Governor drops Medicaid adviser who spoke up for disabled Iowans after services were cut

Tony Leys | The Des Moines Register

Show Caption Hide Caption David Hudson's reaction this summer after he was denied reappointment Medicaid adviser David Hudson was bitter after his request for reappointment to Iowa's Medical Assistance Advisory Council was denied.

Gov. Kim Reynolds has dropped an outspoken Medicaid adviser who repeatedly voiced concerns about how private management companies were treating Iowans with disabilities.

David Hudson spent two years as co-chairman of Iowa's Medical Assistance Advisory Council, whose duties include monitoring the state's shift to private management of its $5 billion Medicaid program.

“I felt that I was asking the questions the governor should have been asking,” he said in an interview at his Windsor Heights home. “… I guess I pushed back too hard or something.”

A spokeswoman for Reynolds declined to comment on Hudson’s contention that he was pushed out for being outspoken. The governor on Tuesday announced four new appointees to the council. They did not include Hudson.

Hudson, 61, served as a lobbyist for then-Gov. Terry Branstad in the 1990s. He said Branstad, a fellow Republican, appointed him as co-chairman of the Medicaid council two years ago because of his experience caring for his profoundly disabled son, Matthew. Matthew, 30, is covered by Medicaid, the joint state and federal health-care program.

Hudson said he initially supported Branstad's 2015 decision to hire private companies to manage care for the 600,000 Iowans on Medicaid. But he said he felt a duty to speak up when he saw those companies cut crucial services to his son and other Iowans with disabilities.

Hudson believes his detailed inquiries led Branstad's successor, Reynolds, to deny his request for reappointment when his council term expired June 30.

Reynolds and other supporters of private Medicaid management say it is leading to more efficient, effective care. Critics say privatization has led to drastic cuts in services for disabled people and piles of unpaid bills to the agencies that provide their care.

Hudson supports privatization concept, but not how it works in Iowa

Hudson said he still believes in the concept of private Medicaid management, and he didn’t set out to make waves as co-chairman of the advisory council. But he believed his assignment was to represent the interests of disabled Iowans and their families.

In a council meeting last November, Hudson sharply questioned the circumstances leading to the death of Todd Mouw, an Orange City man who was paralyzed from the waist down. Mouw’s widow had blamed the 53-year-old man’s death on his managed-care company’s unwillingness to pay for the kind of care that had let him remain in their home for years.

During the meeting, Hudson grilled a representative of the company, Amerigroup. “Where was the case management for Todd?” he asked. “Why wasn’t there a fight to the death to get Todd the services he needed so he could come home? … This is what’s so troubling. The managed care version that I want is the version that comes with a soul.”

The Amerigroup official, Natalie Kerber, told Hudson she couldn’t comment on an individual case. Hudson responded by saying he understood her position, but he continued to air his frustration. “All I know is that you disqualified caregivers that had been with him for years,” he said of Mouw. “… Your decision triggered this whole avalanche of misery and hardship and eventually tragedy.”

At several other council meetings, Hudson referred to his own family’s struggles with another managed-care company. He said AmeriHealth Caritas had threatened to cut off payment for much of the care Matthew Hudson was receiving in their home.

Matthew Hudson was paralyzed by sudden bleeding on his brain when he was a teenager. Now, he can't walk, see, speak or feed himself. His parents, David and Mary Jo, help provide daily care, for which Medicaid pays. If not for such assistance, Matthew would need to live in an expensive, specialized facility, such as a state institution, his parents said.

AmeriHealth backed off its attempt to cut the family's benefits after a lawyer from the advocacy group Disability Rights Iowa helped the Hudsons file a formal appeal last year. AmeriHealth, which reported losing hundreds of millions of dollars in Iowa, pulled out of the state last fall after failing to negotiate substantially higher payment rates from the state.

In a Jan. 4 council meeting, Hudson shone a spotlight on state officials' drastically reduced estimate of how much Iowa taxpayers were saving by having private companies manage Medicaid. The new Department of Human Services estimate said those annual savings had dropped 80 percent, from $232 million to $47 million. The department had published the reduced savings estimate on page 50 of a 70-page report, which Hudson highlighted during the public meeting.

His disclosure led to Des Moines Register coverage of the plummeting savings estimates. The news sparked outrage among critics of privatized Medicaid, who said it showed privatization had failed to live up to promises from Branstad and his successor, Reynolds.

Medicaid Director Mike Randol, whom Reynolds hired, revised the savings estimate up to $141 million in May. Hudson pushed for details on why the number kept changing.

After Hudson learned in July that he had not been reappointed to the advisory council, he wrote a letter to State Auditor Mary Mosiman, asking her to investigate Randol’s specific claim that the state is avoiding costly hospitalizations.

Mosiman, a Republican, agreed in June to a Democratic legislator’s request that she review how the Department of Human Services estimates state savings from privately managed Medicaid. Her spokesman told the Register recently the agency would not comment on whether the review will include looking at hospitalizations.

Hudson served as council co-chairman with Iowa Department of Public Health Director Gerd Clabaugh. Hudson said Clabaugh encouraged him this spring to request reappointment, saying the council valued his insights as the parent of a disabled Iowan covered by Medicaid. Clabaugh declined to comment to the Register on the situation.

Department of Human Services Director Jerry Foxhoven, whose agency oversees Medicaid, said he and his staff did not encourage the governor to drop Hudson as co-chairman of the advisory council. "We didn't ask for that," Foxhoven said in a brief interview. He said he didn't know why Hudson lost the seat, but added, "I think there's always an attitude of 'There ought to constantly be some new blood' in some groups."

Reynolds also didn't re-appoint another critic

The council has an executive committee, with about 12 members, which meets monthly. The full council, with more than 50 members, meets quarterly. Hudson was co-chairman of both and was paid $50 per meeting. He and two other members of the executive committee, Jodi Tomlonovic and Julie Fugenschuh, were not reappointed by Reynolds when their terms expired June 30.

Tomlonovic is executive director of the Family Planning Council of Iowa, but said she represents the public on the Medicaid panel. Like Hudson, she was a critic of the impact of privatization.

Fugenschuh, the executive director of the Project Iowa job-training program, did not request reappointment, but was disappointed Hudson and Tomlonovic were dropped. "I do believe he and Jodi asked hard questions that sometimes made people uncomfortable," she said.

Reynolds' office announced June 29 that she had appointed an Ankeny physician, Amy Kumagai, to fill a board vacancy. But the governor's spokeswoman, Brenna Smith, later said that announcement was in error. On Tuesday, the governor's office announced Reynolds had made four appointments to the full council, which is to meet Thursday. The new appointees are Thomas Broeker of Burlington, Jason Haglund of Story City, and Amy Shriver and Marcie Strouse, both of Clive.

Smith said the council will decide which members to appoint to the executive committee and as the new co-chair. "Gov. Reynolds is proud of the people she’s appointed. She’s working to incorporate new individuals with unique perspectives, including members who are willing to be vocal about what’s not going right, but also individuals who have an increased focus on mental health issues," Smith wrote in an email to the Register.

Hudson said he will continue to advocate for his son and other Iowans with serious disabilities.

Matthew Hudson sat silently in his wheelchair as his father explained the situation last month. The young man was covered in a blanket and wore a stocking cap because his body struggles to maintain warmth. His eyes shifted side-to-side, and he occasionally made small sounds as his father spoke.

David Hudson said the family's current Medicaid management company, UnitedHealthcare, is spending about $5,000 per month on his son's in-home care. He worries that the Medicaid companies, known as managed care organizations, will always be looking to cut services to such Iowans because they require so much assistance and their health will never improve.

"I think the MCOs look at people like Matt as problems,'" Hudson said. "... No. He's not a problem. He is expensive, but he's a human being."