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To the new director of the Iowa Department of Human Services, her charge to take the department in a new direction is ensuring the agency is accountable, transparent and open on 'the spaces where we have room to grow.'
'This is a big system,' said Kelly Garcia in an interview with The Gazette Friday. 'There's always room for improvement and we will make mistakes.
'But when we do that, we own up to it, we talk about how we fixed it and then we talk about how we're going to put processes and procedures on an administrative side that help us from making repetitive mistakes.'
'A new direction' was a term used by Gov. Kim Reynolds earlier this year in reference to her plans for the Iowa Department of Human Services after dismissing the department's director at the time, Jerry Foxhoven.
Iowa's human services department — which oversees the state's Medicaid managed-care program, foster care system and behavioral and mental health programs, among others — is one of the state's largest, with a federally supported annual budget of $6.5 billion and a workforce of about 4,600.
Reynolds, in a statement at the time of Garcia's appointment in early September, described her as 'an experienced social service leader and team builder with a passion for helping people and leading change.'
However, what that new direction might entail was not made immediately clear by the governor.
Garcia said it is her priority to ensure the agency is accountable to its stakeholders by being responsive to their concerns and by providing accurate and timely information to help drive decision-making.
'That's the space that I see the most immediate improvement that needs to be made,' Garcia said on Friday.
'I need to learn Iowa'
In accepting the Iowa position, Garcia, 40, left behind a role in the Texas Health and Human Services Commission overseeing its Health, Developmental and Independent Services Department, which has a $1.4 billion annual budget and more than 700 employees.
Garcia joined Texas's health and human services in 2013. She also worked for the state of Texas for 15 years before that, which included a stint as a senior adviser to then-Texas Gov. Rick Perry.
Garcia's annual starting salary will be $154,300, with a $50,000 retention bonus, said Pat Garrett, Governor's Office spokesman.
She's focused her first five weeks as director on listening, she said on Friday. Garcia has been touring DHS sites across the state to meet with staff and administrators in every division to better see the challenges the agency faces in their effort to address the needs of Iowans.
'I do understand health and human services and I understand Texas government, but I need to learn Iowa,' she said. 'Health and human services have a lot of common threads, and certainly some of the challenges and spaces to grow in this state are not dissimilar to what Texas has experienced, but I don't know Iowa yet.'
A lesson learned during her time at the Texas Health and Human Services Commission is the importance of communication between top-level administrators and front-line workers. She recalled how a foster care policy enhancement was developed at the state level during her tenure, but officials didn't talk with case workers on how the new policy could affect them.
'It ended up becoming this inefficient process that didn't really work for them in their practice and didn't support them in the way that they needed it to,' Garcia said.
Priority for managed care
Garcia said the challenges facing Iowa's managed-care program, which is handled by private insurance companies, are 'not dissimilar to what we were experiencing in Texas.'
However, she believes the program is in a stable enough market at this time to start improving health outcomes of the more than 600,000 Iowans enrolled in Medicaid under managed-care organizations.
'That's where I'm going to be focused, which is really understanding places where we might have room to grow in terms of our oversight of the program,' Garcia said. 'Because as you move from fee-for-service to managed care, the role of the organization shifts quite substantially.'
Garcia said she's been working with Iowa Medicaid Enterprises Director Michael Randol on understanding the data available, which should show officials 'the health of the system and where we need to focus our efforts.'
But Iowa's managed-care system always will be an area she watches for potential issues down the road. It's the department's job to be looking at the program's data early and often, she said, so they can catch those problems 'long before we're hearing from those providers.'
Garcia said she has not yet met with any of the managed-care organization officials, and declined to comment on whether there needs to be expanded oversight of the companies.
'This early on in my tenure, I don't know that I have an answer for that,' she said. 'I know there needs to be consistent (oversight), and I know what that looks like, so I intend to do that.'
Mental health in Iowa
Earlier this week, the Des Moines Register reported the U.S. Department of Justice was investigating two of Iowa's state-run institutions, Glenwood Resource Center and Woodward Resource Center, for alleged violation of residents' the federal rights.
Garcia said she takes the investigation 'incredibly seriously,' noting she has assembled a group to gather additional facts on the allegations to inform her next steps.
'I will absolutely be moving forward on additional efforts to make sure that I am taking the appropriate steps to ensure that our residents are safe and healthy and thriving,' she said. 'But right now, we're gathering more information.'
Garcia spoke with The Gazette ahead of a meeting of the Children's Mental Health Board, tasked with developing a state program around children's services and a group she described as 'an incredible first step.'
'I think where we stand today is to have a deeper understanding of where gaps still exists, so it's not dissimilar to the Medicaid managed-care conversation,' she said. 'We — the collective we — and certainly DHS need to further understand to really be able to target where additional resources are needed, and we're still working on those pieces of information.'
The director defined success in children's mental health services as ensuring the parents have the support they need, and that the child is on the road to becoming a healthy, independent and successful adult.
'The culture I want to have'
Garcia took over for Foxhoven in Nov. 1. Foxhoven had been ousted from the role in June after two years.
He since has filed a $2 million complaint against the state for wrongful dismissal, alleging Reynolds and her staff dismissed him to prevent him from disclosing information he believed was illegal.
The complaint was filed before the State Appeals Board in August.
Garcia did not specifically comment on her predecessor's dismissal, but said she has been having many conversations about employee morale during her month-long listening tour.
She hopes to create a culture in which information travels quickly to the top, and where officials can work 'to stop those repetitive mistakes.'
'That's the culture I want to have,' she said. 'I don't know that we're quite there yet, but we will be.'
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Kelly Gracia's resume
• Kelly Garcia became the director of the Iowa Department of Human Service on Nov. 1, overseeing the one of the state's largest agencies that has a federally supported annual budget of $6.5 billion and a workforce of about 4,600.
Her annual starting salary is $154,300, with a $50,000 retention bonus.
• Before coming to Iowa, Garcia worked for the Texas Health and Human Services Commission since 2013. She most recently served as deputy executive commissioner, overseeing Texas' Health, Developmental and Independence Services Department, which has a $1.4 billion annual budget and more than 700 employees.
Garcia also worked as the director of government and stakeholder relations and the director of operations and policy for the medical and social services division within the Texas Health and Human Services Commission.
• Before the Texas HHS, Garcia worked for 15 years within state government. She was a senior adviser to then-Gov. Rick Perry as well as manager and senior analyst at the Texas Sunset Advisory Commission.
• Garcia holds a bachelor's degree in government from the University of Texas at Austin and a master's degree in public service and administration from Texas A&M University.