Well, it’s official. The Centers for Medicare and Medicaid Services (CMS) has approved Iowa’s plans to “modernize” Medicaid by moving everyone into managed care. A guest post from April 2015 laid out the details of what was being proposed, and now it’s soon to be upon us. CMS has given the thumbs up for an April 1st start to the process, which is actually already well underway. In fact, the state originally planned for modernization to occur on January 1st. But, thanks to some serious opposition from key stakeholders and members of the public, CMS put the brakes on things for a while and required the state to at least give the appearance of addressing some concerns. The state then said things would roll out March 1–today–but CMS still wasn’t convinced that the state was ready, so the final date was set for April 1, 2016.
People are concerned that the state’s attempt to control costs will come at the expense of some of the most vulnerable Iowans and, as this recent report from KCRG-TV9 out of Cedar Rapids highlights, if the results of similar efforts in Kansas are any indication of what to expect, those concerns are more than legitimate. There’s little question that things are going to be disruptive during the transition. The biggest open-ended questions that remain are how effective oversight of the program will be, to what extent the private managed care organizations will provide the state (and health services researchers) with individual-level (rather than aggregated) claims data, and what actually happens in terms of utilization and spending.
Evaluating those outcomes may play a key role in shaping the future politics of the state. Iowa Governor Terry Branstad, already the longest serving governor in American history, is now contemplating running for a 7th term, and the move to Medicaid managed care in Iowa has taken a central place in the political narrative between Branstad and his possible challenger former Governor Chet Culver. So says this column in The Des Moines Register by Kathie Obradovich. It might actually be nice if Iowans elected a new governor. Someone who hadn’t ever held the office before. Ironically, it seems the more things change for the worse in Medicaid, the more they stay the same in Des Moines. It all feels a little bit like a nightmare. The kind of thing someone says to you on April 1st to get a reaction out of you before exclaiming “April Fool’s!” Only this time, it’s not a joke, and try as they might, I don’t think that the state or the managed care organizations are fooling anyone.