The Register's editorial

Medicaid is a federal program designed to provide health insurance to low-income Americans. Guidelines are set by Washington, which pays most of the expense. When a state wants to deviate from those guidelines, it needs to obtain a “waiver” from the federal government.

Such waivers are common. But using them to deny care is unconscionable.

Iowa has secured waivers for numerous endeavors, including covering people with brain injuries who might not otherwise be poor enough to qualify for Medicaid and helping disabled people receive care in their homes instead of institutions. Gov. Terry Branstad secured a waiver to implement his own Medicaid expansion plan under Obamacare to insure more Iowans.

In fact, it was a little Iowa girl and President Ronald Reagan who paved the way for what is now known as the “Katie Beckett Waiver.” In 1981 the president demanded the federal government make exceptions in Medicaid rules to help her. After a brain infection left her unable to breathe without a ventilator, the insurance would pay only for her hospital stay. Her family wanted to care for her at home.

Reagan was furious the government was willing to pay $6,000 a month for a facility but not $1,000 a month for in-home assistance. Federal officials allowed an exception, and since then hundreds of thousands of disabled children have avoided institutions.

States have repeatedly used waivers to provide needed care to residents in a way that makes sense. But times have changed. Attitudes toward poor people and Medicaid have changed. Iowa has changed.

This state now seeks federal permission to deny care to Iowans and avoid paying health providers.

House File 653, passed by lawmakers this year and signed by Branstad, orders the Iowa Department of Human Services to seek a waiver amendment to circumvent the federal government’s “retroactive eligibility provision.”

That provision allows for Medicaid payments for health-care services provided in the three months leading up to a person being formally declared eligible for the health insurance. These individuals may not yet have applied for benefits or their coverage has lapsed.

Iowa’s elected officials want approval to eliminate the three-month time frame. If the feds agree, Iowa's Medicaid program would pay only for the care that’s delivered from the first day of the month in which the patient applies for eligibility.

The state says the move would save $36.7 million, including about $9 million in state dollars. That savings comes from stiffing health providers.

That fact is not lost on the Iowa Hospital Association.

“This amendment will place a significant financial burden on hospitals and safety net providers, and reduce their ability to serve Medicaid patients,” it wrote to the federal government in July. The poorest Iowans will be faced with potentially huge medical bills for emergency care, and hospitals will be faced with more bad debt and charity care, which “will affect the financial stability of Iowa’s hospitals, especially in rural areas.”

The hospital association also took issue with the state’s attempt to impose the limitation on all Medicaid beneficiaries by making changes to a waiver pertaining to only Iowans who received coverage due to the expansion allowed under Obamacare. The change is expected to affect more than 3,300 Iowans each month or more than 40,000 each year.

But the Branstad administration states in its waiver amendment request that it is seeking to align “Medicaid policy with that of the commercial market, which does not allow for an individual to apply for retroactive health insurance coverage.”

The people affected will not only be uninsured Iowans who never applied for Medicaid and then landed in the emergency room. They will include people who had previously secured Medicaid coverage but didn’t realize they no longer had it. Iowans remain in the throes of confusion created by the governor's disastrous privatization of the health insurance program.

Unfortunately, Iowa is no longer a state that wants to ensure the poorest residents receive health care. It is now a state that seeks special federal permission to avoid paying for that care.

This is shameful.

Iowa lawmakers now share blame for Medicaid cuts

When Gov. Terry Branstad decided to privatize Medicaid, he didn’t ask the Iowa Legislature for permission. Ignoring 150 lawmakers, he secured permission from the federal government to hand over administration of the health insurance program to for-profit companies.

Unlike some states, Iowa does not require a governor to obtain legislative approval before seeking a federal waiver to make major changes to Medicaid or implementing those changes.

So much for checks and balances in government.

Some lawmakers griped, but they were able to escape blame for the ensuing privatization disaster. As patients lost care, providers closed their doors and a federal lawsuit was filed against the state for reducing services to disabled people, legislators could maintain they did not vote to funnel billions of dollars to profit-seeking companies. They could claim they didn't have anything to do with the federal waiver that allowed it.

Then a Republican-controlled Legislature approved House File 653, ordering the state to seek a waiver to make life even harder for their poorest constituents. Lawmakers are no longer blameless.