Current Events > Iowa man dies after Medicaid services he relied on are ended

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https://www.desmoinesregister.com/story/news/investigations/2017/08/13/medicaid-patient-lost-care-hed- received-20-years-3-months-later-he-dead/488367001/

Thirty-two years ago, a vehicle accident left Todd Mouw a quadriplegic, unable to feed himself and needing a ventilator to breathe.

Yet for decades he was able to live at home with the help of family, aided by medical staff who visited him daily to help provide 24-hour care.

That care abruptly ended when a for-profit company that Iowa hired last year to manage the state's Medicaid program announced that some of the staffers who had attended to Mouw all those years weren't qualified, and it wouldn't pay for the cost.

As he and his wife Cyndi futilely searched for qualified help, Todd's health dissipated. He had to leave his home for care, and on July 8 he died at age 53.

Now, Cyndi Mouw is speaking out, blaming her husband's death on Iowa's decision to turn over its Medicaid program to for-profit companies she believes are unilaterally denying or revoking medical services to potentially thousands of other disabled or elderly Iowans.

"If they're trying to do this because they need to save money? Well, find other places," Cyndi Mouw said. "And, yeah, I'm sure he's not the only one."

Her criticisms have echoed those of other families who complain that the private companies now managing the state's Medicaid program are denying care that the state once approved.

And the state's long-term care ombudsman said she has received hundreds of complaints from Medicaid recipients who are appealing decisions of the private managers hired by the state.

Todd Mouw's problems began in March.

That's when Amerigroup, one of three companies hired in 2016 to manage Iowas Medicaid program, notified the family that it was terminating a longtime waiver that allowed some of Mouw's in-home workers to assist in such tasks as tracheostomy care.

Although some of the health provider firms and their employees had for nearly two decades provided Mouw's care and equipment, Amerigroup said they no longer considered the workers qualified.

Amerigroup instead required registered nurses to provide some of the services that had for years been provided by home-health aides.

The requirement for higher-qualified staffing left the family scrambling for months to find workers Amerigroup would approve for payment.

When Cyndi Mouw thought she had identified potentially qualified workers, she said weeks of administrative delays resulted in repeated missed care for her husband.

In the months that followed, Todd Mouw would sometimes go unsupervised because no staff had been approved to provide care for him, Cyndi Mouw said.

When she had to go to work, she would monitor her cellphone in case her husband alerted her to an emergency care issue.

Several times, she said, she found her husband nearly unresponsive because the passageway of his trachea tubes needed to be cleared of mucus buildup.

"When I got the calls, I'd put on my hazard lights and I'd fly home," she said, describing calls where all she could hear were the background sounds of his vent alarm system blaring warnings about her husband's dropping oxygen levels.

"There were a couple times when he was blue when I got home. But we had no other option."

In May, Todd Mouw developed pneumonia and was hospitalized.

Although he initially improved, he was never able to return home for lack of in-home workers.

Instead, he was sent to a facility in Sioux Falls, S.D., that specialized in respiratory ailments. He died at the facility about six weeks after he arrived.

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Jesus fucking Christ, leave it to Republicans to make death panels come true.
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announced that some of the staffers who had attended to Mouw all those years weren't qualified, and it wouldn't pay for the cost.

Amerigroup instead required registered nurses to provide some of the services that had for years been provided by home-health aides.

This sounds like an incredibly misleading representation of a state Medicaid program being forced into modern compliance laws.

We can't even discharge people from the hospital on ventilators unless they have 24/7 access to skilled nursing.
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King_Hellebuyck posted...

Jesus fucking Christ, leave it to Republicans to make death panels come true.

This wouldn't have happened if the man had a gun
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I'm impressed at how easily a news source can spin forced Joint Commission / Centers for Medicare and Medicaid compliance requirements as a company's fault.
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Coffeebeanz posted...

I'm impressed at how easily a news source can spin forced Joint Commission / Centers for Medicare and Medicaid compliance requirements as a company's fault.

The company made zero effort to help link the patient with qualified care, and stalled the process of approving any properly qualified care providers which resulted in missed care for him. So yeah, they killed him.
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That care abruptly ended when a for-profit company that Iowa hired

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gunplagirl posted...

Coffeebeanz posted...

I'm impressed at how easily a news source can spin forced Joint Commission / Centers for Medicare and Medicaid compliance requirements as a company's fault.

The company made zero effort to help link the patient with qualified care, and stalled the process of approving any properly qualified care providers which resulted in missed care for him. So yeah, they killed him.

I take it you've never dealt with Medicare and Medicaid before.

let me give you an example, I had a patient with obstructive sleep apnea. So severe that it caused right heart failure. Medicaid wouldn't cover a sleep study, and because they wouldn't cover a sleep study, she didn't qualify for a CPAP machine.
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Atleast he's not suffering anymore. That's not any way to live.
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glitteringfairy posted...

Atleast he's not suffering anymore. That's not any way to live.

No, that's not for us to decide.

But I can't tell you how many patients I've had who have been denied care by Medicaid. It's infuriating.
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Antifar posted...

That's when Amerigroup, one of three companies hired in 2016 to manage Iowas Medicaid program, notified the family that it was terminating a longtime waiver that allowed some of Mouw's in-home workers to assist in such tasks as tracheostomy care.

Although some of the health provider firms and their employees had for nearly two decades provided Mouw's care and equipment, Amerigroup said they no longer considered the workers qualified.

Amerigroup instead required registered nurses to provide some of the services that had for years been provided by home-health aides.

The requirement for higher-qualified staffing left the family scrambling for months to find workers Amerigroup would approve for payment.

When Cyndi Mouw thought she had identified potentially qualified workers, she said weeks of administrative delays resulted in repeated missed care for her husband.

In the months that followed, Todd Mouw would sometimes go unsupervised because no staff had been approved to provide care for him, Cyndi Mouw said.

abominable
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Not to be misinterpreted here, my criticism is that Medicaid often finds loopholes to deny care, like the aforementioned CPAP thing. They'd only cover a CPAP if the patient had a sleep study, but they wouldn't cover a sleep study. That's the kind of loopy bullshit that goes on all the time.

As far as this specific case goes, I'm actually more amazed that the family ever got approval for home health aides to manage ventilators. That's easy lawsuit money if anything goes wrong.
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bored, why are you so clickbait-y on this board?
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I hope the administrators feel good about want they did

Zikten posted...

I hope the administrators feel good about want they did

I can promise you that healthcare administrators have no souls.
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Coffeebeanz posted...

gunplagirl posted...

Coffeebeanz posted...

I'm impressed at how easily a news source can spin forced Joint Commission / Centers for Medicare and Medicaid compliance requirements as a company's fault.

The company made zero effort to help link the patient with qualified care, and stalled the process of approving any properly qualified care providers which resulted in missed care for him. So yeah, they killed him.

I take it you've never dealt with Medicare and Medicaid before.

let me give you an example, I had a patient with obstructive sleep apnea. So severe that it caused right heart failure. Medicaid wouldn't cover a sleep study, and because they wouldn't cover a sleep study, she didn't qualify for a CPAP machine.

I'm literally certified in insurance processing and worked at a company that processed anesthesia insurance payments for surgeons to receive compensation.

I'm well aware that one misfiled section can be enough that, even if corrected, results in reduced compensation to the provider. That's kind of irrelevant when the state had been providing coverage prior to these for-profit companies coming in. So then, I guess the issue is whether or not what the prior people were doing was in legal compliance with national law. Seeing as the state was approving the compensation, I'm inclined to say it was.
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Oh snap, a Doctor vs Insurance Processor battle is brewing

Seeing as the state was approving the compensation, I'm inclined to say it was.

I'm not sure. First, they mentioned that the family had a waiver for it, and the waiver was issued thirty years ago.

The increased focus on liability in the past decade alone makes me wonder if this waiver was honored longer than it should've been.

Like I said before, I've not once ever discharged a ventilator-dependent patient home unless it was for hospice reasons. The hospital's case management would axe that in a heartbeat. The liability is just too great.

If anything went wrong, the lawsuits would be endless.
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NeverOffended posted...

Oh snap, a Doctor vs Insurance Processor battle is brewing

Not really, my last bit is agreeing that there was possibly some issue at the state level that ever allowed them to get payments approved for the caretakers they had for years.
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King_Hellebuyck posted...

leave it to Republicans to make death panels come true.

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gunplagirl posted...

NeverOffended posted...

Oh snap, a Doctor vs Insurance Processor battle is brewing

Not really, my last bit is agreeing that there was possibly some issue at the state level that ever allowed them to get payments approved for the caretakers they had for years.

Yeah, honestly I'm wondering if this was something that was approved so long ago that nobody really paid attention or thought to re-evaluate the legality of it by 2018 standards.

I actually cringe at the thought of what kind of shitstorm would happen if I discharged a patient home on a ventilator without 24/7 skilled nursing. I'd be sued by sundown.
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Wait, why wasn't he on Medicare and a subsidiary instead of being on Medicaid? A subsidiary, like Humana, would have covered it all and got the help he needed.
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DirkDiggles posted...

Wait, why wasn't he on Medicare and a subsidiary instead of being on Medicaid? A subsidiary, like Humana, would have covered it all and got the help he needed.

Because Medicare has unusual requirements for eligibility, I assume.

Either age > 65, on hemodialysis or a handful of other things.
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Making America great again.
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Coffeebeanz posted...

Because Medicare has unusual requirements for eligibility, I assume.

Either age > 65, on hemodialysis or a handful of other things.

If he was on SSI, then he would be eligible for Medicare.
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Coffeebeanz posted...


True enough. Lawsuits definitely are a big issue with compliance regulations.

For what it's worth, everyone who isn't involved in medical payment, be glad that HIPAA exists. If not, 99% of all payments would have all paperwork for payments handled in India. Instead it's still 99% with but only non-identifying paperwork can get filed over there meaning it's unlikely you'll have your information compromised or identity stolen unless the US processors who pass info along to the India businesses sends paperwork they weren't supposed to.
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King_Hellebuyck posted...

Jesus fucking Christ, leave it to Republicans to make death panels come true.

Yep, and in the same breath they will still unironically call themselves "pro-life".
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Coffeebeanz posted...

gunplagirl posted...

NeverOffended posted...

Oh snap, a Doctor vs Insurance Processor battle is brewing

Not really, my last bit is agreeing that there was possibly some issue at the state level that ever allowed them to get payments approved for the caretakers they had for years.

Yeah, honestly I'm wondering if this was something that was approved so long ago that nobody really paid attention or thought to re-evaluate the legality of it by 2018 standards.

I actually cringe at the thought of what kind of shitstorm would happen if I discharged a patient home on a ventilator without 24/7 skilled nursing. I'd be sued by sundown.

Or if not sued, the patient's family would post about it on facebook, they'd be told that's lawsuit material, they'd call somebody, you'd get an audit or whatever, and you'd have your practice searched top to bottom for compliance lapses, AND THEN get sued and open to lawsuit from other patients even if you were in compliance with those ones.
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Coffeebeanz posted...

gunplagirl posted...

Coffeebeanz posted...

I'm impressed at how easily a news source can spin forced Joint Commission / Centers for Medicare and Medicaid compliance requirements as a company's fault.

The company made zero effort to help link the patient with qualified care, and stalled the process of approving any properly qualified care providers which resulted in missed care for him. So yeah, they killed him.

I take it you've never dealt with Medicare and Medicaid before.

let me give you an example, I had a patient with obstructive sleep apnea. So severe that it caused right heart failure. Medicaid wouldn't cover a sleep study, and because they wouldn't cover a sleep study, she didn't qualify for a CPAP machine.

medicaid doesn't cover it but medicare does. Medicare also covers the CPAP machine although they only cover "rental" of the machine.
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Coffeebeanz posted...

The increased focus on liability in the past decade alone makes me wonder if this waiver was honored longer than it should've been.

It's not that the waiver is no longer available, it is that the MCO did not approve his use of the waiver
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gunplagirl posted...

Coffeebeanz posted...

gunplagirl posted...

NeverOffended posted...

Oh snap, a Doctor vs Insurance Processor battle is brewing

Not really, my last bit is agreeing that there was possibly some issue at the state level that ever allowed them to get payments approved for the caretakers they had for years.

Yeah, honestly I'm wondering if this was something that was approved so long ago that nobody really paid attention or thought to re-evaluate the legality of it by 2018 standards.

I actually cringe at the thought of what kind of shitstorm would happen if I discharged a patient home on a ventilator without 24/7 skilled nursing. I'd be sued by sundown.

Or if not sued, the patient's family would post about it on facebook, they'd be told that's lawsuit material, they'd call somebody, you'd get an audit or whatever, and you'd have your practice searched top to bottom for compliance lapses, AND THEN get sued and open to lawsuit from other patients even if you were in compliance with those ones.

You two make this sound like less a case of "death panels" and more an unfortunate case of "we need to cover our ashes before something goes wrong and we get sued to shit" and the guy died because they couldn't find qualified help in time.

Is it a lack of enough qualified help or just the grind of bureaucracy in the industry?
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Honestly, it's probably a little bit of both.
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fenderbender321 posted...

Another reason why government programs are shit.

well I mean he'd be dead without the decades of time he spent on government programs too
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fenderbender321 posted...

Another reason why government programs are shit.

We have to look at the reasons behind contracting this out.

Was it someone's cousin behind the company?
Were the costs bloated so much that paying some contractor a percentage off the top to manage the program actually saved the state money?

I'd say 30/70 with 30 being covering their asses and 70 being that it's financially lucrative to be in conpliance to the strictest degree. Nobody who gets deep into insurance stuff does so because they care. It's also why I got out of that company and I won't renew before my certifications expire later this year. It's not worth it when you know that HIPAA is the only reason the field even exists in the US to the degree it does.
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There is like a 99.9% chance that the reason they are scaling back LTSS is because there is a powerful nursing home lobby that wants more clients for themselves
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Balrog0 posted...

There is like a 99.9% chance that the reason they are scaling back LTSS is because there is a powerful nursing home lobby that wants more clients for themselves

huh.

Balrog0 posted...

There is like a 99.9% chance that the reason they are scaling back LTSS is because there is a powerful nursing home lobby that wants more clients for themselves

There's a difference between a nursing home and skilled nursing.
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Coffeebeanz posted...

Balrog0 posted...

There is like a 99.9% chance that the reason they are scaling back LTSS is because there is a powerful nursing home lobby that wants more clients for themselves

There's a difference between a nursing home and skilled nursing.

While true, nursing home payments are easier to get approved and so balrog has a point, it's definitely a thing in some states already.
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Questionmarktarius posted...

Balrog0 posted...

There is like a 99.9% chance that the reason they are scaling back LTSS is because there is a powerful nursing home lobby that wants more clients for themselves

huh.

LTSS are long-term support and services.

https://www.macpac.gov/medicaid-optional-long-term-services-and-supports-2/

Notice that 'enable independent life in the community' is actually optional under Medicaid rules, whereas institutional coverage is mandatory.

https://academic.oup.com/ppar/article/25/2/56/1500901

This is becoming an issue because Medicaid puts pressure on state budgets and you can argue that it is more efficient to have your patients in one setting where care can be coordinated in a centrally staffed location vs attempting to coordinate care for home supports

Coffeebeanz posted...

Balrog0 posted...

There is like a 99.9% chance that the reason they are scaling back LTSS is because there is a powerful nursing home lobby that wants more clients for themselves

There's a difference between a nursing home and skilled nursing.

I'm aware. But notice that he ended up being institutionalized.
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Balrog0 posted...

There is like a 99.9% chance that the reason they are scaling back LTSS is because there is a powerful nursing home lobby that wants more clients for themselves

Nursing homes typically only have a small amount of medical staff. Most of the people there are basically just maids/stewards with some first aid training. You don't need a nurse to deliver someone's regular medical prescriptions.
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Balrog0 posted...

This is becoming an issue because Medicaid puts pressure on state budgets and you can argue that it is more efficient to have your patients in one setting where care can be coordinated in a centrally staffed location vs attempting to coordinate care for home supports

Who would argue against that?

So I mean technically nursing care is itself an LTSS, I mispoke. What I should have said is the optional parts of LTSS are being scaled back because, well, they're optional and you cut what you can cut
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Tyranthraxus posted...

Nursing homes typically only have a small amount of medical staff. Most of the people there are basically just maids/stewards with some first aid training. You don't need a nurse to deliver someone's regular medical prescriptions.

I mean, there's actually a huge problem with this from a regulatory perspective. A lot of nursing homes are understaffed with respect to medical professionals.

But that conversation is orthogonal to what I'm saying, I think.

Questionmarktarius posted...

Balrog0 posted...

This is becoming an issue because Medicaid puts pressure on state budgets and you can argue that it is more efficient to have your patients in one setting where care can be coordinated in a centrally staffed location vs attempting to coordinate care for home supports

Who would argue against that?

I mean, it depends on where on the spectrum of medical needs you are and what specific things you need done for you

it's kind of like jail vs house arrest

You can argue its more efficient to centrally locate criminals and administer justice from one area, but there are upsides and downsides to doing that -- one obvious one is that you are then responsible for paying for them essentially 24/7 vs house arrest where you only perform certain functions but they are allowed to go about their lives more or less unharrassed

yeah we should keep people in jail, but there are a lot of people who it would be more efficient to serve in community-based alternatives. just depends
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Balrog0 posted...

I mean, it depends on where on the spectrum of medical needs you are and what specific things you need done for you

Well, yeah.
If you just need dialysis or something a handful of times per day, in-home seems reasonable and cost-effective.
If, however, you need medical professionals hovering over you all hours, you are not independent at all, and need to be in a facility.

yeah, health care is tough man

glad I won't be working in that policy arena much longer
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