At what cost?


Thousands of disabled Iowans rely on Long Term Support Services (LTSS) through Medicaid. These services were designed to provide daily living assistance for individuals to maintain normal lives in their homes. Since Medicaid’s privatization, individuals are being forced to consider nursing home placement, which is typically more expensive than community living.

Shelley Jaspering, Ames, uses a wheelchair due to a cervical spinal cord injury. She relies on agency caregivers to help her get up and ready for work. She received a 30 day notice from her healthcare agency stating her services will end after Sept. 7. Then, Shelley faces the possibility of losing her Habitat for Humanity home and entering a nursing home. She has trained over 40 caregivers in just three years but most had to pursue other jobs because of the low wages offered by Iowa Medicaid.

Elaine Gartelos, Waterloo, has Spinal Muscular Atrophy and uses a power wheelchair to stay productive and active. After Medicaid’s privatization, her caregivers weren’t getting paid — sometimes for months. Slow payments and low wages forced them to leave for better paying jobs. Healthcare agencies drastically reduced the hours of care she gets. Due to staff shortages, agencies left her lying in one spot in bed for 45 hours. Elaine lives in constant threat of pressure sores and other health issues because of this.

Kyle Spading, Fairfax, is a former Iowa Football player with a cervical spinal cord injury. He lives with constant uncertainty, not knowing if he can keep home care services at a level high enough to achieve and maintain employment using his master’s degree and certification in rehabilitation counseling. His agency’s staffing levels are constantly affected by the low pay strains that Managed Care Organizations (MCOs) have pushed onto waiver-funded services.

These are just three of hundreds of personal stories heard since profit-based MCOs took over Iowa’s Medicaid system through privatization.

When Medicaid was privatized, the goals were to:

1. Have greater accountability for outcomes.

Iowa’s Legislature eliminated any accountability by removing the oversight clause from the IOWA MEDICAID MANAGED CARE IMPROVEMENT BILL—SF 2213, passed 3/17/16.

2. Improve quality and access. 

Quantitative evidence is hard to find with no oversight. Qualitative evidence can be found on the website.

3. Create a more predictable, sustainable Medicaid budget for the State. 

A DHS report suggesting Iowa could save $141 million annually from privatization (Des Moines Register, Sept. 20, 2018) seems unrealistic, when our legislature granted the MCOs an extra $334 million in 2018 and another $386 million in 2019. 

Iowans being impacted by these issues don’t believe these goals are being met.

We challenge you, the reader, to contact your legislators, the Iowa Department of Human Services Director, Mike Randol, and Governor Kim Reynolds.  Find their information at

Ask them to use taxpayer’s money more efficiently on community support services and caregiver wages to keep individuals in their homes.

Ask them to invest in Iowans with disabilities and the caregivers that support them.

Ask them to #UpgradeMedicaid!

#UpgradeMedicaid organizers

Jenn Wolff


Shelley Jaspering


Kyle Spading


Elaine Gartelos


Tucker Cassidy


Evan Schultz

Des Moines

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