid.

An estimated 40,000 Iowans are expected to be affected by the change, and the state's share of the savings is an estimated $9.7 million.

"Since the time that this was adopted in the legislative process, a lot more information has come to light that tells me that we made a mistake," said Sen. Pam Jochum, D-Dubuque. "We made a mistake, and we have to be statesmanlike enough to admit that a mistake was made and to correct it."

She and Pettengill said they have had countless emails from providers, particularly long-term care providers, who say their practices and their ability to care for patients will be dramatically affected.

Brent Willett, president and CEO of the Iowa Health Care Association, spoke before the committee, urging them to rethink the policy.

If the law stands as is "... it will result in a further erosion of access to long-term care supports and services for some of the most vulnerable Iowans," Willett said. "Facilities will be forced to accept fewer individuals who are Medicaid qualifying because they will have no way to recover the daily costs associated with caring for the individual during the period between when that person becomes eligible and when that application is submitted."

Sen. Mark Chelgren, R-Ottumwa, said he already has legislation drafted that would tweak the law, but would not entirely roll back elimination of the 90-day retroactive eligibility provision.

"I think it’s unrealistic for us to expect that we’ll ever go back to a full 90-day lookback process," he said. "Because (the Iowa Department of Human Services) has a very good point, which is: insurance is insurance. And you really can’t get insurance after the fact."

Among his proposed changes, Chelgren said, is a plan to ensure that children all the way up through age 18 would be exempt from the new law change, as well as kids up to age 21 who are in the state foster care system.

Currently, only pregnant women and infants younger than 1 are exempt from the change.

Chelgern said he hopes to have a bill passed within the first two weeks of the legislative session, which begins Jan. 8, 2018.