As complaints mount, Iowa lawmakers shirk oversight of privatized Medicaid

A legislative committee tasked with oversight of the for-profit companies that manage Iowa’s Medicaid system hasn’t met this year, undercutting the state’s contention that the companies are being held accountable, critics say.

The Legislature’s Health Policy Oversight Committee was tasked in 2015 with evaluating the state's privatization of its Medicaid system, specifically to ensure the effective administration of the program, which provides health care to 568,000 poor or elderly Iowans.

But despite a record number of complaints and a federal lawsuit alleging Medicaid services are being illegally or improperly cut, the 10-member legislative committee has yet to convene in 2017.

“It was set up, and it was given lots of lip service, and now it hasn’t met," said Bill Dodds, president of Optimae LifeServices, a statewide mental health agency. "… I just think (Medicaid privatization) is somewhat on automatic pilot, and the goal is focused on money.”

Iowa’s Department of Human Services has held public meetings throughout Iowa to discuss issues with privatized Medicaid management.

However, the legislative Oversight Committee arguably is more influential since its roster includes some of the most powerful lawmakers in the state.

Its previous meetings have served as public forums where citizens and lawmakers directly discussed issues with representatives of the private companies.

The committee is supposed to meet at least twice a year. The last meeting was in December 2016.

The legislators contacted by The Des Moines Register about their committee’s lack of activity blamed opposing party members or the ongoing complexities regarding secret payment negotiations with the private companies.

Those negotiations were supposed to be completed by July 1, and the ultimate decision could cost taxpayers millions of dollars more each year, depending upon the outcome.

By not meeting, the committee is effectively stifling Iowans' ability to speak out about their concerns with the state's privately managed Medicaid program, some health advocates said.

“If they were supposed to meet, and if they haven’t done it, then you can’t (publicly) comment,” said Kerry Sauser, a family nurse practitioner and registered nurse who owns and operates Complementary Care Health & Wellness in Atlantic.

Sauser submitted comments to the committee a year ago expressing concern that some of the companies had delayed payments to doctors for their Medicaid services by four or more months.

In addition, the amount paid to doctors was cut by as much as 64 percent, making it hard for some medical providers to continue to offer Medicaid services, she warned.

Sauser’s Aug. 26, 2016, letter was made public through the committee and led to Sen. Tom Shipley, R-Nodaway, and Rep. Tom Moore, R-Griswold, contacting her.

Her letter is among the last public comments the committee has posted.

Sauser said regular meetings would help Iowa’s elected officials better identify and resolve issues associated with the transition.

“If they said they were going to meet, then they ought to do it,” Sauser said.

The making of the committee

Then-Gov. Terry Branstad decided in early 2015 to privatize management of Iowa’s $4.2 billion Medicaid program, contending it would become more effective and save tens of millions of dollars annually.

The companies the state hired — AmeriHealth, UnitedHealthcare and Amerigroup — began managing the program in April 2016, following a three-month delay after federal officials determined the state wasn't ready for the transition.

The move was highly controversial.

Critics in 2015 warned that management by private companies would mean that profits, not public health, would drive decisions regarding the poor or elderly Iowans who use the program.

The oversight committee was established as part of a system to hold the private companies accountable.

DHS spokeswoman Amy McCoy this month said DHS’ role in the committee’s work and schedules is minimal.

“The committee is a legislative committee,” McCoy said. “Our only role would be to confirm dates when the committee wishes to meet.”

Bob Welsch, a member of the Johnson County Task Force on Aging, last year presented concerns to the committee that he said are still continuing.

He also questioned the committee’s lack of public meetings.

“One of our basic questions is: Has the goal of managed care been achieved? How much money has been saved?” Welsch said.

Lawmakers disagree

Sen. Mark Costello, R-Imogene and co-chairman of the committee, said he believed the intent was to meet later this year, but there have been no significant talks about that schedule.

Costello said he hasn’t heard many complaints from constituents about the new privatized Medicaid management system. He believes the companies have made improvements and the system is working relatively well.

Part of the delay in meeting is because of the Department of Human Services' ongoing negotiations with the private management companies, said Rep. Dave Heaton, R-Mount Pleasant and the other co-chairman.

Heaton has ongoing concerns about a possible lack of "case workers," employees who work directly with Medicaid recipients and wield influence about what medical services the private companies will pay.

He acknowledged it might be helpful to review that issue through his committee before new contracts are signed with the private companies.

“I think by now we should be operating a lot more smoothly with a lot less controversy,” Heaton said. “Other states have. I just don’t understand why it continues to be rocky.”

Sen. Liz Mathis, a Democrat who represents the Cedar Rapids area and is a member of the committee, blamed Republicans for the committee's inactivity.

Mathis said she and her party have made multiple inquiries about the committee’s meeting schedule to Republicans. But the matter is out of their hands, since Republicans control the Iowa House and Senate, she said.

Mathis said she agrees with advocates who question the committee's role.

​​​​​​“Those meetings are not only to give us (lawmakers) the status of what’s going on, but also to tell the public what’s going on,” Mathis said.