DES MOINES, Iowa -- Medicaid oversight is under the microscope across the country. "We need someone to intervene look at this from a nationwide issue and come back and say things have to change," said Iowa Senator and Democrat Liz Mathis.
Tuesday, the Office of Inspector General's investigation said it will look into claims of Medicaid Managed Care Organizations denying coverage to patients with severe needs. "It's usually people that have complex cases and maybe those claims cost more money than someone going in for a vaccination and those costs are higher but the healthcare is more important because they are very vulnerable and it's not working for them," said Senator Mathis.
Many Democrats say for Iowans, privatized Medicaid has never got off the ground since then Governor Terry Branstad gave it wings. Mathis said, "We've had managed care here since April 1 of 2016 and how is it working? It's not."
Republican Governor Kim Reynolds carried the torch of privatized Medicaid and continues to fight opponents of its sustainability and affordability. In November, State Auditor Mary Mosiman revealed it helped save Iowa $141,000,000. Responding to that report in November, Governor Reynolds said, "It's not about the savings. It's really about making sure we have a program that is sustainable. That's a component of it, but we want to make sure we are taking care of our providers. they're getting paid in a timely manner, but most importantly that Iowans are getting the services that they need and we are starting to get the outcomes that we hope for."
Governor Reynolds recently ended negotiations with UnitedHealth Care because of unreasonable and unsustainable terms proving to some of her naysayers that the effort of Governor oversight in Iowa is there. Mathis said, "As much as the Governor says she's trying and trying to make sure all our bases are covered it's still not working."
The investigation may be casting its net nationally but Senator Mathis sees red flags in Iowa. "These are taxpayer dollars and we want to make sure they are being spent in the right way and that private companies are not making profits on some of our people that are very sick and very vulnerable," said Mathis.
Senator Mathis believes the state could alleviate some problems by placing the more complex and costly cases under state control and leaving the rest to managed care.
Governor Reynolds declined on-camera interview requests to discuss the national investigation into Medicaid oversight.