This is a brilliantly executed feature on how hard it is to actually get services from Medicaid in Iowa even if everyone agrees you are owed those services.
A Des Moines Register investigation into those 200 cases found an appeal process that presents a thicket of administrative and legal roadblocks to patients and their families, who must clear hurdle after hurdle to secure care.
Specifically, the Register investigation found:
• Due process violations: In at least four cases, administrative law judges concluded or the Medicaid recipient alleges in ongoing district court appeals that the companies failed to properly notify recipients about health care reductions and their appeal rights.
• Denials of in-home care: Medicaid expenses for in-home care that had been routinely approved when the state ran the program are now being rejected by managed-care providers as unnecessary and outside the scope of what the program authorizes. Families say they are left struggling to care for their loved ones, who are losing their independence and autonomy.
• Endless appeals: Even when Medicaid patients win their cases in administrative hearings, the managed-care companies routinely “re-evaluate” their health needs, again denying their care in as little as 60 days. That forces patients to embark on yet another round of appeals.
What’s more, as I reported in November, the situation in Iowa is going to get worse.
I’m struck by the way that disability systems are built, funded, and run on the assumption that people mostly won’t get full access to the services they are due.