If Iowa’s experience privatizing Medicaid is an indicator, the movement might proceed with a little more caution. The independent Iowa Office of Ombudsman reported that the state’s privatized Medicaid program saw its number of complaints nearly triple last year.

In the program’s first year, 2016, there were 85 complaints. Last year, the number jumped to 225.

Private insurance companies run Iowa’s Medicaid health programs for more than 750,000 poor or disabled residents. Several other states are also considering increasing managed or privatized care options around the country.

The Iowa ombudsman’s report included 15 examples of Medicaid investigations, many of them looking into contractors who reduced care or funding by arguing that beneficiaries were receiving too many services.

Earlier this year, Iowa’s program came under fire when a managed care doctor was caught on tape saying a man with cerebral palsy whose home care was reduced could be a “little dirty” for a few days between visits.

In her report, ombudsman Kristie Hirschman said official notices of similar reductions were often not provided as required by law, and that the managed care organizations pressured members to sign new care plans along with their service providers and case managers.