Auditor says Iowa can’t measure Medicaid success due to bad data

Iowa Auditor of State Rob Sand issued a stinging indictment of Iowa’s privatized Medicaid system Thursday, saying his office has been unable to collect reliable data to measure the quality of services provided to vulnerable Iowans.

“If we can’t assess the quality of care because the data are not reliable, that certainly calls into question the quality of that care,” Sand said.

Sand said his office spent the better part of a year attempting to collect complete, reliable data from the Iowa Department of Human Services that would show whether the managed care organizations (MCOs) that run Iowa Medicaid are living up to the terms of their contracts, specifically with regard to home-health services.

Those efforts, he said, were initially met with a lack of cooperation. Ultimately, the auditors obtained the information they were seeking, but it was often incomplete or unreliable, Sand said.

He said that carries implications not just for the Iowans who rely on the MCOs to pay for health care services through Medicaid, but for the taxpayers who fund the program, as well.

“The contract the state of Iowa signed with the MCOs – it says that data analysis is crucial to ensure that we’re getting good quality,” Sand said. “As a taxpayer, I want to know what is happening with my money. We’re standing here today and telling you that due to the quality of data that we were repeatedly provided by DHS, we can’t answer that question. I think that’s pretty concerning.”

DHS spokesman Matt Highland said the department “relies on thorough third-party validation with independent actuarial reviews for all Medicaid data to ensure we’re good stewards of the resources entrusted to us by taxpayers.”

Highland said that over the past 14 months, “our team was very detailed and meticulous in accommodating the auditor’s requests to best equip their team with a deep understanding of the information they asked for.”

Roughly 650,000 Iowans are enrolled in Medicaid, a $5 billion program that utilizes a mix of state and federal money to pay for health care services for the poor and the disabled.

Sand said his office could have issued a report in February 2018 that said the information his office was receiving from the MCOs, through DHS, was unreliable. But his staff continued to ask for better data, hoping they could determine whether the MCOs were doing what they’re paid to do.

“We kept trying because we wanted to provide answers,” he said. “As we kept trying, we continued to get unreliable data.”

Auditors in the state of Kansas have run into similar problems. After a year of investigations, auditors working for the Kansas legislature issued a report in 2018 that said data maintained on KanCare, the state’s privatized Medicaid system, was so unreliable it “prevented us from evaluating KanCare’s effect on beneficiaries’ health outcomes.”

Sand, a Democrat, said the ultimate responsibility for ensuring the MCOs live up to their contracts with the state of Iowa rests with Gov. Kim Reynolds, a Republican.

“Terry Branstad decided to privatize the program, right?” he said, referring to Reynolds’ Republican predecessor.  “What we’re doing with (Medicaid) program stops and starts with the governor’s office … At the end of the day, good or bad, the program depends on the governor taking action to assess problems and to address problems.”

Reynolds’ spokesman, Pat Garrett, said the governor “has made significant improvements to Iowa’s managed care system to better serve Iowans. All Medicaid data is independently verified by third-party review and an independent actuary.”

 Ten months ago,  the department sent data to the state auditor with a written disclaimer that said the information was being provided “as is,” adding that the agency could not “ensure the accuracy, completeness, or reliability of the data.”

 Garrett said Thursday that “the governor commends Iowa Department of Human Services employees for an outstanding job providing thorough information to the auditors’ various requests over these last 14 months.”

The Auditor of State’s Office is currently examining other areas of the Medicaid program, but office spokesman Andrew Turner declined to say whether auditors expect to run into problems with the reliability of data collected as part of those investigations. Sand warned that “we were probably more patient in this audit than we will be in future audits.”

A week ago, state officials announced they were withholding $44 million in payments to one of its Medicaid MCOs, Iowa Total Care. The state is alleging that Iowa Total Care has not paid more than 100,000 claims that private health care providers have submitted to the managed care organization.

Iowa Total Care is not one of the managed care organizations involved in the audit of home-health services. That audit included claims made from April 2016 through December 2018, a period in which Amerigroup and UnitedHealthcare were functioning as the state’s Medicaid managed care organizations, Sand said.