“I’m a firm believer in managed care,” Randol told reporters in 2019 as he defended the Iowa program at a news conference announcing an 8.6% annual increase in the rate the state would pay its two management companies.

Managed care got a bad reputation in Montana after the state contracted with an outside company to manage Medicaid-covered mental health care in the 1990s. The state eventually took back management after numerous patient and provider complaints and after the company, Magellan Behavioral Health, cut provider rates to make up for the loss of millions of dollars in its first year. In 2011, widespread opposition led the state to scrap plans for a managed-Medicaid pilot program in five counties.

By Katheryn Houghton and Tony Leys (KHN)