Disabled Iowans are being denied medical services or having them reduced in a “stubborn and absurd” way that “makes a mockery” out of the state’s appeal processes, according to a new state ombudsman report released Monday.
The findings mirror a Des Moines Register investigation published earlier this year that examined hundreds of appeals and found that patients were systematically being denied care.
Both the ombudsman and the Register found that the private companies hired to manage Iowa's Medicaid program — known as Managed Care Organizations or MCOs — continued to deny services to some people even after they won their appeals.
- In one case, the ombudsman found, an MCO reduced a quadriplegic’s in-home care by 71 percent, resulting in him being moved to a nursing home. But instead of saving money, the man’s nursing home care ended up costing taxpayers an additional $1,815 a month, the report shows.
- In another case, an MCO cut in half the twice daily care for an 80-year-old woman who is physically unable to pull on or remove support hose to treat her critical vascular issues. She ultimately prevailed following months of appeals, only to be again denied the services three weeks later.
- In multiple other cases, care reductions were implemented without notice and deprived Medicaid recipients of their due process rights, according to Monday’s report.
“In our view, the MCOs' position on the matter was stubborn and absurd, and it makes a mockery of the fair-hearing appeals process,” Iowa Ombudsman Kristie Hirschman said in her annual report published Monday.
The governor's office referred questions to the Iowa Department of Human Services, which oversees the state's Medicaid program.
DHS spokesman Matt Highland said a review of the appeals process is ongoing. Only a small percent of Medicaid recipients — less than 0.5 percent — have filed more than one appeal, he noted. The department is also in the process of launching new federal appeal rules that begin July 1, he noted.