State agency mergers ‘difficult’ but necessary, director tells boards

DES MOINES — The ongoing merger of multiple health-related agencies will create a more efficient and productive state government, the newly formed department’s director told board members from the absorbed agencies Wednesday.

Kelly Garcia, director of the new Iowa Department of Health and Human Services, explained her rationale for the merger of the Iowa Department of Public Health and Department of Human Services to the state Board of Health and Council on Human Services at a combined meeting of the two groups.

Both those boards now will be part of the new Health and Human Services department.

Garcia said her belief is that for state sub-agencies like the Board of Health and Council on Human Services to be productive, the overarching agency’s director should be able to hear directly from those groups. As state government is now constructed, there are too many sub-agencies for an agency director to accomplish that level of engagement, Garcia said.

“Any of the advisory boards that we have, whether we’re talking about the Board of Health or the DHS Council, or any of the other entities that are on our list in that appendix, what are we asking them to do?” Garcia said. “And what I see in some spaces is some really thoughtful contribution.

“But what purpose is it serving? Are we truly advising the agency, advising the director, advising a division administrator, making a recommendation to the Legislature? Is that happening or not? Are we just sitting in a room and talking? …

“So really thinking about how we spend our time, and how we realize thoughtful engagement and true feedback — not just something that makes us feel better about saying it out loud, but really meaningful engagement with agency leadership that provides a forum for the public to see that dialogue. That is what would be most beneficial to me.”

The former Department of Human Services, which includes Iowa’s Medicaid program, had a nearly $10 billion budget and employed 4,233 in the most recent state budget year, according to state records.

The former Department of Public Health budget was nearly $800 million with 525 people.

“You all bring individual contributions that, of course, none of us want to lose,” Garcia told the sub-agency board members Wednesday. “I’m going to need us to think about something different. And I do realize that that is tricky. It’s difficult.”

Garcia said eventually the new department will propose legislation for state lawmakers to codify the departments’ mergers.

PUBLIC HEALTH REGIONALIZATION

Garcia also said that while no proposals are imminent, she hopes to have a discussion at the state level about the regionalization of public health.

She said the state and county public health departments worked during the COVID-19 pandemic, but she believes a different approach is needed. Garcia said she hopes to continue the conversation once newly hired state medical director, Dr. Robert Kruse, is on board.

“I think I can say with certainty that having 99 separate entities is something that was very cumbersome during our pandemic response,” Garcia said. “You can see us as a state in a variety of different spaces think about things like regionalization. …

“I think what (Kruse) will hear is an eagerness for us to revisit this conversation but be thoughtful about how we move forward. So we are actively having those conversations. There is nothing predetermined from this vantage point, but it is causing a lot of questions.”

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