Iowa agency reduces Medicaid oversight requirements in bill
By BARBARA RODRIGUEZ
Feb. 11, 2018
DES MOINES, Iowa (AP) — An Iowa health agency is proposing to roll back requirements in its oversight of the state's privatized Medicaid program, a move that comes amid growing public scrutiny over the department's plans to improve the program.
The Iowa Department of Human Services requested a bill be filed last week in the Legislature that would reduce how often it must report performance data on the health care program for the poor and disabled. The legislation would also remove some consumer protection metrics and eliminate a requirement that the agency report its expected savings under the privatized system.
The department insisted the bill will not worsen transparency and is aimed at increasing flexibility in presenting data to the public.
The wide-ranging proposal surprised lawmakers, both Republican and Democrat, who worked to enact oversight provisions in 2016 when the program was turned over to private insurance companies, known as managed care companies or MCOs.
"We had all these different things that we wanted the department to report on," said Rep. Dave Heaton, a Mount Pleasant Republican who worked on the requirements and reviewed the new legislation in a House subcommittee meeting last week. "Here comes this department bill ... that wants to take away a lot of those sources or points of information."
The oversight language is tucked into a bill that proposes a range of technical changes for the department, from how it oversees a federal-state children's program to medical-related incarceration data. That's part of why it advanced out of the three-person panel that included Heaton. But those lawmakers say they want to see several changes, particularly on the oversight proposal, before the bill can move out of a full House Human Resources Committee this week.
Rep. Lisa Heddens, an Ames Democrat on the subcommittee, said department officials implied to her that the information would be available on the agency's website. She said that requires a level of effort from legislators and the public that may obscure critical data. She said constituents contact her daily with issues that are measured in the agency data.
"To me the bill was kind of a way of just saying, 'We're just not going to provide that to you now. You can go search for it,'" she said of DHS. "No. We need as much transparency."
DHS appears to have been considering the bill for months. In a Nov. 27 letter made recently available about the legislation, the agency wrote the oversight section changes — particularly releasing program reports annually rather than quarterly — was an effort to improve its system. "It is the goal moving forward to collect as meaningful data as possible and report on a frequency that reflects actual trends and program evaluation," the department stated.
Department spokesman Matt Highland said the proposed changes are needed to give state officials more flexibility in structuring data to make it helpful to stakeholders. He pointed out some data points in existing reports are not mandated by law. He also said the department plans to still include data about savings, but would instead describe it as "cost avoidance." Removing the codified language helps allow that.
Rep. Kevin Koester, an Ankeny Republican who was on the subcommittee, said he understands if the agency sees room for improving existing oversight language in Iowa law. Still, Koester said he's working on an amendment that keeps more requirements in place.
"We're completely disinterested in a notion that takes transparency away and public access as well as legislator access to information about how Iowans are being served through the program," he said.
Iowa privatized its roughly $4 billion Medicaid program, which serves about 600,000 residents, in 2016. At the time, former Gov. Terry Branstad argued the new setup would be more efficient and save the state money. Since then, health care providers and Medicaid recipients have filed complaints about reduced services and delayed reimbursements. Data on costs also shows the state hasn't reached its intended goal on savings.
Gov. Kim Reynolds, a Republican who is seeking her first four-year term as governor, has acknowledged there have been mistakes in the program's transition.
The department has vowed to make improvements, though the agency has released few specifics on its plans. Some legislators have taken action themselves, introducing several bills aimed at fixing different aspects of the Medicaid system.
Jane Hudson, executive director of Disability Rights Iowa, said in an email the Department of Human Services needs to provide more oversight, not less. She's particularly concerned about language in the bill that would eliminate a requirement for the agency to make sure the MCOs continue benefits during an appeal process.
Disability Rights Iowa helped file a lawsuit against the state that claimed the privatized system has cut services for disabled patients, but the suit was dismissed.
"This bill looks like DHS is washing its hands of the state's Medicaid responsibilities and is turning the keys to our health system over to private for-profit companies," she said.
The bill is House Study Bill 632 .