The average cost of insuring an Iowan on Medicaid has climbed nearly three times as fast since the state hired private companies to manage the program, when compared to the previous six years, new state figures show.

Since fiscal 2017, the first full year of privatization, the per-member cost of Iowa's Medicaid program has risen an average of 4.4 percent per year, according to the non-partisan Legislative Services Agency. In the previous six years, the per-member cost rose an average of 1.5 percent per year, the agency said.

The new cost figures come amid continuing controversy over whether Iowa should have hired private companies to run the $5 billion program. The shift’s supporters said it would slow growth in health care spending on the more than 600,000 poor or disabled Iowans covered by Medicaid.

The Legislative Services Agency compiled the new cost increase figures from past budget reports published by the Department of Human Services, which oversees Medicaid.

The human service department's leaders defend Iowa’s transition to privately managed Medicaid and contend the per-member cost figures can be misleading. They said some years' cost totals could be inflated because they include bills paid for services that were provided to Medicaid members in previous years.

But a leading critic of privatized Medicaid said the new numbers are clear evidence the transition is not fulfilling its promises.

“From Day One, we’ve doubted privatization of Medicaid would save money,” said state Sen. Liz Mathis, a Hiawatha Democrat. She said the numbers should be hard to dispute, since they come from the department’s own reports.

Mathis said the department has yet to offer solid data backing claims that private Medicaid managers have prevented costly health problems. “They’ve been unable to show any data that Iowans are better off,” the senator said.

Republican Gov. Kim Reynolds said in an interview Wednesday she remains confident in the promise of private Medicaid management, despite the new cost numbers.

Reynolds said Department of Human Services administrators have assured her part of the explanation for the recent spike in per-member Medicaid costs was bills incurred in past years were being paid in the current budget year.

Reynolds’ Republican predecessor, Gov. Terry Branstad, ordered the shift to private Medicaid management in 2015.

The change has become a major issue in this fall’s elections for governor and Legislature. Reynolds said she remains open to making changes to the program, but she continues to believe it is on firmer footing than Iowa’s previous Medicaid system, which was directly run by state administrators.

“Iowans need to be confident that I, as the governor, am going to make sure we have a sustainable program in place that can take care of their loved ones,” Reynolds said. She added that many Iowans are pleased with the services they are receiving under the current Medicaid system.

Reynolds said that doesn't mean she's satisfied with the way everything in Medicaid is going. She vowed to continue talking to Medicaid members, families, service providers the managed-care companies and outside experts.

"We'll find out where the pain points are and what we need to do differently," she said. "That's what I'm focused on."

Some of the per-member cost numbers were in a budget report Medicaid Director Mike Randol presented last week to an advisory committee for the Department of Human Services. Randol, who works for the department, told the committee he didn’t know what was behind the numbers, which were included in a chart going back to fiscal year 2015.

After the meeting, Randol told reporters he was unsure of the meaning behind the chart included in his report.

“I didn’t create that chart, so I need to go back and understand the background,” he said. “I need to understand the numbers behind the chart and understand the factors that could potentially be driving the increase.”

The Des Moines Register obtained more extensive per-member Medicaid cost figures from the Legislative Services Agency. The agency prepares detailed reports for legislators on an array of issues. Jess Benson, an analyst for the agency, said he found comparable budget figures going back to fiscal year 2011.

The Medicaid cost increases for this fiscal year are partly driven by an 8.4 percent raise the Iowa Department of Human Services agreed last month to give the two managed-care companies running the program. That raise, which includes state and federal tax dollars, will send $344 million more to Amerigroup and United Healthcare this fiscal year, which runs through June 2019.

Department of Human Services spokesman Matt Highland said this week that if per-member Medicaid costs were re-figured to reflect only the cost of services provided to members in each fiscal year, the increases would be less steep.

The cost increase for fiscal year 2018 would be just 1.4 percent instead of 6.6 percent, he said, and the increase for fiscal year 2019 would be 5.6 percent instead of 11 percent. However, his new figures did not show corresponding increases in per-member costs for the previous two years.

The chart Randol offered last week included projected per-member spending on Medicaid for the next two budget years.

It showed state administrators expect those costs to drop 4.7 percent next fiscal year, then climb 1.8 percent the following year. Those projections, however, did not include any raises the state might negotiate with the managed-care companies for those years, which could significantly push up taxpayer spending.