Listening posts indicate Iowans not ready for Governor's plan for Medicaid privatization

by Lissa Blake

When it comes to privatizing Medicaid services for more than half a million Iowans, many people think Iowa Governor Terry Branstad is moving way too fast.
That is the gist of the feedback Iowans are giving at listening posts around the state in regard to the Governor's proposed plan slated to go into effect at the beginning of the new year.
Monday, November 16, around 40 area residents expressed their concerns regarding Branstad’s proposed privatization of Medicaid at a listening post forum held at Luther College in Decorah.
By January 1, 2016, the health care of more than half a million Iowans is scheduled to be turned over to four managed care companies. Because the federal government shares the cost of Iowa’s Medicaid services, opponents of Branstad’s plan hope federal officials will either reject or delay the plan.

OVERSIGHT
Moderating the Decorah post at Luther’s Olin Building were State Senator Amanda Regan (D) of Mason City and State Senator Joe Bolkcom (D) of Iowa City. Both are members of the Joint House and Senate Health Policy Oversight Committee.
Also attending were Iowa Department of Public Services representatives Lindsay Buechel and Sean Bagniewski, who offered to visit with people privately about their concerns following the meeting.
“Local health care providers and families facing very challenging medical issues were blindsided by the move to turn the management of Medicaid over to private companies,” said Ragan. “Iowans are asking basic questions and we still haven’t heard the answers.”
Iowa follows a list of around 30 states that have moved to a privatization of Medicaid; however, according to Bolkcom, Iowa has the shortest turnaround time for implementing the measure. “Other states are looking at 2017 and 2018,” said Bolkcom.

THE CONTROVERSY
Branstad contends that by shifting the state’s $4.2 billion Medicaid program from a state-run system to one managed by private entities, he will save the state $51 million during the first six months. By January 1, 2016, the administration of health care of 560,000 low-income and older Iowans will be turned over to four managed care companies.
Opponents to Branstad’s plan point out the only way for the state to pay for the administrative increase from three to 12 percent will be to deny services to Iowans and cut payments to Iowa providers. “Medicaid privatization directly affects the health care of one in six Iowans,” said Ragan.

MANY CONCERNED
During last week’s listening post, Bolkcom and Ragan heard from a number of representatives from local organizations that serve Iowans utilizing Medicaid as well as patients and family members of patients. Those in attendance included representatives from Winneshiek County Public Health (WCPH), Northeast Iowa Community Action Corporation, Winneshiek Medical Center, area agencies on aging, Iowa Association of Community Providers, HAWC Partnerships for Children, as well as retired physicians, physical therapists, senior case workers and more.
“What we’ve heard from many advocates is how this change is going to seriously impact them,” said Bolkcom, noting that Iowa already has a well-run Medicaid program. “It is a low-cost program with good health outcomes.”
Bolkcom added that the Governor should just slow down. “This change is just moving too fast. There are too many unanswered questions for providers and they’re being asked to sign contracts (with one of the four managed care companies) and they don’t know what the rates are,” he explained.

THE DISCUSSION
Decorah’s Anna Linnell said the impending change is “very scary to not know if your own doctor is going to be able to see you. We have built up relationships and intricate teams of medical professionals… It’s very difficult to think that we may not be able to see those people because we don’t know, out of these four companies, who is going to be seeing whom.”
Sue English, who is retired from Northland Agency on Aging, asked if local case managers are going to lose their jobs. “We just don’t know how these managed care organizations are going to handle case management,” said Ragan.
“I look at how confused and how overwhelming this can be… seniors have always had a local case manager and the Area Agency on Aging was just a phone call away,” said English.
Bolkcom said that is one of the most troubling unknowns about the change. “These people have a relationship with their case workers… The people who do this work have long-term relationships in their communities that have all types of support. If Mrs. Smith needs a special thing, you know how to get that special thing. The network that keeps people safe will be in tatters,” said Bolkcom.
When Decorah’s Dick Janson questioned the fairness of the process used in selecting the four managed care organizations, Bolkcom answered, “The ‘due diligence’ by the governor and his staff has a lot of people shaking their heads.”
Kevin Sand, a retired doctor from Decorah, said he has “great reservations” about the governor’s plans. “I have big concerns. There is no free lunch as far as medical care. Did Branstad decide we need more overhead and we need a for-profit entity to make more profit? The money has to come from somewhere and this will increase the hassle factor for providers,” said Sand.

UNKNOWN FUTURE
Jacque Dawley, whose daughter attends college out of state, asked how the change would affect her daughter’s health care providers. “I was told if my daughter doesn’t pick one of the four (companies), she will be assigned one. If she is assigned one and her doctor signs up later, can she switch?” she asked Medicaid’s Lindsay Buechel, who answered, “Yes.”
Melanie Tietz expressed frustration about the fact her mother, who lives in a long-term care facility, hasn’t received her informational packet about the upcoming changes. “When are they coming, and how can anyone in the Department of Human Services (DHS) or the governor’s office say this will be ready on January 1? My mom has five providers… It’s not going to work. This needs to slow down,” said Tietz.
Brita Nelson, who works for the Iowa Association of Community Providers, said when she has expressed concerns about her clients not seeing a gap in services, she was told, “This isn’t DHS’s first rodeo. We have a plan B. This will be fine.”
“I’d feel better if we knew what was going to happen,” said Nelson.
Leslie Sand, who previously worked for the AEA as a pediatric physical therapist, said she is concerned about developmentally disabled adults. “This is going to be so confusing for them… I don’t want (this process) to slow down. I want it to be reversed,” she said.
Krista Vanden Brink, WCPH nurse administrator, said she has not yet been contacted by two of the managed care organizations. “It makes it impossible for us to take care of the most vulnerable population in Winneshiek County,” she said. “The fact that no hospitals have been willing to sign the contracts should speak volumes to Governor Branstad and our elected officials.”
Decorah’s Barb Dale added she is concerned about the fact these companies’ incentive is the profit. “The Department of Human Services (DHS) could not provide a spreadsheet of how they are going to save $51 million. It’s coming from the savings they will reap from not having to provide services,” she expressed.
Bolkcom said DHS is under a lot of pressure to try to meet the governor’s timeline. “He’s got a date in his mind, and he’s not backing down,” said Bolkcom.

WHAT TO DO
Ragan and Bolkcom encourage all concerned Iowans to let their voices be heard by contacting one of the following:
• Governor Terry Branstad, 515-281-5211
• Andrew Slavitt, acting federal administrator, Centers for Medicare and Medicaid Services, andy.slavitt@cms.hhs.gov.
• State Senator Michael Breitbach, 563-920-7399 or michael.breitbach@legis.iowa.gov
• Representative Darrel Branhagen, 563-419-9991 or darrel.branhagen@legis.iowa.gov.
General inquiries about the plan can be made to the Iowa Department of Human Services at 800-338-8366 (members) or 800-338-7909.