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Iowa has lost control over its Medicaid program, Democratic gubernatorial hopeful Fred Hubbell said Wednesday in Davenport, renewing his criticism over the state's decision to shift day to day management to private insurance companies.

Hubbell met with about a dozen providers and direct service workers as part of a two-stop swing through the area.

"What you heard here is that basically the state has no control now," Hubbell said after the hour-long meeting at which several people told him of their difficulties with the state-hired managed care organizations, or MCOs.

"The MCOs write the contracts, the MCOs basically tell the providers what they’re going to pay, when they’re going to pay, here’s the rules and then they can change the rules anytime they want," Hubbell said.

Several providers told of struggling to get authorization for services and getting paid for their work, as well as problems with coordinating services for their clients.

In particular, they regretted the loss of state-employed case managers who oversaw and helped coordinate care.

"I'm constantly on the phone, behind a desk, yelling at the MCOs," said Mary Allen-Des Jardines, who runs Quad-City Service Providers, which employs about 35 people. The company provides supported community living services.

Amy Simpson said she did a risk analysis in April and decided to close her small business, New Found Hope, as a result of difficulties with the new system.

She said most of her caseload was folded into a larger company.

Several people said the bureaucracy required to deal with the managed care companies made it difficult for all providers, but particularly smaller firms. Allen Des-Jardines said she is worried this will lead to larger companies swallowing up smaller ones.

The controversy over the Medicaid switch is a key issue in this year's campaign for governor.

Democrats have criticized the shift to managed care, saying it's meant service cuts and confusion. But Reynolds, who was lieutenant governor when then-Gov. Terry Branstad made the switch, has defended the move.

She and allies have pointed out that costs in the program were rising and could not be maintained over the long term.

Pat Garrett, a Reynolds spokesman, responded Wednesday that Hubbell wants to return to a "broken, unsustainable" system.

"Governor Reynolds is focused on getting results and help for every Iowan who relies on this Medicaid system. She's working to make Medicaid sustainable for the long term and working to improve health care overall which includes fighting to create affordable health care options for farmers, small business owners, and hard working Iowans," he said.

Last month, the state agreed to a 7.5 percent increase in spending for the program.

Department of Human Services officials said the increase would ensure the program is properly funded but sustainable.

They also said the new deal had important oversight provisions. Critics, though, say it just putting more money into a system that isn't working.

The administration has said the shift has resulted in cost savings, but Democrats have been skeptical.

A report to the state Council on Human Services this week said the average per-member cost for Medicaid would increase by 11 percent in fiscal year 2019. It was expected to decline in fiscal year 2020, the report said.

In two of the previous three years, the average per-member cost declined, the report said.

The Medicaid program serves about 680,000 Iowans.

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