In the wake of a recent announcement federal investigators will conduct a deep dive into privatized Medicaid, Iowa lawmakers and the public are anxious to see what they uncover about the formerly state-run system.
On April 4, U.S. Sen. Bob Casey, D-Pennsylvania, wrote a letter to the U.S. Department of Health and Human Services inspector general requesting the office investigative nationwide reports "alleging that some Medicaid managed care companies continuously deny care to patients sorely in need of care."
The letter referenced articles from the Dallas (Texas) Morning News and Des Moines Register when providing examples of mismanaged care for poor, elderly and disabled patients.
"The United States went through this Mueller investigation for a year-and-a-half," said state Sen. Rich Taylor, D-Mount Pleasant, referencing the special counsel investigation into whether members of President Donald Trump's 2016 campaign coordinated with Russia to influence the election. "I don't think we've seen anything compared to what we're going to find when they open up this can of worms."
The inspector general's inquiry into Medicaid managed care won't draw near the national frenzy that followed Special Counsel Robert Mueller's investigation, but it will provide sought-after information for Iowa Medicaid recipients and health care providers who are impacted significantly by the new system, implemented in 2016 by then-Gov. Terry Branstad.
Sen. Casey, a ranking member on multiple health care committees in Congress, posed eight specific questions in the letter, including, "Do Medicaid MCOs systemically deny care to patients?" and "Do children, people with disabilities, older adults or individuals with complex or chronic conditions face additional hurdles in gaining access to care from Medicaid MCOs?"
"Due to concerns that some MCOs are putting their bottom line ahead of patient health and safety, I am requesting that you open an investigation into this industry to shed light on whether all patients enrolled in Medicaid managed care can successfully access the services to which they are entitled," Casey wrote.
In addition to the announcement of a federal investigation, Iowans learned late last month a new MCO will enter the marketplace this year to replace UnitedHealthcare (UHC), set to turn over its patients July 1.
"It's a debacle," said state Rep. Jeff Kurtz, D-Fort Madison. "This whole privatized Medicaid issue has been in flux since it started."
UnitedHealthcare serves about 425,000 of the roughly 600,000 Iowans receiving Medicaid services. In Lee County, Kurtz said, more than 6,000 people will be transitioned to incoming MCO Iowa Total Care. In Des Moines County, 7,203 people, about 62 percent, of Medicaid recipients are insured by UnitedHealthcare, according to an analysis by the Iowa news site Bleeding Heartland.
Wayne Marple, president and chief financial officer at Inhance Corporation in Fort Madison, predicted Iowa Total Care would have a difficult time serving a significant portion of the state's Medicaid population due to its limited size and resources compared to UHC.
"I'm sure you're going to be getting a lot of calls over the summer and into the fall with providers not getting paid by Iowa Total Care," said Marple, at a legislative forum last week in Fort Madison. "It's just going to happen, unfortunately. They're brand new, they're small compared to UHC. UHC was the best of the three (MCOs), and now they're gone."
As a result of the federal investigation, which has an unknown timeline, Taylor said he expected "to see some drastic changes."
"If we're going to be stuck with this system, we have to see some drastic changes," he said.
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