Iowa's managed Medicaid program often denies enrollees care and traps them in an endless appeals process, according to an investigation conducted by the Des Moines Register.
Iowa's Medicaid program has been managed by three private payers since April 2016: Amerigroup, AmeriHealth Caritas and UnitedHealthcare. Since the program's inception, Iowa has recorded 501 compliance violations by the managed care companies in the program. AmeriHealth Caritas left Iowa's Medicaid program in November, after posting $300 million in losses and reaching an impasse in contract negotiations.
The Des Moines Register investigated all 201 cases appealed by Medicaid enrollees to state administrative law judges since Iowa began its managed Medicaid program. In these cases, the Des Moines Register found the following issues:
- Managed care companies often violated due process — they did not notify enrollees of reductions in care and appeals rights.
- In-home care typically approved under the state-run program was often rejected.
- Managed care companies often re-evaluated patient needs, even after a patient had won a case under an administrative law judge. This voids administrative rulings and requires the patient to appeal the case again, according to the report.
Although appeals for denied care have gone down 28 to 44 percent compared to the five years prior to the managed care program, the new system requires enrollees to first appeal to the management company internally, according to the Des Moines Register. The managed care companies often fail to tell patients they can appeal to a judge, or the companies wait until the appeal deadline is nearly closed, according to the report.
Read the full report here.
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