Rob Sand, State Auditor - Is Iowa Medicaid a Lemon?

Bremer County Town Hall on October 1st with State Auditor Rob Sand

Rob shared a few issues the auditor's office is currently focused on. One of the bigger issues he talked about revolves around Iowa's privatized Medicaid struggles. Previously, he publicly announced that the Auditor’s Office is completing a contract compliance audit investigating the MCOs and shared why that was happening.

His interest in the issue began when two people living with quadriplegia in North Eastern Iowa contacted him about issues they were having with the MCOs. Each individual was experiencing a lack of responsiveness from each of their MCOs which resulted in the loss of services. Each individual faced days without access to bathing/toileting. The alternatives incurred more expensive ways to provide those services. Shockingly, they were told they needed to consider admission into a nursing home for their care, which would incur an even greater taxpayer cost.

Rob expressed that public policy should be based on data collection and facts. Also, that the job of the Auditor’s Office is to help policy makers have the evidence they need to make adjustments by helping collect that data and those facts. The state and the MCOs signed legally binding 260 page contracts agreeing to provide a certain level of service to Iowans on Medicaid/waiver services. Currently, the auditor's office is looking into whether the MCOs are following those requirements. The Auditor’s office is also looking at the slowness of the MCOs in paying providers. Because of the confidentiality of both the individuals cases that set the MCO audit in motion, Rob is unable to share their cases' details and progress until the case is closed.

Sand had a great allegory he used to express why the audit of the MCOs needed to be set in motion. He said, "If I told my wife I got a deal on a new car, she would ask what year, make and model. What if I responded, 'I don’t know?’ She would then ask how many miles. 'I don’t know' Does the car have 4 tires? 'I don’t know'." He then rhetorically asked all of us, "Is that really a deal?"

Sand then expressed that he believes that our elected officials need to look beyond finances and delve into the contractual promises made to provide adequate healthcare and support. He stressed that the MCOs are focused on making as much money as they can, in any way they can, so we need our policy makers to start supporting their constituents, not the businesses.

When we asked Auditor Sand when it is appropriate for individuals to contact him, he stated that he is not always the best person to contact for problem solving. He explained that he is doing more data collecting and investigating these problems to provide evidence of how the MCO’s are effectively or ineffectively completing their contractual services. He did say that he will listen and help guide individuals to resources that can help them, if his office were contacted.

When a problem arises with an MCO or waiver:

1. Call your case manager (If you are still not sure of you your case manager is, call and ask Amerigroup at 800.600.4441 or Iowa Total Care at 833.404.1061.

2. If he/she is not sufficiently dealing with the issue, contact the Ombudsman’s Office


Telephone: 515.281.3592 or 888.426.6283

TTY (Teletypewriter) 515.242.5065

3. CÇ'ing your local Senator or Representative on the email to the Ombudsman's office can help bring additional attention to your issue and make your elected officials more aware of how this has impacted you and other constituents in similar situations.

4. Contact Disability Rights Iowa and file a grievance. This can be done by phone using the following number: 515.278.2502. It is also very easy and quick to file a grievance online using the following link.

5. Contact Rob Sand if your case manager and/or MCO is suggesting nursing home placement over your right to live in the community. You should also contact his office if your care hours have been drastically cut without explanation or if your providers aren’t getting paid. Email:

Not sure about your rights?? Definitely consult “How to Be Your Own Best Advocate: A Guide on How to Navigate Managed Care in Iowa”. To be specific, page 8 has your rights listed and is available at the link below.

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