State Auditor: ‘Bad data’ from Iowa DHS make it impossible to assess state’s Medicaid home health program

Blood draw — Thirteen of Clubs/Flickr

A new report from the Office of the State Auditor was supposed to summarize the results of an 18-month-long attempt to audit the Medicaid program administered by the Iowa Department of Human Services (DHS) that provides health services to patients in their homes. But that proved to be impossible, because repeated attempts to get accurate information from DHS over an almost 18-month period were unsuccessful.

“Long story short, the finding in this audit is that we do not have reliable data,” Auditor Rob Sand explained during a press conference on Thursday morning. “Data are missing, data are incomplete and incorrect.”

Iowa’s Medicaid program, which is funded by both the federal and state governments, has an annual budget of approximately $5 billion, and provides health care for more than 650,000 Iowans. In 2016, Gov. Terry Branstad privatized the state’s Medicaid program, turning over the management of patient care to for-profit managed care companies.

The change was supposed to reduce costs and improve care. But a 2018 report by the Legislative Services Agency found the costs to insure each Medicaid recipient almost tripled once private companies took over.

The quality of care provided by the managed care organizations has also been repeatedly criticized, although Branstad and Gov. Reynolds have both insisted the privatized system is working well.

But as Sand noted during his press conference, “If we can’t assess the quality of care because the data are not reliable, that certainly calls into question the quality of that care.”

Sand said that once his staff realized the information DHS was providing contained errors and omission, they made repeated requests for the correct data. But the problems went beyond individual instances of “bad data” and indicated systemic problems at DHS, he said.

“We determined that the process used by DHS for obtaining the [home health service] data was not efficient and was not effective,” Sand said. “We also encountered resistance from IME [Iowa Medicaid Enterprises, the division of DHS with direct responsibility for overseeing the privatized Medicaid system] in our ability to actually contact the individuals who are most able to answer the questions for us.”

In a statement issued after Sand’s press conference, a DHS spokesperson said, “our team was very detailed and meticulous in accommodating the auditor’s requests to best equip their team with a deep understanding of the information they asked for.”

Regarding the quality of its data, the department said it “relies on thorough third-party validation with independent actuarial reviews for all Medicaid data to ensure we’re good stewards of the resources entrusted to us by taxpayers.”

DHS was less confident in its communications with the Auditor’s office, though. The report quotes a March email from DHS that stated, “The data provided by the Iowa Medicaid Enterprise (IME) in response to your request is provided ‘as is.’ The IME cannot ensure the accuracy, completeness, or reliability of the data.”

In response the audit report, the governor’s office issued a written statement expressing confidence in the data DHS provides. “The governor commends Iowa DHS employees for an outstanding job providing thorough information to the auditors’ various requests over these last 14 months,” the statement said.


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According to Sand, Thursday’s report was just the first of several audits examining various parts of Iowa’s Medicaid program.

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