Tag: Issues

Feds launch investigative review of oversight of privatized Medicaid

Iowa Senate News Release
For Immediate Release:  April 17, 2019

 Key Iowa Senators applaud investigation by U.S. Inspector General

DES MOINES – The U.S. Office of Inspector General has launched an investigative review of whether federal officials are providing sufficient and appropriate oversight to ensure that people with Medicaid are receiving the care to which they are entitled.

Citing the lack of oversight of privatized Medicaid by Governor Reynolds and the Republican-controlled Legislature, two key Iowa State Senators today praised the new investigation.

“Since it was launched three years ago in Iowa, privatized Medicaid has been unsustainable, unaffordable and unaccountable,” Senator Amanda Ragan of Mason City and Liz Mathis of Hiawatha wrote in a letter to U.S. Inspector General Daniel R. Levinson. “There has been little effort by the Governor or majority party in the Iowa General Assembly to provide proper oversight for the out-of-state managed care organizations (MCOs).”

The Senators added: “Medicaid advocates, policymakers and other taxpayers deserve an investigation by the Inspector General that provides an answer to the question that we have asked since the start of Medicaid privatization in Iowa: Are some MCOs putting the bottom line ahead of patient health and safety?”

The Inspector General initiated the review of the oversight role of the Centers for Medicare & Medicaid Services (CMS) at the request of U.S. Senator Robert Casey of Pennsylvania, Ranking Member of the Special Committee on Aging.

In his request, Casey cited reports from across the country “alleging that some Medicaid managed care companies (MCOs) continuously deny care to patients sorely in need of care. In some cases, patients have experienced entirely preventable life-altering harms.”

“Medicaid is emblematic of who we are as a nation, reflecting who we value and the ideals we are willing to fight for,” Casey added. “We must ensure Medicaid MCOs live up to these ideals and provide Americans with the health care that they deserve.”

In its description of the investigation, the Inspector General acknowledges that privatized Medicaid “can create an incentive to deny beneficiaries’ access to covered services.”

“Our review will determine whether Medicaid MCOs complied with Federal requirements when denying access to requested medical and dental services and drug prescriptions that required prior authorization,” the agency’s website states (https://tinyurl.com/y2x257yx ).


Don’t let Medicaid mess undermine children’s health insurance

Iowa Senate News Release
Senator Nate Boulton
Representative John Forbes
For Immediate Release:  April 15, 2019


Don’t let Medicaid mess undermine Iowa’s successful children’s health insurance program

Two members of the board of Hawki, Iowa’s nationally recognized Hawki children’s health insurance program, today raised concerns in a letter about maintaining quality as it becomes part of Iowa’s troubled privatized Medicaid program.

“This is another challenging transition for Iowa families,” said Senator Nate Boulton.  “Unitedhealthcare had been a Hawki provider for more than five years.  Those families need as much support as possible to make sure their care is not interrupted.  Specifically, we must make sure providers continue to welcome Hawki kids into their care.”

“The Hawki transition is another opportunity for the Reynolds Administration to show that it has learned from past mistakes,” said Representative John Forbes.  “Iowans were promised that a privatized health care system would increase quality and access to care. However, too often they have instead gotten more headaches and problems.”

Hawki provides low-cost health coverage for more than 70,000 children from working families across the state.   The Hawki Board of Directors guides the Department of Human Services’ efforts to develop, implement and administer the Hawki program.

The questions for the board included:

  • How will the Board/DHS communicate with Hawki families about the transition from UnitedHealthcare to one of the two remaining managed-care organizations, Amerigroup Iowa or Iowa Total Care?
  • How will the Board/DHS communicate with schools across the state to make sure that parents and school officials are aware of the upcoming changes?  This is especially concerning for parents/guardians because they will be scheduling annual physicals, immunizations and other routine care during the summer months.
  • How will parents/guardians learn whether they will be able to keep their current pediatrician or other health care provider if they are transitioning to Amerigroup Iowa or Iowa Total Care?
  • How will the Board/DHS ensure healthcare providers continue to see Hawki as a secure and trustworthy benefit program, one that they want to be involved with?