Iowa’s Two Medicaid Providers Are Breaking State Contracts, Iowa Auditor Says

State Auditor Rob Sand said Wednesday Iowa’s two Managed Care Organizations are breaking their contracts with the state by not providing proper care for two quadriplegic people who live in rural Iowa.

Sand did not name the two people whose cases he’s looking into, but he said their provider, ComfortCare, recently gave them each a 30-day notice to terminate services.

“During that 30-day period, they each personally made scores of phone calls attempted daily to ensure continuity of their care,” according to a news release from Sand. “I, too, made dozens of phone calls and sent dozens of emails to better understand their situations and to review the MCO’s compliance with their obligations … Both were pushed by their MCOs towards moving into a nursing home.”

Sand said the only way the two were able to avoid moving into a nursing home is because of their families, who stepped in to care for them. One person’s care workers also agreed to help them even if they weren’t being paid.

Sand cited several clauses the MCOs seemed to be breaking by failing to provide services and said the MCOs should have required the provider to continue to serve the two Iowans until they  found a new provider. Sand will host a news conference in the coming weeks to address how the auditor’s office will respond to the situation.

There are “more than a few” complaints on Sand’s desk now, he said, but that doesn’t necessarily mean all of those complaints include a lack of compliance with the state’s contract.

“Even if the issues they’re experiencing don’t comply within the contract, it doesn’t minimize the fact they are experiencing a lot of stress and experiencing a lot of frustration in their dealings with Medicaid,” Sand said.

The goal, Sand said of his current investigation into the issue, is to figure out how big of a compliance problem there is in Iowa.

One consequence Sand said the state could deliver should it be found the MCOs aren’t complying is to withhold payment to the MCOs in part or in whole.

Sand also said he’s not sure who has the obligation to provide care — the MCOs or the State of Iowa.

“I do not know if that obligation fundamentally, at the absolute bottom level, is contracted out to the MCOs or still belongs to the state,” Sand said. “That would be a much deeper dive. However, I also point out if the federal regulations are in fact an issue, that that is a determination is probably going to be made at a federal level and not at the state auditor’s office.”

by Paige Godden
Photo by Julie Fleming
Posted 6/26/19