Collective Bargaining Iowa

Sen. Liz Mathis, D-Cedar Rapids, speaks during debate on the floor of the Iowa Senate in 2017.

DES MOINES --- Long-term patients in Iowa’s Medicaid system would be returned to public management under a package of proposals floated by Iowa Senate Democrats.

A pair of Senate Democratic leaders said Thursday they acknowledge private management of the state’s $5 billion Medicaid program is here to stay under all-Republican control at the Iowa Capitol.

But minority Senate Democrats said they have legislative suggestions to fix some the problems with private management system that helped make it one of the top issues in the state’s 2018 gubernatorial campaign.

“It looks like the governor and the Legislature are going to hold fast to privatized Medicaid,” said Amanda Ragan, the top Democrat on the Senate’s health care budget committee. “We still think there are clearly some things that need to be changed.”

Former Gov. Terry Branstad in 2015 established the managed care program, under which private companies assumed management of the public health care program for disabled and low-income residents. The goal was to reduce state costs while still offering the same or better services to Medicaid recipients.

Critics, including Medicaid recipients and their family members, say managed care has resulted in fewer services, and health care providers have raised concerns about late reimbursement payments.

Among the provisions in the Senate Democrats’ bill is one that would move long-term patients out of private management and back under state management. Democrats argue the services required for those patients are too significant to work under a program managed by for-profit, private companies.

“I’ve said over and over that the architecture of this was flawed from the beginning when we pushed everyone across the table into managed care,” said Liz Mathis, the top Democrat on the Senate’s health care policy committee. “The commercial insurance template doesn’t fully pay for these issues or provide for the care around these issues.”

Among the other provisions in the Democrats’ bill:

• If a patient's doctor switches the health care company with which he or she is contracted, the Medicaid recipient can do the same. Currently, Medicaid recipients must wait up to 45 days before petitioning for such a change, Democrats said.

• Require independent case management and patient assessments. Those are now performed by the management companies, which Democrats say is a conflict of interest.

• Create an external review process for providers. Now, when one of the health care management companies denies a claim, the health care provider can only attempt to negotiate with the management company, Democrats said. Their legislation would establish a separate appeals process.

“Managed care is here to stay. We all know that. So what can we do to improve it at this point,” Mathis said. “This bill is an attempt to call attention to some of the things that are still problems and some of the things we can fix if we still have the will to do that.”

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