Iowa Providers Still Struggling with Medicaid Privatization
Fewer Services, Rising Costs Cited in New Provider Survey
DES MOINES – A new survey released today finds Iowa Medicaid providers are still struggling under Governor Branstad’s privatization plan, which began earlier this year. Providers said the privatization plan has led to increased costs, reduced services for clients, and even forced them to borrow money because they are not getting paid on time.
“These survey results confirm what Iowans across the state have been saying to us for months: The Medicaid mess is a major burden for Iowa health care providers. That’s terrible news for thousands of Medicaid recipients because it will lead to reduced access to care and poorer health outcomes,” said Rep. Lisa Heddens of Ames, Ranking Member of the House Human Services Budget Committee.
According the survey, 90% of providers have seen their administrative costs increase and nearly two- thirds of them have received lower reimbursement rates. Nearly eight in ten providers said they are not getting paid on time and 28% of providers have been forced to take out loans to cover their expenses while waiting for payment.
“Ever since Governor Branstad turned over management of Iowa’s Medicaid system to three out-of-state corporations, Iowa physicians and other health care providers have faced more hurdles and headaches as they have attempted to provide quality healthcare. These survey results are more evidence that the Medicaid mess is getting worse, not better,” said Sen. Liz Mathis of Robins, Chair of the Senate Human Resources Committee.
Providers who completed the survey also said services for Iowans on Medicaid will suffer as a result of privatization. Forty-six percent of providers said they have, or will be reducing services, while 61% said quality of services is suffering as a result of privatization. Of those surveyed, 38% also said their clients are no longer able to continue seeing specialty providers out-of-network.
“We must continue to listen to Iowans, be vigilant about holding Governor Branstad, the Department of Human Services, Iowa Medicaid Enterprise and the out-of-state corporations accountable for their actions to ensure that vulnerable Iowans get the health care they deserve,” Mathis added.
The survey was completed by over 400 Medicaid providers from around Iowa, including doctors, hospitals, local clinics, and non-profit health care providers.
Highlights from Medicaid Provider Survey
423 Responses from Iowa Providers
- 46% of providers will or are planning to reduce services
- 80% have seen an increase in the rates of denied claims since privatization began
- 19% said their organization or clients have successfully appealed denials, while 45% have not
- 61% said privatization has reduced the quality of services they can provide
- 38% said Iowa Medicaid patients are not able to continue seeing their specialty providers out-of-network
- 90% said Medicaid privatization has increased their administrative costs
- 28% of providers have been forced to take out loans to cover their expenses while waiting for payment
- 66% said reimbursed rates have been lower than their contractual rates
- 79% of providers said they are not getting paid on time
Comments from Medicaid Providers
“We cannot provide for our patients if we can’t get things implemented. No one can ever give us a straight answer. What a mess. If we can’t get things approved, we can’t help the patients.”
“Personally, it has harmed our most vulnerable locally, as they now have little to no options for some services (such as those on the ID Waiver program) and sometimes no local options at all (with this being a rural area and limited providers who are not on all three MCOs).”
“MCOs not reimbursing the Medicare coinsurance amount that was reimbursed previously. Also, we have patients that went to Mayo Clinic previously and would be better served to remain with them but they are being told they will have to transition to another provider that is in-network. Some of these patients are children with cancer and they will have to re-establish with a different facility with new faces and this can be terrifying to a child. The MCOs don’t care about that fact. They are more interested in saving money.”
“The switch has caused a significant hardship to rural mental health centers. Our agency has had to take out loans and some staff have volunteered to go without pay for a couple of pay periods. This is all because the MCOs owe approximately $200,000 to us at this time. We are forced to do new process, but are not told about it until we follow up on denials. The MCOs were not at all prepared for what they took on in such a short time. We need help!!!!”
“We are facing a dangerous situation with one particular MCO denying authorization for care needed to keep clients in their home. They are ignoring the Iowa Medicaid coverage benefit for home health clients. This situation is deplorable!”
“(Privatization has) harmed the level of care. We can have patients in 10/10 acute pain that are referred to PT but according to certain MCOs, we have to perform only an evaluation and cannot treat this person. We then submit a request for therapy treatment and at times are waiting 3-4 weeks to receive the green light to be able to perform treatment. This is not serving our patients in the best manner.”
“Some simply cannot get medication that they previously could. Some have had to shift to alternatives that do not work or do not work as well. Most alarmingly, at the two residential centers, the only places I actually treat Medicaid only patients, the standard for staying in long-term treatment has drastically changed to the point where it is jeopardizing the entire system. Both facilities are spending dramatically more time reviewing cases with the MCO’s and less time in care and care coordination.”