Iowa’s new Medicaid director to prioritize health outcomes, health’s social determinants

As Iowa’s new Medicaid director prepares to step into the role next month, she and other state leaders say they are focused on strong oversight of the insurance companies administering the program and delivering good outcomes for its members.

Elizabeth Matney said the state’s managed-care program has sent “signals of a stable program” since its switch to a privatized program five years ago, enabling state officials to focus on addressing overall population health for the poor and disabled Iowans who rely on Medicaid.

“We have very committed managed-care organizations,” Matney said in an interview with The Gazette on Monday. “We’re not having the same type of conversations we were four or five years ago. What we’re talking about now is, ‘How do we make the program better?,’ which is an amazing spot to be in.”

Matney, formerly a health policy adviser to the governor, was appointed earlier this month as the new Medicaid director. Starting June 1, she will oversee the state’s $5 billion Medicaid program that serves more than 700,000 Iowans each year.

Her salary will be $155,168, according to a Department of Human Services spokesman.

She is the third Medicaid director since the state switched to a managed-care model in April 2016, when the state handed over administration of the program to privately run insurance companies, known as managed-care organizations.

Critics of the switch to privatized managed care have decried the program as unstable, particularly after the departure of some managed-care organizations over the past five years. Two of the insurance companies left the state program — the first on in 2017 and the second in 2019 — each stating that chronic underfunding of the program resulted in millions of dollars in revenue losses.

There currently are two insurers administering the program — Amerigroup and Iowa Total Care. As of the second quarter of state’s fiscal year 2021, about 720,000 Iowans’ benefits fall under these managed-care organizations.

The program has stabilized from the upheaval in the initial rollout, said Kelly Garcia, who holds a dual role as the director of the Department of Human Services and as the head of the state’s public health agency. She appointed Matney as Medicaid director following a nationwide search.

In addition, state officials have created strong oversight of the program, Garcia said Monday. She pointed to Iowa’s withholding of nearly $44 million from Iowa Total Care, which is a subsidiary of the insurance company Centene, after it failed to pay more than 100,000 bills from providers.

“We are stable,” Garcia told The Gazette.

Garcia did not confirm if state officials plan to bring a third managed-care organization into the program. She indicated that is a key topic under discussion as officials look to the end of Amerigroup’s current contract, scheduled to expire in mid-2023

Despite previous managed-care organization officials’ statements that Iowa’s program is underfunded, Garcia said it won’t be a challenge to entice another insurance carrier to administer Medicaid benefits.

“I think we’ve made some significant strides in our rate structure and we have two deeply committed (managed-care organizations) in the state today that have outwardly voiced their commitment to the state of Iowa,” Garcia said. “So I don’t think those concerns are lingering.”

Aligning benefits with other service lines

As the new Medicaid director, Matney’s priorities will include a focus on addressing social determinants of health and addressing other challenges members are facing, such as barriers to housing, food insecurity and unemployment, she said.

“Ultimately the state has a lot of responsibility for helping individuals make their lives better,” Matney said. “We can do that in a better way.”

Garcia also told The Gazette she is keenly focused on overseeing an alignment of the Medicaid program with other state-run service lines, such as child welfare, to move the program into an outcome-focused model that addresses overall population health.

“Through the pandemic and the derecho, we’ve been able to see fractures in our health care delivery system that now we have this renewed focus and a catalyzing even to really make good on,” Garcia said.

Matney pointed to the increasing number of labor and delivery unit closures at hospitals across the state as an example, noting that telehealth offers the opportunity to improve access to those services.

“We’re uniquely positioned to be able to drive major policy initiatives at a state level,” she said.

Garcia said Matney also will be leading an internal study of rate reviews of the reimbursement Medicaid offers to providers for health care services, and how those payments from managed-care organizations compare to private market insurers.

The Iowa Hospital Association and other health care advocacy groups have cited what they say is an alarming number of health care systems that have faced steep financial losses this past year as a result of the pandemic, raising concerns about an increasing rate of services being cut across the state.

Garcia said the pandemic highlighted spaces where the state can change the way it administers the program in an effort to alleviate friction for providers caring for Iowans. That first step would focus on the administrative burden on health care providers, such as obtaining prior authorizations for services.

“When you see prior authorizations be approved at a rate upward of 80 percent, then there may not be a need for one any longer,” Garcia said.

Matney has been the health policy adviser to Gov. Kim Reynolds since June 2019, a position she said taught her a broader perspective of the overall health care system and the role Medicaid plays as one of the largest insurers in the state.

Her annual salary for fiscal year 2020 was listed by the Iowa Department of Administrative Services at $120,790.

Before her current position in the Governor’s Office, Matney has held several roles at the Department of Human Services overseeing Iowa’s Medicaid program, including as Medicaid managed-care director and Medicaid quality assurance director.

Those years at the state agency and the governor’s office, as well as previous experience as a case manager at a women’s domestic violence shelter and as a provider for individuals with autism, means she is poised to take on the role, Matney said.

“Ultimately it’s my passion,” she said. “I want to make a difference.”

Matney was appointed by Garcia following the departure of the previous Medicaid Director, Michael Randol, who left the role in August after two and a half years to take a job in the private sector.

Randol was proceeded as Medicaid director by Mikki Stier, who retired from her role as Deputy Human Services director.

Comments: (319) 398-8469; michaela.ramm@thegazette.com