State. Rep. Steven Holt (R-Crawford) is entering the 2020 legislative session with the intention of addressing continued challenges with Iowa’s Medicaid system.
“We continue to have a lot of challenges in managed care that I’m deeply concerned about,” Holt said. “Most recently, I heard in the middle of the contract year, one of the managed care providers has but by more than half what they are paying for certain services, and even lower than what the provider can do it for basically. So, it’s really an unacceptable situation.”
It’s an issue the legislature will need to address, he said.
“The feedback I’ve received so far is yes, they did it and they have the ability to do it within the contract,” Holt said. “I don’t think they should have the ability to do that in the middle of a contract year.”
It is yet another speedbump in what has been a clunky process since Iowa switched its Medicaid system a few years ago.
“I can’t speak for Governor Branstad and what he might’ve anticipated for problems, but I can certainly speak for myself and say what the legislature was told and led to believe was certainly not what has taken place,” Holt said. “I don’t mean to suggest anybody misled anybody, I don’t think some of the issues we’ve had were anticipated. Other states moved to managed care a little bit at a time. We moved it all at one time. I think that, probably in retrospect, wasn’t a great idea.”
Holt said the initial cost structure wasn’t accurate, and that also resulted in many problems.
“It’s used in 39 other states to varying degrees of success,” Holt said. “We were on an unsustainable path financially. The trajectory was up in a way that it was absolutely unaffordable and going to eat up the entire budget. We’re led to believe this is saving us some money. I think that is probably true, but I think we’re also seeing, without a doubt, a reduction in care and a reduction in services and reliability for payments for the providers.”
Holt said a hospital in his district was owed more than $1 million. He, along with Senators Jason Schultz and Mark Segebart, spoke with the Managed Care Organization and Iowa Medicaid Enterprise and a few days later the hospital was paid about $750,000 of what they were owed.
“Improvements are being made,” Holt said. “However, in general, there are still tremendous problems that remain and this needs to be addressed. The MCOs need to make timely payments. If in fact in their contracts they are allowed in the middle of the contract year to make such a drastic cut, I think we need to really look at that. That doesn’t make a lot of sense to me in terms of stability. The danger here is a lot of providers are talking about not taking Medicaid. We cannot allow that to happen.”