The Courtney Report: The Medicaid Mess

Courtney Report

This came in late last weekend, but is still quite relevant. Governor Branstad and his compadres have totally botched this transition in their haste to start funneling our tax money to their donors. This was, of course, a change that made no sense at all except as a way to funnel our tax money to private corporations.

“The Medicaid members are all fearful of losing any and all services. This has been one of the worst handled processes Iowa has been involved in!”
– Southeast Iowa organization that works with Medicaid recipients



Iowa Medicaid providers are struggling under the Branstad-Reynolds privatization plan, according to a new survey.

The survey was completed by more than 400 doctors, hospitals, local clinics and non-profit health care providers. They have faced hurdles and headaches in providing high-quality care since Iowa’s $5 billion Medicaid program was privatized on April 1.

According the survey, Medicaid providers are seeing higher costs in running their businesses. For example:

* 90 percent say privatization has increased their administrative expenses
* 79 percent are not getting paid on time by the for-profit corporations now running Iowa Medicaid
* 28 percent have had to borrow money to pay their bills while waiting to be reimbursed by out-of- state Managed Care Organizations
* 66 percent say when they do get reimbursed, it’s at lower rates than agreed upon

The switch to private Medicaid has caused a significant hardship, according to one mental health center. “Our agency has had to take out loans and some staff have volunteered to go without pay for a couple of pay periods. This is all because the MCOs owe approximately $200,000 to us at this time… The MCOs were not at all prepared for what they took on in such a short time. We need help!!!!”

Those who completed the survey say services for Iowans on Medicaid will suffer because of privatization:

* 46 percent of providers are planning to reduce services
* 61 percent say privatization has reduced the quality of services they can provide
* 38 percent say Medicaid patients can no longer see their out-of-network specialty providers

One survey respondent said, “it has harmed our most vulnerable locally, as they now have little to no options for some services… and sometimes no local options at all….”

Iowa Medicaid is in a state of emergency. Iowa physicians may be forced to stop taking Medicaid patients or close their doors all together. That would be bad for the 560,000 elderly, disabled and low-income Iowans who rely on Medicaid.

For full survey results and to read the experiences of Iowa Medicaid providers in their own words, go to

“Getting advanced radiology exams approved is a confusing mess. My nurses are spending huge amounts of time fighting with insurance companies to get medications and MRI/CT scans approved. Patients are going without insulin because of long prior authorization times. What a mess!!!”

– Muscatine health care provider who sees Medicaid patients


Senate Democrats are listening and remain committed to addressing the difficulties private Medicaid has created for patients, health care providers and caregivers. We tried to prevent these problems when a bipartisan Senate majority voted to stop the transition to private Medicaid (SF 2125), but the Republican-controlled House refused to consider the bill.

Instead, we continue to hear from Iowans struggling to cut through the Medicaid red tape. Legislative Democrats have held help sessions in communities across the state to ensure they get the assistance and answers they need.

At these forums, Iowans with disabilities, caregivers, patient advocates and health care providers shared their frustrations with Governor Branstad’s privatized Medicaid.

The forums prepared legislators for a recent meeting of the Senate Human Resources Committee, where the Iowa Department of Human Services and Managed Care Organizations were asked what they’re doing to fix the ongoing Medicaid problems.

We must be vigilant about holding them accountable and insisting they do better by Iowa patients, health care providers and taxpayers. We will expect further updates and progress when the Health Policy Oversight Committee meets August 29 at the Statehouse.

Bipartisan Medicaid oversight legislation, approved as part of this year’s Health & Human Services Budget (HF 2460), will help in the push for improvements. It sets standards for Medicaid services to ensure patients get the care they need, and calls for expanded reporting on consumer protections, health outcomes and program integrity.

You can follow our efforts, find out about upcoming meetings and subscribe to Medicaid updates at

Governor Branstad’s closing of Mental Health Institutes is taking its toll. Iowa is worst in the nation when it comes to the state’s ability to provide inpatient mental health treatment for our citizens.

According to the nonpartisan Treatment Advocacy Center, Iowa has only 64 state beds (down from 149 in 2010) for mental health patients—that’s two beds for every 100,000 Iowans – and most of them are already being used by inmates.

Iowans often have long waits to get the mental health services they need. Without treatment, many end up behind bars, which adds to the burden on our already strained corrections system.

The situation has gotten worse under Governor Branstad. He has shut down mental health institutes in Mt. Pleasant and Clarinda, the Iowa Juvenile Home in Toledo, and the Psychiatric Medical Institution for Children in Independence.

That leaves Iowa with about 731 mental health beds (public and private), not nearly enough to help Iowa children and adults with serious mental illnesses.

It’s a shame to lose successful, high-quality health care programs with skilled local caregivers who worked with Iowans in need. In the end, Iowans and Iowa tax dollars will be sent out of state for health care that had been provided close to home.

For more on the troubles states face when they don’t have enough psychiatric beds, see the 2016 report from the Treatment Advocacy Center.

About Dave Bradley

retired in West Liberty
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1 Response to The Courtney Report: The Medicaid Mess

  1. Mary Kemen MD says:

    Thank you for confirming information that the Gazette published. Our Medicaid mess is disgusting, a prime example of greed in action and a business-oriented governor.


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