Hunter
10/20/21
State Auditor Rob Sand released a report Wednesday showing that the privatization of Medicaid in Iowa has resulted in a five-to-nearly-nine-fold increase in members being illegally denied services or care.
The report studied a six year period, analyzing data for the three years before and three years after the state went to a managed care system.
When services are denied or reduced by Medicaid service providers, members have the opportunity to appeal to an independent judge. Sand’s report determined that the percentage of appeals where the judge agreed with the reduction or denial of services dropped by 72 percent under privatization, and the percentage of cases where a judge overturned the reduction or denial rose by 890%.
The combination of figures, according to Sand, shows that privatized Medicaid in Iowa is substantially less likely to follow the laws and regulations regarding providing care to its members.
The report also says Amerigroup and Iowa Total Care violated provisions of their contracts with the state Department of Human Services. Amerigroup was dinged for one violation, but the audit found multiple documented instances with ITC failing to comply with a clause that required them to provide services to a member until they were transitioned to a new provider. The violations resulted in members going without care.
A copy of the report is available on the state Auditor’s website: http://auditor.iowa.gov