Agency report: Iowa Medicaid complaints doubled in 2017

The number of complaints related to Iowa's privatized Medicaid program more than doubled in 2017.

Posted: Apr 3, 2018 6:40 AM

DES MOINES, Iowa (AP) — The number of complaints related to Iowa's privatized Medicaid program more than doubled in 2017, according to a report released Monday by an independent state agency.

The Iowa Office of Ombudsman said in its annual report that it received more than 225 complaints last year related to the private health insurance companies that run the state's Medicaid program for the poor and disabled.

That's more than double from the nearly 85 related complaints lodged in 2016, the first year Medicaid was switched from a state-run program. The Medicaid program launched in April of that year.

The report includes details on some of the complaints, shedding light on the range of issues that were brought to the ombudsman's office, an impartial agency where citizens can file complaints about state and local governments.

One involved a quadriplegic receiving at-home care whose monthly services were reduced by more than 70 percent, even though his private insurance company had not cited any evidence that his condition had improved. The man was later moved to a nursing home that resulted in more costs to the state. In another case, a health care provider claimed a private insurance company was more than $289,000 behind in making timely payments. The amount was later reduced, but the case was open for more than a year.

Ombudsman Kristie Hirschman said the cases in the report "do not begin to describe the systemic frustration voiced by our complainants."

The report added the agency has received "numerous" complaints from patients whose services were reduced without an official notification, which is required by federal law. One case highlighted involved an 80-year-old woman with several medical conditions who won an appeal to restore services that had been reduced. A few weeks later, her services were denied again. The report called the private insurance company's position "stubborn and absurd, and it makes a mockery of the fair-hearing appeal process."

Hirschman said in the report that she's not convinced the Iowa Department of Human Services is providing adequate oversight of the private insurance companies, known as managed care organization or MCOs. But she added that a bill moving through the Legislature this session could address some concerns.

Matt Highland, a spokesman for DHS, said Monday about the report: "The Department is committed to providing strong oversight of our managed care partners."

Representatives for the private insurance companies have repeatedly defended their work in the state.

The ombudsman's office said complaints overall are up for the fourth straight year, in part because of issues tied to Medicaid privatization and the state's corrections system.

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