Iowa must consider the appeals of a Council Bluffs dentist who says a Medicaid company is improperly denying payment for the services he provides to poor and elderly residents, the Iowa Supreme Court ruled Friday.
The government program is managed by private corporations and provides dental services to more than 155,000 Iowans.
If dentists can't appeal payment denials, fewer dentists will offer care under the Medicaid program, and more low-income Iowans won't get the care they need, the dentist's attorney argued.
Dentist Robert Colwell contends Delta Dental has for years denied him payment for tens of thousands of dollars in services he provided under the program.
And he says the Iowa Department of Human Services has failed in its responsibility to provide oversight of the for-profit company by refusing him a chance to appeal Delta Dental’s denials.
With no possibility of appeal to DHS, it's more difficult for doctors to challenge wrongful denials and maintain the financial solvency that allows them to provide services to the state’s poor, said Rebecca Brommel, Colwell’s attorney.
Friday’s ruling is a win for accountability, Brommel said.
“Doctors start to say, ‘I don’t want to deal with Medicaid or Delta Dental, so I’m not going to provide services to those patients at all,’” Brommel said. “That then creates an access-to-care problem.”
Segments of Iowa’s $60 million annual dental care program have been managed by two private companies — MCNA Insurance Co. and Delta Dental of Iowa — since 2014. Private management in the dental program expanded in 2017 and now covers almost all adult participants.
The expansion followed a larger shift by Iowa Gov. Terry Branstad in 2015 to privatize the overarching statewide $5 billion Medicaid program, which provides services to 600,000 people.
Hundreds of Iowans in the larger Medicaid program have been denied services since the privatization in situations that were not routinely denied when the state managed the program, doctors and patient advocates say. But in hundreds of those cases, patients were allowed to pursue an appeal through the DHS, and their cases were heard before an administrative law judge.
In Colwell’s case, DHS contended the issue was a contractual dispute between the dentist and the private company. DHS determined Colwell was not entitled to an administrative review, as is the case with individual patients.
Friday’s Supreme Court ruling affirms a Polk County District Court ruling that said Colwell is entitled to a hearing, as outlined in the state’s administrative rules. The ruling, however, reversed the district court’s judgment that awarded Colwell attorney fees.
Spokespeople for Delta Dental and DHS did not immediately respond Friday to requests for comment.