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FILE - In this Dec. 19, 2019, file photo, Iowa State Auditor Rob Sand speaks in Des Moines, Iowa. Iowa's privatized Medicaid system has illegally denied services or care to program recipients, and both private insurance companies managing the system have violated terms of their contracts with the state, according to a state audit released Wednesday, Oct. 20, 2021. (Brian Powers/The Des Moines Register via AP, File0