Iowa Gov. Terry Branstad has highlighted extra benefits under Iowa's new Medicaid program to show the privatized system functions better than the former state-run setup, but the agency overseeing Medicaid acknowledges it knows little about how the so-called value-added services are actually working for patients.
That lack of detail hasn't stopped Branstad from using the perks — such as waived gym membership fees, prenatal services and free cellphones — to help sell in public remarks and press releases the pros of Medicaid under private management.
"These are exactly the type of additional services that are going to make lasting, meaningful impact on improving the health of Medicaid patients," Branstad told reporters in April.
More than six months later, the state is collecting little data about how many people have used the value-added services and no information about whether the services are effective. The Iowa Department of Human Services, which oversees the three private insurance companies that now run Medicaid, isn't required to closely track the services, said agency spokeswoman Amy McCoy, in response to a public records request by The Associated Press seeking detailed information about the services.
Some health providers and patients have criticized the state for its tracking of payment and service complaints, and the lack of close oversight of the value-added benefits means it's hard to tell whether people are accessing services publicly touted by the governor as a sign of the new system's success.
DHS relies on self-reporting from three insurance companies — known as managed care organizations or MCOs — to provide insight into the value-added services. But the department wrote in a quarterly report in August that data submitted by the companies in the first three months of the new system appeared to show underreporting on use of the services. DHS provided data to AP that showed inconsistencies on how the services were categorized and tallied.
McCoy said the department plans to work with the companies to improve self-reporting, and she emphasized value-added services are separate from the agency's job of tracking how Medicaid is working. Value-added services are referenced in state contracts with the companies, but the language gives the department leeway in how it monitors them.
"Our focus is ensuring that members are able to access medically necessary services and that providers are being paid appropriately," McCoy wrote in an email.
Because there is little monitoring of the data by the state, it's unclear how limited some services might be.
Catherine Gray, of Des Moines, wanted to utilize the free gym membership offered by AmeriHealth Caritas for her 25-year-old son, who has moderate autism and other medical conditions.
After repeated calls over several months, Gray said she was told this month her son was eligible for only one gym in their area. The facility is billed as offering recreation for children and adults with disabilities, but Gray said her son has visited the facility and it's geared primarily toward children. Her son also had a negative experience at the facility and refuses to return.
Gray equated the value-added services to candy "that they've dangled in front of people to entice them."
"They've really sugar coated it," she said.
Joshua Brett, a spokesman for AmeriHealth Caritas, confirmed one gym is currently contracted for patients in Polk County, where Des Moines is located. He said the company has a contract with more than 40 gyms, and "as we add more gyms, even more of our members will be able to benefit from this value-added service."
A review of the gyms shows more than 60 Iowa counties don't have any gyms available.
There was also some initial confusion about how many value-added services are available overall. The governor's office has listed more than 80 in multiple press releases. DHS noted a little over 60 in its quarterly report, which was given to lawmakers. Branstad's spokesman, Ben Hammes, said his office separated some services that were listed under one category by DHS, and he noted additional value-added services could be added in the future.
Some Medicaid patients also question whether all the services are new.
Allen Kittrell of Coralville said he read promotional material and press releases and felt everything was talked up as unique.
The 62-year-old with severe osteoarthritis then noticed perks like the free cellphone and free calling minutes. Kittrell said he received such a benefit years ago under a federal program, open to Medicaid patients, that's been available for decades.
Medicaid patients have also long been eligible to services that help people quit tobacco. Variations of such efforts are listed as extra benefits by the companies operating Iowa's Medicaid system.
It seemed like false advertising, said Kittrell, who described it as "carrots dangling in front of you, but there's no carrots."
McCoy said there may be some overlap between old and new benefits, but she noted it wasn't DHS that directly offered the services previously.
Hammes said in an email the new Medicaid program is only 6 months old, and "it may take time for the MCOs to assess their patients before delivering value added services."
"However, we are confident that these value added services will demonstrate that they effectively improve patient care and help reduce overall health care costs," he said.
