DES MOINES, Iowa — Iowa lawmakers’ concerns about the state’s privatized Medicaid program amid reports of problems haven’t translated into much legislation so far.
Just a handful of bills that would make selective changes to the health care program for the poor and disabled advanced beyond a legislative deadline last week, even though lawmakers from both parties came into the session saying something needed to be done. And the proposals so far don’t address key issues surrounding reports of reduced services and delayed reimbursements to health care providers. It’s also unclear whether the bills have enough support in the GOP-controlled Legislature.
Republicans have indicated in recent months that they want to address complaints under the program, which was privatized in 2016 after a push by former Gov. Terry Branstad. GOP Gov. Kim Reynolds, who was lieutenant governor at the time, acknowledged in a January speech that “mistakes were made” in the transition from a state-run program.
Some Democrats in the minority have begun highlighting the limited legislative action. Rep. Lisa Heddens, an Ames Democrat, tried to include what she said were Medicaid improvements to a health care bill during House floor debate Thursday. Her measure failed.
“I think the families that are being denied the services and the children that are being denied deserve so much better than this,” she said.
Separately, a state agency that oversees the private insurance companies that run the roughly $4 billion Medicaid program has offered few details publicly about how it’s addressing problems. The Iowa Department of Human Services has highlighted upcoming private workgroup meetings that will include discussions between health care providers and the insurance companies. Lawmakers and the press were not invited to the meetings.
Michael Randol, the new DHS Medicaid director, has indicated to lawmakers in public meetings in recent weeks that he believes the agency can make needed program changes without legislative action.
Asked how the agency is measuring its changes toward Medicaid, spokesman Matt Highland told The Associated Press in an email: “There are multiple changes and potential changes to various parts of the Medicaid program.”
Reynolds’ press secretary, Brenna Smith, focused on the work of DHS when asked about possible legislative action. She pointed to recent public and private meetings led by the department.
“DHS has engaged in extensive outreach statewide to improve the Medicaid program,” Smith said in an email.
Highland added that the department is rejecting public access to the upcoming meetings, including one scheduled Thursday, to allow open discussion on Medicaid issues.
“The presence of press or legislators may complicate that effort,” he said in an email. “Though the Department will provide public with regular updates on the progress of this group.”
Sen. Mark Chelgren, an Ottumwa Republican, helped author some existing Medicaid bills that survived the legislative deadline known as funnel week. They address some accountability with the insurance companies, and he believes it can move out of his chamber. He’s not sure yet about the House.
“I think it’s imperative that we do something,” he said.
House Speaker Linda Upmeyer, a Clear Lake Republican, said there is a health-related bill alive in the House that can be amended with Medicaid improvements if it’s needed before the end of the session. She said she hopes new leadership at DHS can make needed fixes alone, but she was clear a chamber committee can step in to “move forward in what they believe is necessary to help with making sure that we do see a smoother, smother operation moving forward.”
Rep. Dave Heaton, a Mount Pleasant Republican who chairs a key budget group on health care spending, said he understands the department’s decision to limit access to the series of workgroup meetings. He said it’s important to avoid politicizing the issue.
Still, Heaton said the Legislature should play a role this session in addressing reported Medicaid problems. He introduced bills this session in connection to that, but they did not advance beyond the legislative deadline. Heaton is considering whether to revive some provisions by attaching them to a budget bill.
“I’m very concerned that we need to do something,” he said of lawmakers. “There are bumps out there.”