opinion

Is Iowa purposefully breaking the law or just incompetent?

Re: “1 Medicaid insurer down, 2 to go," Nov. 14

I completely understand the desire to return to a state-administered Medicaid program with its lower administrative costs and faster provider reimbursement timelines.

I also realize the state of Iowa entered into contracts with managed-care organizations as allowed by federal law. These contracts were originally entered into between a willing buyer and willing sellers. The state was required to negotiate for a basket of services that meet the federal Medicaid requirements.

Now that AmeriHealth Caritas has pulled out of Iowa, I find myself asking: 1) Did the state have personnel knowledgeable enough to contract for what is required by federal law? The lawsuits filed by Iowa Medicaid recipients will shed some light on whether or not the contracts call for the required services. 2) If the state did enter into adequate contracts, does it have the personnel necessary to adequately monitor the private MCOs to see that they are delivering the full range of services agreed upon?

Is inadequate oversight the reason services have been reduced and providers have to wait so long for payments? After all, as managed-care organizations are paid on a “per member/per month capitated payment” they have an interest in limiting services and slowing down payments.

We are left with two possibilities: 1) Iowa has either deliberately or inadvertently entered into contracts that potentially violate federal law, or 2) DHS has entered into adequate contracts, but the agency lacks the desire or the expertise to monitor the contracts.

None of these possibilities bode well for Iowa, Iowa Medicaid recipients and Iowa health care providers. Either the governor is willing to gamble with violating federal law and harming fellow human beings, or her administration is incompetent to carry out its duties.

— Anne Kinzel, Ames