Effects of Iowa’s Medicaid privatization hit close to home

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Due to the privatization of Iowa Medicaid beginning April 1, 9-year-old Shaun Mohs, from McGregor, was unable to begin chemotherapy for a brain tumor on Wednesday at Mayo Clinic, as anticipated. On Sunday, Mayo Clinic said the Iowa Medicaid managed care organizations agreed to grant an exception for Shaun, allowing Iowa Medicaid to cover his treatments. (Photo by Audrey Posten)

By Audrey Posten, North Iowa Times Editor

Last week, the North Iowa Times detailed the story of Shaun Mohs, a 9-year-old McGregor boy who is battling a brain tumor for the second time in his young life. 

The first was discovered in April 2009, when Shaun was just 2.5 years old. Doctors treated the tumor aggressively from May through October of that year, with chemotherapy killing it, explained Shaun’s mom, Misty Jones.

“It’s still there; it’s just dead,” she noted, adding that, in the proceeding years, doctors at Mayo Clinic in Rochester have routinely monitored the tumor to make sure it doesn’t grow.

In January, during one of Shaun’s regular MRI check-ups, another tumor was found, this one much smaller than the first, Misty said. They hoped to do surgery to get a biopsy of the tumor, determining if it was slow- or fast-growing, but couldn’t get enough of it. Eventually, they determined it was slow-growing.

Misty said Shaun planned to start chemo last Wednesday at Mayo, and continue treatment weekly for one year. However, last Tuesday, the family learned Shaun’s treatment would be delayed.

According to Shaun’s grandfather, Joe Jones, due to the privatization of Iowa Medicaid beginning Friday, April 1, Shaun could not start chemotherapy at Mayo Clinic that day, as anticipated. The three managed care organizations (MCOs) that now manage Iowa’s Medicaid program had been unable to negotiate contracts with Mayo’s main medical center in Rochester.

Joe explained Shaun could have had one treatment at Mayo on Wednesday, but would then have to continue treatment elsewhere, likely in Iowa City. He stated the family has nothing against another hospital, but they feel comfortable at Mayo, where Shaun has doctored for seven years.

“We go to Rochester because it’s the best. Shaun needs to be seen there,” he said. “He knows all his doctors and he’s comfortable with them. Now, to go someplace else, it’s a risk.”

Joe said it’s important to begin treatment now, in case the tumor changes.

“If it would start to grow, [doctors] might need to take more action,” he said.

Currently, 560,000 Iowans receive health care through Medicaid, which is a joint state and federal program. Roughly 70 percent of Iowa Medicaid’s $4.2 billion budget funds the care of Iowans living with disabilities and the very poor elderly. 

The change to privatization was originally planned to start Jan. 1, but the federal government delayed the move twice in order for the Iowa Department of Human Services to better prepare.

Joe said he felt families weren’t given enough warning of the changes.

Rep. Patti Ruff, of McGregor, fought for Shaun at the capitol last week, to show how privatization can disrupt care. She also addressed Medicaid in her weekly update, noting: “I have heard stories from constituents that will have lapse in care, having surgery cleared but the post op care will have to be scheduled with different providers, cancer treatments delayed, etc. With Mayo Healthcare not signing with any of the three MCOs is creating havoc for some in Northeast Iowa.  

“For months, many Medicaid members have complained about the transition process, including poor communication with DHS and the private managed care organizations taking over Medicaid. In addition, not all providers have signed an agreement with the private managed care organizations. For example, the hospital or clinic may have signed with at least one MCO, but the doctors that work at the facility have not. As a result, members are fearful that they will not be able to see their established provider and will lose services as a result. As the change moves forward, there may still be issues including coverage of services and reimbursements for provided services.”

Joe said the family was hopeful an exception could be made to allow Shaun to continue doctoring at Mayo, but worried about the time it would take to make that happen.

On Sunday, Mayo Clinic said the Iowa Medicaid managed care organizations agreed to grant an exception for Shaun, allowing Iowa Medicaid to cover his treatments.

A local public meeting on Medicaid privatization has been scheduled for Friday, April 15, at 2:30 p.m., at the Elkader City Hall. Local lawmakers want to hear from Iowans about any problems or concerns about the transition to private care.   

Ruff and State Senator Joe Bolkcom, of Iowa City, will also provide an update on efforts to pass strong Medicaid oversight and accountability before the end of the 2016 legislative session.

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