Amanda Ragan

All 50 state senators are pushing for more legislative oversight of a shift that will turn over management of nearly all of the state’s more than $4 billion Medicaid program to private “managed care” companies.

Senator Amanda Ragan, a Democrat from Mason City, said there’s “great uncertainty” about how this transition will impact the 560,000 low-income, elderly and disabled Iowans who get health care coverage through Medicaid.

“It’s critical that we will have a voice in this because many of the people that we are representing don’t have a voice,” Ragan said.

A bill on the subject has passed the senate on unanimous vote. Senator Joe Bolkcom, a Democrat from Iowa City, said private companies stand to gain big if they get the contract.

“If you look at the fine print…those managed care companies will extract about $800 million a year that’s currently being spent on services to our constituents for the pleasure of operating the program,” Bolkcom said.

And Bolkcom argued it’s likely health care services to poor and disabled Iowans will be cut to cover the cost of the contracts. Republican Senator David Johnson of Ocheyedan told Democrats their tone was not helpful.

“Let’s just settle down here a little bit,” Johnson said. “I’m going to support this bill, but I’m not here to knock the administration about this.”

Johnson said while he supports the idea of having the legislature more involved in the decision-making, nearly 40 other states are moving to sign managed care contracts for Medicaid programs. Governor Branstad’s administration expects to hire up to four managed care companies to run most of Iowa’s Medicaid program. When announcing the initiative last month, officials said their aim was to implement the change starting July 1. Iowans on Medicaid who’re being treated for mental illnesses are already part of a managed care plan, but the plan is to have most Medicaid-financed services in Iowa under a managed care plan. That includes nursing home care for elderly Iowans who are on Medicaid.