Dismissal of Co-Chair of Iowa Medicaid Advisory Panel is Setback for Much Needed Oversight

Medicaid is evolving. Its consumer advisory committees should too.

State Medicaid programs are bureaucracies, and it’s understandable that agency leaders may not always have a pulse on what’s happening with members and providers and plans at any given moment. That’s why federal law has long required states to set up medical care advisory committees (MCACs), so that agency leaders can hear directly from providers and beneficiaries about what’s happening on the ground. The committee members are appointed by the Medicaid director or a higher-ranking official, and the panels are supposed to represent the voice of the people and providers who interact with the Medicaid program every day.

MCACs came of age in the fee-for-service era of Medicaid, where the relationship between members and providers and the state Medicaid agency was more direct. Now, with most states contracting with managed care organizations to deliver care, the role for the committee is less clear but potentially even more important, as they can sift through the extra layer of complexity that managed care companies add to Medicaid administration.

In Iowa, the committee members made it their business to hold plans accountable. In the two years since Iowa rolled its entire Medicaid population into managed care, the consumer members on the Medicaid Assistance Advisory Council—the state’s MCAC—were frequent critics of the managed care plans when they heard reports of people with disabilities being denied critical services.

When a disabled man died after a managed care plan stopped paying for his in-home care and moved him to a South Dakota nursing home, the committee hammered plan executives, demanding to know why they cut payments.

But earlier this summer, two appointed committee members, who frequently spoke up for people with disabilities, were disinvited to participate in the committee next year.

Gov. Kim Reynolds recently rejected the request of David Hudson, who had been the committee’s co-chair, to stay on the council another year. Hudson had served as a lobbyist for former Gov. Terry Branstad, who put the managed care program into place. Branstad appointed Hudson, a fellow Republican, to the committee because of his experience caring for his son with severe disabilities. He asked tough questions of the health plans and the state, and he says that got him dismissed. 

“I felt that I was asking the questions the governor should have been asking,” he said in an interview with the Des Moines Register. “… I guess I pushed back too hard or something.”

Reynolds disputes the claim, saying it’s always good to have new perspectives in the committee.

On the one hand, it’s troubling to think that someone who asked questions and spoke up for vulnerable people might have been silenced by powerful interests. But it’s a sure sign your questions have touched a nerve when you get silenced. It’s also a sure sign that the committees can be an important source of accountability for managed care plans, making program improvements and giving voice to the millions of people enrolled in plans who depend on Medicaid for survival. 

This evolution of the medical advisory committee concept is taking shape in other states too.

For instance, in Colorado, the state Medicaid agency is using the advisory committee model to create both in-person and virtual “member experience advisory councils” to help the agency engage directly with members and their families and caregivers on what’s working in Medicaid and what’s not. The state still has an official advisory committee, but the 10- and 14-member experience councils respectively provided input on dozens of topics last year, including the format of redetermination letters, health plan communication, and the creation of a “customer journey map.” The councils are part of the agency’s goal of “working with members and families, not doing things to or for them.”

More voices at the table is a good thing. And having more consumer voices in the mix takes the pressure off the one or two “squeaky wheels” who often carry the weight of speaking for thousands. As Medicaid programs continue to grow and change, official Medicaid advisory committees and their offshoots have the potential to be an important oversight and advocacy vehicle to make Medicaid work better.

Maggie Clark is a Program Director at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.