State has learned from previous Medicaid transition missteps, agency director says

CEDAR RAPIDS — Kelly Garcia said the state has learned from missteps made during previous times of transition under the privately managed care of the state’s $7 billion Medicaid program, and pledged that those hard lessons are being applied as the state once again brings on a new private partner.

“Obviously through some of the pain points experienced with the managed care rollout and onboarding MCOs in the state, we have a number of lessons learned that we have taken,” Garcia said Thursday in an interview for The Gazette’s Iowa Ideas 2022 conference. “We built it into the (request for proposals) and we built into our timeline to ensure that claims processing was ready to go. … A lot of lessons learned to not have repeat failures.”

The state recently contracted with California-based Molina Healthcare to become the third managed care organization for the state’s roughly 800,000 Medicaid recipients.

In previous transitions between Medicaid managed care organizations, some Iowans have complained of confusion and frustration.

“Making sure that we really do again, learn those lessons from the abrasion that occurred in the past. We have a really deep plan. It is very intense,” Garcia said.

During a one-hour session for the “Iowa Ideas” virtual conference, Garcia also discussed the combining of multiple state agencies into the new Iowa Department of Health and Human Services, and the closure of the state-operated facility for Iowans with intellectual and developmental disabilities in Glenwood.

Garcia said Gov. Kim Reynolds asked her to evaluate whether the state should merge the former public health and human services departments, but that it was ultimately her recommendation.

“She gave me the space to give her that independent analysis,” Garcia said. “And ultimately, it was my very strong recommendation to her that we do.”

Garcia said one consideration was the myriad agencies’ involvement in services in mental health care, substance abuse, maternal health care, and Medicaid.

“What I found were some significant gaps in that strategy. In fact, in some areas, lack of strategy,” Garcia said. “And that’s not me saying that we didn’t have really great team members working on these very important topic areas. But what we lacked was a real integrated approach to thinking about how we serve Iowans kind of in totality.”

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.

Garcia said throughout the transition she has been in contact with staff, boards under the former structure, and stakeholders.

“It was completely led by our team and the incredible amount of stakeholder engagement that we received over this more than a year,” she said. “That’s what success looks like for me, is really engaging, bringing the people who do the work and who we partner with to do the work to the table to help craft an organizational structure that allows us to drive home on really solving these big subject matter areas, while really getting down to the kind of brass tacks of improvement. And you have to do both.”

Garcia said her staff is working closely with the families of residents of the Glenwood Resource Center as plans are made for when the facility closes in 2024. She said the decision to close the facility, which faced scrutiny from federal regulators, was not reached lightly.

“That announcement did not come easily at all,” she said. “We did our absolute best effort to reshape what we’re doing at Glenwood.”

Garcia said because most states have closed state-run facilities like Glenwood, she was already considering plans for a similar transition.

“Most states have closed their state-run facilities or reshaped them tremendously. And we’re one of the last states to do that really intensive work. So I already had plans underway to kind of reshape it,” Garcia said. “But ultimately, we really are struggling with providing the level of medical care out at that facility that we need to, and so I couldn’t in good faith look at the guardians or the clients or my own team members in the eye and say, ‘We can do this.’ We just can’t. And so we are on a path.”

Garcia said nearly 30 community-based providers have talked to the state about housing Glenwood residents.

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