When Red States Attack: Medicaid in Iowa

This is a brilliantly executed feature on how hard it is to actually get services from Medicaid in Iowa even if everyone agrees you are owed those services.

A Des Moines Register investigation into those 200 cases found an appeal process that presents a thicket of administrative and legal roadblocks to patients and their families, who must clear hurdle after hurdle to secure care.
Specifically, the Register investigation found:
• Due process violations: In at least four cases, administrative law judges concluded or the Medicaid recipient alleges in ongoing district court appeals that the companies failed to properly notify recipients about health care reductions and their appeal rights.
• Denials of in-home care: Medicaid expenses for in-home care that had been routinely approved when the state ran the program are now being rejected by managed-care providers as unnecessary and outside the scope of what the program authorizes. Families say they are left struggling to care for their loved ones, who are losing their independence and autonomy.
• Endless appeals: Even when Medicaid patients win their cases in administrative hearings, the managed-care companies routinely "re-evaluate" their health needs, again denying their care in as little as 60 days. That forces patients to embark on yet another round of appeals.

What's more, as I reported in November, the situation in Iowa is going to get worse.

I'm struck by the way that disability systems are built, funded, and run on the assumption that people mostly won't get full access to the services they are due.

Red States and Disability

My latest in The Nation:

Mostly buried beneath early November’s onslaught of news, stories from Oklahoma, Iowa, and Maine reveal the ways that state governments, through both apparent incompetence and maliciousness, are failing disabled residents and their families. In the first two examples, disability programs are being cut as a result of self-imposed budget crises. In the third, the governor is using disability as a shield to ignore the will of the voters, while at the same time not serving disabled Mainers.

Oklahoma is the worst of the three. At the beginning of November, agencies received letters stating that the “ADvantage Waiver,” a program funding home-based care for disabled individuals and seniors, would lose funding as of December 1. About 21,000 Oklahomans will lose the care that enables them to live independently. About 10,000, according to the Department of Human Services, will be forced to move into nursing homes—except that the state doesn’t have enough beds in nursing homes. So disabled Oklahomans are caught waiting to find out what will happen: Will they be trapped in their homes without services? Will they be forced into nursing homes or Hospitals? Will they be abandoned?

The problem, of course, is money. The conservative state has stripped awayits tax base in a wave of Tea Party glee. Now it’s broke and, rather than raise taxes (a budget just failed to pass in special session), it is closing nursing homes and slashing Medicaid.

Right Wing Attacks on Academia Continue: Iowa Law Mandates Political Affiliation

Amidst all the furor over Milo and UC Berkeley, in which non-students staged an action to shut down a speech, the GOP keeps doing its thing - using money and access to power to try and overthrow public universities. I wrote about this most recently here for Pacific Standard and on the blog.

Latest examples:

Waiting excitedly for the libertarian free speech media to cover GOP threats to academia.
Waiting
Still waiting
Yup, still waiting
Come on.. https://t.co/oSjvnjuMke

— David M. Perry (@Lollardfish) February 21, 2017

The law in question has been proposed in Iowa, requiring "political balance" among professors. It comes shortly after another bill ending tenure was proposed.

A bill in the Iowa Senate seeks to achieve greater political diversity among professors at the state's Board of Regents universities. Senate File 288 would institute a hiring freeze until the number of registered Republicans and Democrats on the university faculty fall within 10 percent of each other.
"I’m under the understanding that right now they can hire people because of diversity," said the bill's author, Sen. Mark Chelgren, R-Ottumwa. "They want to have people of different thinking, different processes, different expertise. So this would fall right into category with what existing hiring practices are."

Three notes:

1) Using coercive power of the states to force ideology into public universities is the standard conservative move.

2) The couching of in the frame of "diversity" is relatively new (last 5 years or so). Of course they are actually opposed to diversity in all other contexts.

3) Legislators propose all kinds of ridiculous bills for the sake of political posturing, but such proposals don't happen in a vacuum. It may not make it through Iowa. It might not make it through the courts if  it was passed. But it will in some states. ALEC and the like help draft these bills and pass them around. This is a garbage law, and unworkable. But any hint of forcing people to declare party affiliation for hiring is a totalitarian move.

Meanwhile, I'm sure the high visibility writers with all the diversity of Chait, Haidt, Kristof, and Soave are super focused to see how the next big threat to free speech is coming from Oberlin students.

UPDATE: Also NC. I smell ALEC's legislation-writing folks at work.

NC Senate has tabled this amendment from Republican Sen. Hise to require political party quotas in hiring UNC system professors. #ncpol pic.twitter.com/2ej6oYsQLx

— Colin Campbell (@RaleighReporter) February 21, 2017