A new special report out this weekend from the Des Moines Register highlights the human toll of ReynoldsCare. The report reveals extensive issues with Iowa’s privatized Medicaid program, including denials of medically necessary care.
“Our hearts are with the families struggling to receive basic, lifesaving care under this horrendous ReynoldsCare system. This is a failure of the highest degree from the Governor and nothing but bold and decisive change will be enough to fix it,” said Iowa Democratic Party Chair Troy Price.
“Governor Reynolds was repeatedly warned that these unacceptable and inhumane conditions were happening and going to get worse in our state, but it took her over two years to admit there was a problem. Even now, she’s saying this is a personnel issue, but the official she brought in to ‘save’ the program has an arguably worse record of providing care. It’s time for her to set aside the partisanship and help us save these people.”
Excerpts from the report can be found below:
DES MOINES REGISTER: Care denied: How Iowa’s Medicaid maze is trapping sick and elderly patients in endless appeals
“Due process violations: In at least four cases, administrative law judges concluded or the Medicaid recipient alleges in ongoing district court appeals that the companies failed to properly notify recipients about health care reductions and their appeal rights.
Denials of in-home care: Medicaid expenses for in-home care that had been routinely approved when the state ran the program are now being rejected by managed-care providers as unnecessary and outside the scope of what the program authorizes. Families say they are left struggling to care for their loved ones, who are losing their independence and autonomy.
Endless appeals: Even when Medicaid patients win their cases in administrative hearings, the managed-care companies routinely “re-evaluate” their health needs, again denying their care in as little as 60 days. That forces patients to embark on yet another round of appeals.”
“ ‘The denial of care for Medicaid services, especially those who had already been approved through the state, is an endemic problem in Iowa,’ said Jen De Kock, a Des Moines attorney who represents the family of a suicidal teen who repeatedly was denied placement at a psychiatric medical institution for children.”
“At the Nov. 28 meeting with the governor, Foxhoven said Iowa ranks among the top in Medicaid customer satisfaction, citing a J.D. Power survey released in July. J.D. Power refused to disclose who paid for the survey or how it was conducted.”
“Iowa’s long-term care ombudsman in early 2016 warned lawmakers that failure to provide proper oversight of privatized Medicaid would result in the types of fraud and mismanagement that have dogged other states.”
“Since Iowa has shifted to managed care, state officials have recorded at least 501 ‘corrective actions’ or compliance violations against the private companies for failing to follow Medicaid rules.”
“The three companies hired by Iowa — AmeriHealth, UnitedHealthcare and Amerigroup — are paid up to 12 percent of the program’s annual $4.8 billion cost.
The state’s previous annual management costs were between 4 and 8 percent. Advocates of private management say a long-term savings can be achieved through system-wide efficiencies implemented by the companies.
But savings, so far, have been elusive.”