Democratic senator calls for public meeting on Medicaid cost savings estimates

May 29--A lawmaker says she sees "too many similarities" between Iowa's Medicaid managed-care program and that of another state that's had a troubled history.

State Sen. Pam Jochum, D-Dubuque, cited differing savings estimates by Iowa's Department of Human Services, a recent auditor's report in Kansas that said it couldn't determine whether that state had seen any savings, and the fact Iowa next year will have the same three managed-care organizations that now operate in Kansas.

The long holiday weekend did not dispel the questions surrounding the latest cost savings estimates of privatized Medicaid released by DHS on May 17. Those numbers don't match previous estimates made by the Branstad administration and recent department reports.

After Gov. Kim Reynolds in a news conference last week described the blowback as "political" and invited members of the media to review the projections with Michael Randol, the director of the Iowa Medicaid program, Jochum released a statement Tuesday saying she was willing to do just that.

"I accept the offer," Jochum told The Gazette Tuesday. "And no this is not political. This is very personal. This is personal as a legislator who is getting many phone calls from people who are struggling under the privatized system."

Jochum also called for the meeting to be open to the public.

Reynolds' spokeswoman Brenna Smith said Randol would be glad to sit down with the senator.

"The governor remains committed to improving the quality of care provided by Medicaid modernization because it is far more proactive and patient-centered than the previous system," Smith said in an email The Gazette.

DHS officials did not immediately respond to requests for comment.

The estimates released earlier this month stated the state had saved a "projected annual range" of $140.9 million by switching its program to managed care, but did not clarify how officials calculated that estimate.

The $140.9 million estimate is much higher than figures released in the latest quarterly report published in December by DHS, which stated Iowa was expected to save $47.1 million for the current budget year ending in June.

These estimates also differed from the initial savings amount -- up to $232 million this budget year -- that then-Gov. Terry Branstad predicted before the state's Medicaid program moved to private insurers.

"DHS's newly released analysis reflects that our Medicaid program is the only way to ensure a responsible and sustainable program as health care related costs continue to rise," Smith said.

Following the release of the $140.9 million figure, Jochum asked State Auditor Mary Mosiman last week to subpoena documentation from DHS and the three managed-care organizations that administer Medicaid coverage "to determine if Iowans are really saving money by paying out-of-state, for-profit insurance companies to care for our most vulnerable," according to the letter obtained by The Gazette.

"They've changed their numbers in a very short amount of time -- so what is it?" Jochum asked The Gazette, adding she would like to see the information and calculations used by DHS to arrive at the estimates.

Jochum also cited an auditor's report out of Kansas that said that state's savings couldn't be determined because the data was too unreliable. She said there were "too many similarities" between Kansas and Iowa.

Kansas switched its Medicaid program to managed care in 2013. Both states, Jochum said, moved its entire Medicaid population to the new system all at once, rather than moving enrollees in stages over time.

Come 2019, Iowa and Kansas will have the same private insurances companies handling its Medicaid program. Those companies will be Amerigroup, UnitedHealthcare and Centene.

KanCare, the $3.2 billion Kansas program that Randol oversaw for five years, has been the subject of controversy since its 2012 launch. Proponents touted the program as a success, saying it saved the state $1 billion while caring for about 400,000 enrollees.

Critics, however, say problems, such as cut services for members and late payments to providers, still riddle the system.

A letter from federal officials in late 2016 said investigators found the KanCare program was "substantively out of compliance with federal statutes and regulations, as well as its Medicaid State Plan," according to a report in the Kansas City Star.

In October, the federal Centers for Medicaid and Medicare and CHIP Services granted Kansas a 12-month extension of KanCare, which gives state officials time to implement a corrective plan and to draft a new version of the privatized Medicaid program.

Independent auditors concluded earlier this month, at the end of a yearlong audit, that the state of Kansas's data was so unreliable, there was no way to know KanCare's effect on cost savings, patient outcomes and other factors, according to an article in the Kansas City Star.

"These data issues limited our ability to conclude with certainty on KanCare's effect on service use and limited our ability to interpret cost trends," the auditors wrote, according to the Kansas City Star. "More significantly, data reliability issues entirely prevented us from evaluating KanCare's effect on beneficiaries' health outcomes."

Iowa seems to be running into the same problem, Jochum said. Without transparency, how can legislators, enrollees or health care providers have a complete picture of the program's impact?

Jochum said she hopes revealing the actual numbers will start the conversation to fix the "colossal mistake" that is managed care.

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