Des Moines, Iowa (AP) — Privatized Medicade System in Iowa illegally denies service and care to recipients of the program, and both private insurers that control the system are in the state announced Wednesday. According to an audit by Iowa, it violated the terms and conditions of the contract with the state.
Auditor Rob Sand has released a report of a survey that surveyed the six years from 2013 to 2019. His investigators said they found a significant increase in illegal care denials by managed care organizations (MCOs) under privatized Medicaid.
“This means that privatized Medicaid is unlikely to treat Iowan in accordance with the law. It means that the Medicaid MCO we have contracted does not support the end of the negotiations. “Sand said.
The head of the Medicaid program in Iowa responded within minutes of the release of the audit, rejecting that conclusion, claiming that Sandoz was making a false “apple-orange comparison” of the current program’s characteristics. Did.
In 2016, former Republican Governor Terry Branstad suddenly moved the Iowa Medicaid program from being managed by the Iowa Department of Human Services to a private insurance company. His successor, current Republican Governor Kim Reynolds, helped privatize in complaints that services were suffering, payments to service providers were sometimes delayed, and that savings were not realized. I’m continuing.
Such privatization has become a popular idea among Republican politicians who have claimed that private companies manage Medicaid more efficiently than state agencies. Today, private Medicaid managers provide medical care to more than 781,000 poorly disabled Iowans.
According to Sandoz, after privatization, the number of cases in which judges resumed service to Medicaid participants increased by 891%, concluding that the service was illegally denied by the private insurance company that manages the program.
After being elected in 2018, he promised to produce a compliance report on Medicaid after service providers and recipients complained about the new system not providing equal care and payment.
“It’s been a while. It’s been a lot of work. We’ve reviewed tens of thousands of documents, but in the end, what this is is a statement of fact,” said Sandoz. “It tells Iowans what’s happening in the state. We’re working. It’s about people.”
Sandoz also reported that the two companies that manage the Medicaid program, Amerigroup and Centene Corp., are operating as Iowa Total Care and have violated the terms of the contract established with DHS.
He said the Amerigroup failed to comply with one clause of the contract and the ITC failed to comply with many clauses of the contract. For example, in multiple documented cases, the two companies did not comply with the terms and conditions that required home and community-based service providers to continue to serve members switching from one provider to another. bottom.
“This prevented members from receiving services such as bathing and wound care, violating contracts, state and federal law, but the company is still being paid for care,” Sandoz said in a report. increase.
In her statement in response to the report, Medicaid director Elizabeth Matney called the audit an “inaccurate and flawed report.”
According to Matney, the report inaccurately compares the previous “service fee” system with a managed care approach that allows an appeal to be resolved without having to go to an administrative law judge. Such judges can focus on more complex cases.
“We worked with a team of state auditors to explain why this is a comparison of apples and oranges,” said Matney. “The process is not the same, so it is wrong to compare without considering the improvements incorporated into the MCO appeal process before meeting an administrative law judge.”
She said more information would be needed to substantiate the claims in the audit report.
She said the department was considering allegations of contract breach and offered to meet with Sandoz to discuss in more detail, agreeing that “contract compliance requires diligent oversight.” rice field.
Suggest a fix
Auditor: Iowa’s Privatized Medicaid Illegal Refuses Care | WGN Radio 720
Source link Auditor: Iowa’s Privatized Medicaid Illegal Refuses Care | WGN Radio 720