In April 2016 three for-profit companies took over management of Iowa’s Medicaid program. Gov. Terry Branstad says the program is saving the state money but the companies say they are losing money. Critics worry about a loss of services.
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Amerigroup ignores recommendations of mental health professionals
Dan and Julie Olinger of Des Moines have spent the past decade piecing together help for their mentally ill son. Now that the teen is getting inpatient care at one of Iowa’s few psychiatric facilities for children, his private Medicaid insurer plans to stop paying for it.
The 14-year-old has been living at Orchard Place since April. According to his father, the teen’s therapist and psychiatrist say he should remain until October. But Amerigroup, one of the private managed care companies contracted by the Branstad administration to administer Medicaid, decided the teen should be discharged after 90 days. The therapist persuaded the insurer to cover an additional month, and Amerigroup recently informed the family it will pay only through Aug. 5.
Apparently the for-profit company thinks it knows better than health professionals what is best for the teen.
“That is four months of treatment even though his doctor and his therapist want more time,” Dan Olinger said. “According to many professionals I have talked to in this field, going against health professionals’ recommendations would rarely happen prior to privatized Medicaid.”
Bruce Buchanan, president of Compass Clinical Associates in Urbandale, told a Register editorial writer last week that he is hearing everybody is being pushed to decrease lengths of stays at mental health facilities for children, which are almost exclusively paid by Medicaid.
Orchard Place provides a therapeutic environment, counseling and schooling for children living on campus. It is frequently the last resort for those who have spent years in outpatient therapy and trying different medications.
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The Olingers first sought professional help when their son was hallucinating at age 4, insisting he saw people who were not there. He was later diagnosed with conditions including Asperger’s, attention deficit hyperactivity disorder and oppositional defiant disorder. Over the years he was given a variety of medications, which sometimes helped for short periods of time. Then came the extreme paranoia and anxiety.
Tina Polly is fighting to get her son long-term specialized treatment for Reactive Attachment Disorder. But it’s expensive. And a private firm managing Medicaid has begun pushing for other options.
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The boy believed people were watching the family’s home and planning to kidnap him. While his family slept at night, he paced around the house with a knife, checking and re-checking locks on doors and windows. He tried to commit suicide by hanging himself from duct work in the basement.
“I’ve also become an expert at fixing drywall with all of the holes he would punch in the walls,” said his dad.
The Iowa teen and his mental health professionals know he needs a longer inpatient stay in a facility where he can receive intensive therapy and get medications regulated. The insurer’s refusal to pay “is going to be a huge setback,” Dan said. “Discharging him prior to finishing his treatment is a serious lapse in judgment. While I understand Amerigroup has lost money since taking over Medicaid in Iowa, cutting services to make up that gap only hurts our most vulnerable.”
Hurting the most vulnerable Iowans is a recurring theme under privatized Medicaid. It is difficult to believe the insurers are truly losing money, considering so many Iowans report health service denials, so many providers report not being paid, and the companies continue to demand and receive additional taxpayer dollars.
What are the for-profit insurers doing with the billions of public dollars they are collecting?
Not providing the recommended treatment for the Olingers’ son.