Iowa Public Radio

By: Katarina Sostaric

Ads are flooding screens and mailboxes in Iowa calling the state’s move to privately-managed Medicaid a failure and a health care crisis.

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The program start was delayed by federal regulators. Then complaints started mounting from patients who were denied services, and care providers who were taking financial hits from delayed payments and higher administrative costs. “It seems like the state really did botch the rollout and has been playing catch-up ever since,” says Joan Alker, a research professor at Georgetown University and national Medicaid expert.

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Alker said Iowa seems to have failed to learn lessons from the nearly 40 other states that already had managed care. “I would say that anytime a state moves to managed care in Medicaid, problems will emerge,” Alker said. “But Iowa’s problems seem to be especially severe.”

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Medicaid officials say managed care is saving the state money, but questions about that claim have led the Republican state auditor to look into the issue. Alker said this uncertainty is not surprising. “There really isn’t good evidence to suggest that Medicaid managed care has saved money. And we’ve had managed care around for many years, so this isn’t news,” Alker said. “And certainly the state should’ve been aware of that.”

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Alker said one state has gotten rid of Medicaid managed care. But she says states really need to take a more active role in overseeing these for-profit insurance companies. “And making sure that these taxpayer dollars are spent wisely, and that kids and people with disabilities and others are getting the services they need,” Alker said.

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