Iowa would need to hire 134 additional workers and spend as much as $17 million more a year to properly expand ombudsman oversight of Gov. Terry Branstad’s plan to privatize Iowa’s Medicaid management, a new multi-agency workgroup report shows.
The report mandated by the Legislature includes several key findings behind the privatization plan that has already been delayed once by federal officials because of the state’s unpreparedness:
The recommendation that Iowa hire scores of additional patient advocates would cost just over $16.9 million, according to the report from the state’s long-term care ombudsman and about a dozen other state agencies and offices, including Iowa’s departments of Public Health and Veterans Affairs and its Civil Rights Commission.
The two ombudsmen currently dedicated to oversight of the plan are directed to serve only about 57,000 of it's members and even that is spread too thin, the report says.
“The (Medicaid ombudsman program) as it currently exists does not have adequate staffing or resources to meet anticipated need of even this narrowed group of Medicaid managed care members through the state,” the report says.
The report was mandated as part of a state law passed last year. The goal is to ensure Medicaid privatization doesn’t erode the health care of the program’s recipients. The report is also intended to help guide state officials on to best assist the program's disabled and poor clients when they encounter problems.
The report follows recent legislative hearings In Kansas, where two of the same companies hired by Iowa are accused of systematically denying Medicaid payments in that state. The Iowa report shows Kansas’ ombudsman had nearly 4,000 Medicaid contacts in 2013 and 2014, the first two years that the privatization effort was adopted in that state.
Iowa Department of Human Services spokeswoman Amy McCoy last week described Iowa’s planned oversight as “unprecedented.” But when The Register noted that its plans are — at least structurally — nearly identical to those outlined online by Kansas, she was unable to immediately say what made Iowa’s oversight superior. She said she was unable to touch base with office executives on that question.
The department this week again declined to specify how Iowa’s oversight plan is unique, specifically in comparison with Kansas. DHS has no Iowa-Kansas comparison documents responsive to The Register’s request, McCoy said.
“While our staff may review other states’ experiences as we contemplate Iowa’s program, ultimately, federal regulators will approve Iowa’s waivers based on our state-specific plans,” McCoy said in response.
Branstad did not include the recommendations from the alliance report in his proposed budget released to the Legislature Jan. 12. McCoy said DHS would not comment on whether it would support Iowa hiring more ombudsmen. That office is separate and DHS is not involved with such decisions, she said.
Sen. Janet Petersen, D-Des Moines, said the agency's characterization of its oversight plan falls flat as Iowans learn learn more about how Medicaid privatization efforts have encountered problems in other states.
“Let’s face it, the governor’s Medicaid privatization mess has never been about better care for Iowans, Petersen said. “For (the governor), it’s about saving money and helping his out-of-state company friends churn a profit. I don’t see him giving Iowa families help to navigate his newly created healthcare mess.”
Sen. David Johnson, R- Ocheyedan and a member of the Health Policy Oversight Committee, said he was shocked to read the report recommends hiring more than 100 new ombudsmen.
State officials earlier talked about needing only eight additional ombudsmen. Johnson said he questions whether the proposed savings will materialize, partly because of all the administrative wrinkles Iowa has faced as it tried to launch the plan. Johnson said he believes the hiring level called for in the report is impractical.
Johnson said he believes there will be Medicaid recipients facing problems during the transition but hopes those issues can be resolved in the current setup of state assistance and oversight. Hiring more ombudsmen for oversight might be possible in future years if the state actually realizes savings, he said.
“The recommendation is overwhelming and the cost is beyond this budget to absorb,” Johnson said of the ombudsman’s report.
State Long-Term Care Ombudsman Deanna Clingan-Fischer noted that the alliance that developed the report gave the state options that were less expensive, albeit also less comprehensive for the ideal levels of oversight.
The state has workers that will help answer questions, but they're not ombudsmen, who work as individual advocates to investigate and resolve possible wrongdoing, she noted.
“The alliance felt that there was a definite need for Medicaid beneficiaries to advocate for their wishes and help provide education, support and outreach so they truly understood the transition,” Clingan-Fischer said.
http://www.press-citizen.com/story/...-medicaid-oversight-cost-17-million/78639846/
The report mandated by the Legislature includes several key findings behind the privatization plan that has already been delayed once by federal officials because of the state’s unpreparedness:
- Iowa’s oversight now includes two ombudsmen to investigate complaints in the program that provides health insurance to 560,000 Iowans. The best-practice ratio is one ombudsman for every 3,500 members, or 158 more ombudsmen. (The report recommends at least 134 more.)
- The state should implement a statewide “single point of entry” for Medicaid recipients and their caregivers to access resources, support and assistance with problems related to health care services, coverage and rights.
- Legal aid and disability rights networks should be expanded to meet an anticipated rise in needs of Medicaid members due to privatized Medicaid management.
The recommendation that Iowa hire scores of additional patient advocates would cost just over $16.9 million, according to the report from the state’s long-term care ombudsman and about a dozen other state agencies and offices, including Iowa’s departments of Public Health and Veterans Affairs and its Civil Rights Commission.
The two ombudsmen currently dedicated to oversight of the plan are directed to serve only about 57,000 of it's members and even that is spread too thin, the report says.
“The (Medicaid ombudsman program) as it currently exists does not have adequate staffing or resources to meet anticipated need of even this narrowed group of Medicaid managed care members through the state,” the report says.
The report was mandated as part of a state law passed last year. The goal is to ensure Medicaid privatization doesn’t erode the health care of the program’s recipients. The report is also intended to help guide state officials on to best assist the program's disabled and poor clients when they encounter problems.
The report follows recent legislative hearings In Kansas, where two of the same companies hired by Iowa are accused of systematically denying Medicaid payments in that state. The Iowa report shows Kansas’ ombudsman had nearly 4,000 Medicaid contacts in 2013 and 2014, the first two years that the privatization effort was adopted in that state.
Iowa Department of Human Services spokeswoman Amy McCoy last week described Iowa’s planned oversight as “unprecedented.” But when The Register noted that its plans are — at least structurally — nearly identical to those outlined online by Kansas, she was unable to immediately say what made Iowa’s oversight superior. She said she was unable to touch base with office executives on that question.
The department this week again declined to specify how Iowa’s oversight plan is unique, specifically in comparison with Kansas. DHS has no Iowa-Kansas comparison documents responsive to The Register’s request, McCoy said.
“While our staff may review other states’ experiences as we contemplate Iowa’s program, ultimately, federal regulators will approve Iowa’s waivers based on our state-specific plans,” McCoy said in response.
Branstad did not include the recommendations from the alliance report in his proposed budget released to the Legislature Jan. 12. McCoy said DHS would not comment on whether it would support Iowa hiring more ombudsmen. That office is separate and DHS is not involved with such decisions, she said.
Sen. Janet Petersen, D-Des Moines, said the agency's characterization of its oversight plan falls flat as Iowans learn learn more about how Medicaid privatization efforts have encountered problems in other states.
“Let’s face it, the governor’s Medicaid privatization mess has never been about better care for Iowans, Petersen said. “For (the governor), it’s about saving money and helping his out-of-state company friends churn a profit. I don’t see him giving Iowa families help to navigate his newly created healthcare mess.”
Sen. David Johnson, R- Ocheyedan and a member of the Health Policy Oversight Committee, said he was shocked to read the report recommends hiring more than 100 new ombudsmen.
State officials earlier talked about needing only eight additional ombudsmen. Johnson said he questions whether the proposed savings will materialize, partly because of all the administrative wrinkles Iowa has faced as it tried to launch the plan. Johnson said he believes the hiring level called for in the report is impractical.
Johnson said he believes there will be Medicaid recipients facing problems during the transition but hopes those issues can be resolved in the current setup of state assistance and oversight. Hiring more ombudsmen for oversight might be possible in future years if the state actually realizes savings, he said.
“The recommendation is overwhelming and the cost is beyond this budget to absorb,” Johnson said of the ombudsman’s report.
State Long-Term Care Ombudsman Deanna Clingan-Fischer noted that the alliance that developed the report gave the state options that were less expensive, albeit also less comprehensive for the ideal levels of oversight.
The state has workers that will help answer questions, but they're not ombudsmen, who work as individual advocates to investigate and resolve possible wrongdoing, she noted.
“The alliance felt that there was a definite need for Medicaid beneficiaries to advocate for their wishes and help provide education, support and outreach so they truly understood the transition,” Clingan-Fischer said.
http://www.press-citizen.com/story/...-medicaid-oversight-cost-17-million/78639846/
