Des Moines Register. Dec. 5, 2021.
Editorial: Privatized Medicaid’s wrongful denials of care hurt Iowans. Lawmakers must investigate further — and act
National companies that manage Iowa’s privatized Medicaid system are illegally denying care to some of the hundreds of thousands of poor or disabled Iowans who depend on the public health care program, contends a report released this fall from the state auditor’s office.
As has become common with criticism from the auditor’s office, Gov. Kim Reynolds and Medicaid Director Liz Matney quickly dismissed the report as flawed and much ado about nothing.
But the immediate finger-pointing about how rates of change were calculated misses Auditor Rob Sand’s larger point: Wrongful denials of care hurt Iowans.
Those denials simply must be investigated further. If having private companies administer Medicaid services to Iowans was really working great, the state would crow about it and show everybody the receipts.
Straightforward documentation would back up assertions about how much money Iowa is saving and how turnaround times and outcomes are improving in comparison with the previous state-administered system.
Officials would — faced with this report alleging that managed care organizations were more frequently misapplying rules for what services are covered — provide the correct figures to show why that isn’t so.
But Iowans aren’t seeing such documentation. To be sure, the Department of Human Services collects, analyzes and publishes all sorts of data and touts testimonials from enrollees. The standard, though, should be higher than providing great service to some Iowans, adequate service to most, and no service at all to those who purportedly should qualify, particularly for a privatized system that replaced a trusted, reliable, state-operated program.
When it comes to the well-being and dignity of vulnerable people, Iowans should expect that any indication of providers falling short and letting people fall through the cracks will prompt investigation and, when needed, policy changes.
Evidence of problems has mounted in the five-plus years since the switch to private management. Needed services haven’t been covered. Health providers haven’t been reimbursed, which threatened their ability to stay open. Most of the 900 health providers who responded to a survey by Sand’s office in 2020 said the private system had “harmed or impeded” access to care in Iowa.
The assurances that Reynolds and her deputies have given as answers to such revelations suggest they want us to believe that those dreadful experiences are anomalies — though they’ve been described over and over, by advocates, Medicaid recipients, family members and providers.
Their unsatisfying responses to Sand’s latest report, on how often administrative law judges are reversing managed care companies’ denials of services, fit that pattern.
Before the switch, Medicaid recipients who were told that the government won’t pay for a particular service could appeal for review from a state administrative law judge. Now, recipients have an initial review that their managed care company handles alone, but they usually can still appeal to an administrative law judge if they remain unhappy with the situation.
Sand’s office measured similar time periods (about three years) before and after the 2016 change and found that the number of appeals to the state judges has decreased. But the number of cases where judges found the companies had wrongly denied services increased, from 139 to 231.
The auditor’s report crunches the figures further to show an 890% increase in the percentage of cases where a judge overturned a care denial. That’s one place where state leaders have cried foul, calling it an “apples to oranges” comparison.
“We have seen the administrative law judge reversals go up proportionally in terms of the greater pool,” Matney told an editorial writer Friday. “That’s not particularly surprising.”
Sand has had a colorful response to that criticism — “It’s not even just apples to apples; it’s Honeycrisps to Honeycrisps,” he said after the report’s release. A University of Iowa expert said the office’s methodology was sound. “You’re not going to be able to explain all of that variance just by saying, well, these are the harder cases that are harder to predict,” Sand said last month at a forum hosted by the group Upgrade Medicaid.
We’ve written dozens of times now that the managed care approach has been disastrous for individual Iowans while providing no obvious benefit to most Medicaid users or to taxpayers. We also have acknowledged that with staunch supporter Reynolds at the state’s helm, the managed care approach isn’t going anywhere. So the immediate task for everybody involved is to identify, advocate for and carry out incremental improvements.
That could be insisting that companies use standard medical coding in their work, as state Rep. Mary Wolfe suggested during the same Upgrade Medicaid forum. It could be providing more resources to the state Managed Care Ombudsman Program, or expanding its scope. It could be ensuring that the next company to participate in managed care in Iowa is better than Iowa Total Care, which Sand’s report indicated is struggling to fulfill provisions of its contract with the state, such as demonstrating how much of the taxpayer money it receives is spent on health care.
Even better would be demanding a comprehensive examination of the managed care program, good and bad, by the Legislative Services Agency, as we advised in 2018 in prescient words worth repeating: “Right or wrong, Iowa’s auditor, who is elected and affiliated with a political party, will inevitably be viewed as having an agenda on privatized Medicaid. And the office is not the best one to comprehensively tackle this issue anyway.”
“Remain calm, all is well!” is a disappointing answer to this and earlier earnest investigations. Iowa can and needs to do better in fulfilling its Medicaid obligations. Lawmakers from both parties should agree on an independent agency that will conduct an independent evaluation that they’ll take seriously — and act on. Their constituents should insist on it.
Sioux City Journal. Nov. 28, 2021.
Editorial: As school board members, be a positive force for change
Congratulations to new school board members throughout Iowa.
Among locally elected officials, you play one of the most important roles. You’re not only making decisions for today, you’re affecting our children, our community, our state and our nation for years to come.
Take the job seriously and question proposals you’re given and changes you’re expected to make. Just because someone has the loudest voice in the room doesn’t mean it’s the one you should follow.
Just when you think you’ve heard enough to make an informed decision, take a minute and listen to one more person. Your conscience will thank you.
In Sioux City alone, we’ve seen parents concerned about curriculum, new programs, testing and mask mandates. Just this week, the board had to confront substitute teacher shortages and the growing problem of teacher burnout. Don’t rush to judgment.
Change is as inevitable as a new school year. The idea of virtual classes is something many never considered five years ago.
While specific issues may have fueled your desire to be on the board, don’t make them the focus of your tenure.
Remember: Students, teachers and staff have been through the most difficult two years in recent history. They’ve had to adapt to changing times, lost traditions. Get in the classrooms and talk to them. See what matters and determine how you can meet their needs.
Need proof? Discarding classes in cursive writing may not seem like such a big deal until you hand a child a letter from a grandparent and he or she can’t read it.
Similarly, promoting science, technology and math over writing, reading and the arts creates an imbalance that is often difficult to regain. Fund wisely. Fund well.
Think back to your own education. Remember those teachers who had an impact on you and try to recall what they did to make you want to learn. Lean into that. Schools decades – even centuries – ago produced scholars, leaders, politicians, parents and soldiers who have gotten us through some of the most trying times in history. They, too, had passionate boards.
Be that kind of representative.
And when you hand out diplomas at the end of this school year, be sure you can say you did everything possible to prepare graduates for a future that they never could have imagined.
Be a positive force for change. Future generations will thank you.
Fort Dodge Messenger. Dec, 2, 2021.
Editorial: Lights at Kennedy makes season festive
As Christmas approaches, the campground at John F. Kennedy Memorial Park is once again being transformed into a holiday wonderland. The 18th annual Lights at Kennedy will help make the season more festive for area residents and visitors. Additionally, the event raises money to support the important Backpack Buddies program.
The light display, featuring 32 different exhibits, debuts Friday night. It will be open again on Saturday and Sunday nights.
In addition to this weekend, the upcoming dates are Dec. 10-12 and Dec. 17-19.
The display will be open from 6 p.m. to 9 p.m. on each of those days.
The suggested donation is $5 per vehicle.
All of the donations will support the philanthropic efforts of the event’s sponsors, the Fort Dodge Noon Sertoma Club and the Fort Dodge Young Professionals. Backpack Buddies is one of the best known of those efforts. Since 2010, it has filled the backpacks of elementary school-age children from low income homes with nutritious food to eat during the weekends.
The numerous Christmas-themed displays that are at the heart of Lights at Kennedy are sponsored by businesses and organizations. This enjoyable outing has become a holiday tradition for many Fort Dodgers. It is a superb adventure that can be enjoyed by the whole family. Along the way, there’s a good chance participants will encounter Santa and his many helpers.
Each year there are changes and enhancements to keep the event fresh and exciting.
This month is filled with seasonal events that make it a joyous time of year. The Messenger strongly urges readers to include Lights at Kennedy on their hectic holiday agendas. The outstanding displays will help fill you with holiday cheer. Your visit to Kennedy will also help fund a truly worthy local endeavor – Backpack Buddies.