Newsletter: Rozenboom Report (2/12/2016)


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More than 560,000 Iowans are covered by Medicaid, the $4.5 billion federal/state health care administered by the state of Iowa. Since 2003, the annual cost to Iowa taxpayers for the state portion of Medicaid has increased from $430 million to $1.718 billion. That kind of increase simply is not sustainable. The rising Medicaid costs prompted the state to find ways to modernize how it delivers services to Iowa’s Medicaid recipients by using Managed Care Organizations (MCO). There are 39 states which have managed care in some form. Nationally, nearly 70 percent of Medicaid participants have their care overseen by private, managed-care companies.

The average Medicaid patient has over 4 chronic conditions, sees 5 different doctors, and has 6 different medication prescribers. All those providers are all paid a “fee for service” but there is no incentive to track patient outcomes. The MCO’s will use care coordinators to deal with all the conditions together, stop using the current fragmented system, and improve the health of Medicaid recipients. The objective is to control costs, which is essential to contain unsustainable costs in the future. In the past, Iowa has contracted with MCO’s to deliver services for people with behavioral disabilities and for pregnant mothers served under the former Temporary Assistance to Needy Families program.

As the Medicaid modernization started, a Request for Proposals was issued February 16, 2015, by the Iowa Department of Human Services to deliver healthcare services for the Iowa Medicaid, Iowa Health and Wellness Plan, and Healthy and Well Kids in Iowa (hawk-i) programs. The intent was to contract on a statewide basis with companies which had a demonstrated capacity to coordinate care and provide quality outcomes for the patients. Going to a managed care system allows the state to hire companies to coordinate care and manage spending just as insurance companies do in the private sector.

Under the terms of the state contracts, the managed care organizations cannot cut services or pay providers less than a base rate in order for those companies to earn their profits. The Medicaid Modernization was originally planned to be fully implemented on January 1, 2016, but was delayed to March 1 by federal officials.

While the Department of Human Services has spent the past year moving toward the change and awarding three managed care contracts, Senate Democrats spent the last several months trying to halt the process. On Thursday, Senate Democrats brought forward legislation to fully stop the implementation of Medicaid modernization. That legislation did pass the Senate, but it will almost certainly be blocked in the House because it faces a certain veto by the Governor.

Yes, there are concerns regarding access to providers and services, but those problems have been addressed in recent months. The Iowa DHS has established a 24-hour call system to address these matters in a timely manner. The number of providers that serve Medicaid patients continues to grow, and more nursing homes would be covered under the proposals of the three managed care organizations. Those Iowans currently in nursing homes will see no change for at least two years.
Under the Medicaid modernization plan, quality patient outcomes and access to care are two important goals set forth by the state. This is something I expect from my health care providers, and I believe Iowa’s Medicaid recipients deserve the same.

Many other issues are being worked on in the House and Senate. Next Friday, February 19, is the first “funnel” deadline, which means that bills that have not successfully been approved by one of the standing committees in either the House or the Senate are dead for the year. That means that next week will be even busier than the last with committee work.

I will be at Eggs and Issues in Oskaloosa on Saturday morning, February 13, from 8:30 – 9:30, and in Centerville from 10:00 – 11:00 AM on Saturday, February 20 at the Chariton Valley Planning & Development office at 308 N 12th Street.

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