DES MOINES — Newly approved state oversight of Iowa’s privatized Medicaid program will make it one the most transparent in the country, according to Gov. Terry Branstad, but some health advocates remain skeptical as state officials begin determining plans for organizing and delivering some information required under the oversight.
The Iowa Department of Human Services is tasked under legislation signed by Branstad last month to submit quarterly and annual reports on how three private insurance companies are running the state’s roughly $4.2 billion health care program for poor and disabled residents. Various groups will also monitor the program, which switched to private management on April 1.
DHS spokeswoman Amy Lorentzen McCoy said the reports will be based on hundreds of pieces of information. Those metrics are expected to include everything from how often the insurance companies communicate with Medicaid recipients to the number of grievances filed by patients, according to agency documents.
More specifics on how the reports will actually look have yet to be finalized. The insurance companies will submit raw data to DHS, and the department will analyze it to compile the reports. The first batch of raw data is due at the end of September, and McCoy said a timetable for the first quarterly report has not been determined, though an annual report is due by December.
McCoy also said the department doesn’t plan to post raw data on its website.
“It would be so voluminous that posting it would be difficult,” she said. “And then having it be meaningful and show what kind of outcomes are being achieved would be hard for anyone to do the analysis just on their own.”
McCoy noted the law is brand new and the level of data collection and analysis required will be “something totally different” for the department.
“We want it to be as meaningful as possible,” she said.
Some health advocates say they have reservations about DHS not posting raw data from the insurance companies.
Rhonda Shouse is a Medicaid recipient in Marion who is involved in health care advocacy and has brought others to the Capitol to speak about concerns over the program’s transition. She said DHS provided confusing data analysis on the Medicaid transition during the legislative session.
“I just don’t trust them,” she said. “I don’t trust their interpretation of things because there has been a lot of spin.”
Don Dew is another Medicaid recipient and executive director of Disabilities Resource Center of Siouxland, a nonprofit based in northwest Iowa. He suggested a system where DHS provides both their analysis and the raw data. He said the agency’s current plans are “making an assumption that the public is not as informed as they think it is.”
The public still has the right to seek data through public records requests to the department. DHS also plans to distribute information monthly this summer that shows information on enrollments, claims processing and other measures of performance. That data is being collected as part of the state’s contracts with the three companies and it’s not required to be posted.
McCoy said some information presented during the legislative session was early data, and what’s to come “will be deeper dives.”
“We are absolutely committed to being transparent and making sure that Iowans understand how the program is operating,” she said.
Some lawmakers in the Democratic-controlled Senate and health advocacy groups criticized the transition from a state-run Medicaid program to one managed by out-of-state companies. DHS officials and Branstad have argued the new system will control the program’s rising costs but also provide better health care to the roughly 560,000 people in it.
The program’s implementation was delayed twice amid questions by federal officials about its readiness. Critics insist the transition is riddled with problems, though the insurance companies and DHS say any reports of issues are not systemic.
Lawmakers in the split Legislature debated the merits of Medicaid oversight for months before agreeing to a deal in the final days of the legislative session that wrapped in late April. Some feared Branstad would veto it under his authority as governor, but he signed off and added in a public message it will make the program “one of the most transparent, outcome-focused, and accountable programs in the country.”
Jane Hudson, executive director of Disability Rights Iowa, challenged the expected data reporting and the level of power available to the groups that will monitor the program’s progress. She said they can’t issue fines if the insurance companies mess up consumer services. DHS has state contracts that include such fines, but Hudson remained unconvinced because the agency will lead that oversight instead of a separate state agency.
“Where’s the real teeth for the enforcement of violations?” she asked.