Medicaid Proves to be a Winning Topic in this Year’s Pulitzer Prize Contest


Stories about Medicaid earned top honors in this year’s Pulitzer Prize contest: editorial writer Andie Dominick from the Des Moines Register earned a top prize for her columns on the consequences of Iowa’s transition to Medicaid managed care, and health journalist Andy Marso won a finalist mention for his coverage of the lack of transparency in KanCare’s Medicaid disability program, as part of the Kansas City Star’s series on secrecy in Kansas state government. The Star team was a Pulitzer finalist in public service journalism.

In both cases, the reporting focused on the lack of transparency for patients and providers interacting with Medicaid managed care plans. In Kansas, caregivers for disabled adults and children enrolled in Medicaid were asked to sign blank care plans that they later learned would cut home health care for their family members.

From Marso:

“The Star found other caregivers who were asked to sign off on plans of care without knowing if they included cuts — one of several concerns about transparency that have arisen since the state became the first in the country to privatize its entire Medicaid program by establishing KanCare in 2013…

Bea Judah, a Gardner resident whose 14-year-old daughter receives KanCare services because of severe autism, said an Amerigroup employee asked her to sign a blank iPad screen this year at the end of her daughter’s annual assessment.

Laura Singer, a case manager Judah had hired from Funkhouser’s company, stepped in.

“Laura stopped him and said, ‘Well, how do we know you’re going to comply?’ ” Judah said. “ ‘This isn’t written up in any document, you’re just asking her to sign something.’ ”

Judah said that based on Singer’s advice, she didn’t sign the plan until she got paper copies in the mail that showed how many hours her daughter would receive. But Judah said if Singer hadn’t been there, she probably would have signed the blank screen.”

In Iowa, Dominick’s columns put a spotlight on the quick shift of hundreds of thousands of people from state-run to privately-run Medicaid coverage, with little time to prepare. In one Dominick’s columns, she and the paper’s editorial board expressed outrage after one of the three managed care companies contracted for Iowa’s Medicaid program dropped out, and another froze enrollment.

They wrote:

Having no option in which insurer controls your access to your health care runs counter to former Gov. Terry Branstad’s claim that his privatized Medicaid experiment gives Iowans “more choice than ever before.”

It also runs counter to federal requirements. States that contract out Medicaid management, as Branstad insisted on doing in 2016, must offer recipients more than one option for health insurers.

Last Tuesday’s notice from DHS to lawmakers said the Centers for Medicare and Medicaid Services had “approved a temporary suspension” of the choice requirement. Then a federal spokesperson said the state had not been granted approval. Then the state came back and said it didn’t need approval.

One business day later, DHS confirmed it would resume direct oversight of Medicaid for about 10,000 of the 215,000 Iowans for an undefined period of time.

Confused yet?

Try being a disabled person who relies on in-home caregivers. Or an elderly person in a nursing home. Or a health provider who has no idea whom to bill for services next week.

Welcome to “modernized” Medicaid, Iowa.

Foisted on 600,000 people by a governor who now lives in China, privatization has delivered daily uncertainty for the vulnerable and forced state workers to pluck ideas from thin air to accommodate private insurance companies pocketing millions of precious public health dollars for administration.

Who knows what change DHS will announce tomorrow or next week.

What is known: Patients have lost access to care. Health providers stiffed by for-profit insurers have closed their doors. Taxpayers are funding everything, including the postage on hundreds of thousands of mailings to try to keep Iowans apprised of never-ending changes. And even top state officials seem unaware of what the future holds.”

To be sure, some states have had success when working with Medicaid health plans. For instance, a recent report from the National Association of State Health Policy details strategies from six states on how they’ve worked with plans to serve children with special health care needs. Others states, however, have struggled to ensure access to health care for Medicaid enrollees in managed care plans.

In a paper from CCF’s Andy Schneider published earlier this year, he detailed how there is “no single set of measures in common use by state Medicaid agencies and CMS to assess whether children enrolled in MCOs are receiving quality care, and there is no publicly accessible national database with information on how well individual MCOs are serving children.” In 2016, CMS under the Obama administration published regulations to bring more accountability and transparency to Medicaid managed care, but advocates are concerned that key provisions could be delayed or repealed by the Trump administration.

Reporting on Medicaid is complicated and takes a lot of time, which keeps it on the back burner for most reporters. For those who decide to dive in, we are grateful for their work in bringing to light the stories of families working to take care of their children and support their communities. Congratulations to the Kansas City Star, the Des Moines Register, and to the many other journalists and news organizations who bring health care stories to life.



Maggie Clark
Maggie Clark is a Senior State Health Policy Analyst at the Center for Children and Families (CCF)