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Todd Mouw was a 53-year-old who had lived for 32 years as a quadriplegic with medical staff that visited his home. The state-contracted Managed Care Organization (MCO) decided that his staffers weren’t qualified and wouldn’t pay. Without this assistance, his health deteriorated. He was later admitted to the hospital, and died within three months of the company’s decision.

This was not the first, nor likely the last, tragedy that had resulted from the state’s switch to privatized Medicaid.

Citing concerns about cost increases, then-Gov. Branstad privatized the state’s Medicaid services in 2016 by contacting with MCOs. Managed care is designed to ensure health services are delivered most effectively in order to reduce costs. It generally works with people whose health is undermined by their behavior, not for developmentally or severely physically disabled individuals.

Unlike the 37 other states that opted to use managed care for selected patients in Medicaid, Iowa joined Kansas as the only states to turn the entire program over to private firms.

So what have some of the effects been? The University of Iowa Dental College no longer accepts new Medicaid patients, stating that “program has become so complicated that we no longer have the ability or resources to effectively” serve new patients. The Iowa Dental Association executive director stated this year that the program “has become administratively unworkable for our members.”

A provider in Colfax had $12,000 of billable charges but was reimbursed for only $600. Another company had $30,000 of unreimbursed services. A nursing home in Guthrie Center reported that they were owed $300,000 in May of this year. Like other providers, they’ve used reserve funds, transferred resources and discussed bank loans.

Companies with their own specific processes have created significant challenges for providers seeking to navigate the complex, competing or conflicting rules. As a board member for a non-profit serving developmentally challenged individuals, I know that those seeking to provide services are extraordinarily frustrated. Dr Dave Paulsrud of Jackson Recovery describes the process as “administrative waterboarding.”

After three years, there is no data to show improved care. Nor has there been a sound method to determine any alleged savings. In addition to the impact on providers, however, has been the effect on individuals.

In addition to the 53-year-old paraplegic, a 12-year old disabled child who relies on a feeding tube was denied feeding fluid three weeks ago. After fighting the decision, he will continue with the services – for the next four months.

Matthew Hudson became paralyzed by bleeding on his brain as a teenager. His father, David, worked for Gov. Branstad in the 1980s, and until recently, served as co-chair of Iowa’s Medical Assistance Advisory Council. Hudson feels that MCOs “look at people like Matt as problems. He’s not a problem . . . he’s a human being.”

Oscar Wilde wrote that some “people know the price of everything and the value of nothing.” How much are people with severe disabilities worth? How much time and effort should their loved ones have to spend in order to keep them alive? As citizens and taxpayers, the government is acting in your name.

Inserting a third party between providers and the state creates plausible deniability for politicians. Problems raised to the state by clients or providers get blamed on the MCO, which in turn can blame the state or providers. The system might contain costs, but it removes accountability.

Perhaps you aren’t concerned, since you aren’t on Medicaid. Just remember, you or your loved ones don’t choose to get brain injuries, become paralyzed, or so sick that there is no other option. What would you want then? Then, ask the candidates .

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