Health and Fitness : Virginia Gay and the approval of private mangement of Iowa's Medicaid system

Mike Riege, Virginia Gay Hospital and Clinics Administrator

Despite assurances by the Iowa Medicaid Director that she was "very confident" Iowa would be ready to implement Medicaid privatization as early as Jan. 1, 2016, the process has again been delayed by the Center for Medicaid and Medicare Services (CMS) until April 1. This time the waiver to proceed was granted and soon private companies will manage all services and payments for nearly 560,000 Medicaid patients in Iowa.

Speaking on behalf of Virginia Gay Hospital and Clinics, and for the doctors and other providers delivering front-line care to Iowa’s Medicaid population, I have repeatedly expressed great concern about Iowa’s plan for privatization of Medicaid. With the announcement of approval of Iowa’s plan by CMS, we want to assure all our patients and their loved ones that despite uncertainties and difficulties Virginia Gay will work hard to provide the very best care under the new arrangement.

Virginia Gay Hospital is in the process of doing final reviews of all the contracts required by the state to participate in the program. We plan to sign with all three managed care organizations so we are able to help our patients as much as possible with the transition on April 1st.

The concern among health professionals has been that with an already efficient system like Iowa’s, finding efficiencies sufficient to deliver profits for the privately owned management companies may be difficult. Two profit-making strategies remain if the required efficiencies can’t be found. One strategy would be to restrict access to care by outright denial of services or by creating barriers to access, like excessive travel. The other is to reduce payments to health care providers, many of whom are already struggling to maintain profitability while providing care for Medicaid patients at low rates of reimbursement. Of course the most profitable corporate strategy for the new managers of Iowa’s Medicaid system would be to employ both approaches simultaneously, and without oversight we worry this is what they will do.

I am personally disappointed that both the state and federal governments have put our most vulnerable patients, and their healthcare providers, through what appears to be a massive, unnecessary and poorly planned change.

I commend the Iowa Hospital Association and media outlets throughout the state for being advocates of our Medicaid patients against the interests guiding this decision, and I hope they will continue to act as watchdogs over the performance of this new Medicaid program.

I was glad to hear from Senator Kapucian that Senate File 2213, which would provide oversight of these private companies, was passed unanimously by the Human Resources subcommittee. What should now be a top priority for the legislature and Governor is assuring Medicaid patients they will have a number to call and a powerful advocate in Des Moines to solve the problems they encounter.