For the first time in four years, the state of Iowa submitted its Annual Comprehensive Financial Report and its Single Audit for the previous fiscal year without months of delays. The Iowa Department of Administrative Services released the comprehensive financial report covering fiscal year 2023 (July 2022 through June 2023) in late December, and the State Auditor’s office published the Single Audit on March 29.

The Annual Comprehensive Financial Report typically comes out within six months of the end of a fiscal year. But Iowa State University’s switch to the Workday system for accounting in fiscal year 2020 created enormous difficulty in compiling accurate financial data. As a result, the state’s comprehensive report for FY2020 came out nine months behind schedule.

For the next two years, turnover within the Department of Administrative Services delayed work on the comprehensive report, which came out more than seven months late for FY2021 and eight months late for FY2022.

The Single Audit is a mandatory report covering federal dollars spent by state agencies and universities. It typically comes out in late March but can’t be issued before the comprehensive report is complete. So beginning in FY2020, Iowa’s Single Audit was months late for three years in a row.

When Iowa Republicans gained the trifecta following the 2016 elections, defunding Planned Parenthood was near the top of their agenda. GOP legislators promised a new state-funded family planning program would increase access to reproductive health care and give women more options, especially in rural Iowa.

The latest official data, first reported by the Des Moines Register’s Michaela Ramm, show the program has flopped. In just five years, the number of Iowans receiving services such as contraception, pregnancy tests, Pap smears, and testing or treatment for some sexually transmitted infections dropped by 90 percent compared to the population served during the last year of the previous Medicaid waiver. The number of health care providers involved is down by a staggering 97 percent.

The Iowa Department of Health and Human Services has done almost nothing to promote the program, even as enrollment crashed.

The reality could hardly be more different from the scenario Republicans described in 2017: “connecting folks with their home health care” for essential services by taking Planned Parenthood’s mostly urban clinics out of the equation.

Iowa’s health and human services budget for the coming fiscal year includes a $500,000 appropriation for a new “maternal health” initiative modeled on an ineffective, wasteful Texas program.

But the bill, negotiated by House and Senate Republicans and approved on party-line votes in both chambers May 23, does not extend postpartum coverage for Iowans on Medicaid, a documented way to reduce maternal mortality.

The Iowa Department of Human Services (DHS) is appealing a Polk County District Court ruling that found the state law and policy designed to deny Medicaid coverage for gender-affirming surgery are unconstitutional. The state filed notice of its intent to appeal on December 17, near the end of its 30-day window to do so following the District Court’s decision in November.

The Iowa Attorney General’s office had no comment on the appeal. Governor Kim Reynolds’ office also had no comment on why the governor is determined to prevent transgender Iowans on Medicaid from receiving medically necessary care approved by their doctors.

Plaintiffs Aiden Vasquez and Mika Covington have been waiting for years to obtain surgery and first challenged the state law in court within weeks of Reynolds signing the provision into law in May 2019.

For Aiden Vasquez and Mika Covington, the news was life-changing. Polk County District Court Judge William Kelly ruled on November 19 that Iowa’s law designed to deny Medicaid coverage for gender-affirming surgery “violates the equal protection clause of the Iowa Constitution.”

He ordered the Iowa Department of Human Services to change a longstanding regulation “excluding coverage for sex reassignment surgery” and said the agency must apply the revised rule to allow “transgender individuals coverage under Iowa Medicaid for medically necessary gender affirming surgery for the treatment of Gender Dysphoria and other relevant diagnoses.”

Vasquez and Covington are transgender Iowans who qualify for Medicaid and have been unable to obtain the health care they need for years. They have been seeking legal redress since soon after Governor Kim Reynolds signed the discriminatory statute in May 2019.

Naturally, not everyone was happy with what the ACLU of Iowa’s legal director Rita Bettis Austen described as a “historic win for civil rights in Iowa.” Soon after the court ruling was published on November 22, Reynolds’ spokesperson Alex Murphy told reporters, “The governor’s office is disappointed in today’s decision and disagrees with the district court’s ruling on Medicaid coverage for transgender reassignment surgeries.”

Reynolds echoed the sentiment when speaking to reporters on November 23: “Of course we were disappointed with the ruling and disagree […] My legal team is looking at it. There will be more to come later on. We’re still looking through it and trying to determine what our options are.”

She should stop fighting this battle.

Governor Kim Reynolds’ office was able to spend nearly 40 percent more than its $2.3 million budget appropriation during the last fiscal year, mostly by shifting personnel costs onto other state agencies.

Documents Bleeding Heartland obtained through public records requests show that eight state agencies covered $812,420.83 in salaries and benefits for nine employees in the governor’s office from July 1, 2020 through June 30, 2021. In addition, the Office for State-Federal Relations in Washington, DC remained understaffed, as it has been throughout Reynolds’ tenure. The vacant position should allow roughly $85,000 in unspent funds to be used to balance the rest of the governor’s office budget, as happened last year.

The governor’s communications director Pat Garrett did not respond to four inquiries over the past two weeks related to the office budget. But records indicate that unlike in 2020, federal COVID-19 relief funds will not be tapped to cover salaries for Reynolds’ permanent staffers in fiscal year 2021.

Jerry Foxhoven asserts in a new lawsuit that Governor Kim Reynolds and her senior staff forced him out as Iowa Department of Human Services director “because he refused to engage in illegal activity” and to prevent him from seeking legal advice about possible misuse of federal Medicaid funds.

The petition filed in Polk County District Court on June 9 closely tracks allegations Foxhoven made in a wrongful termination claim soon after he resigned under pressure in 2019. Reynolds, her chief of staff Sara Craig Gongol, and her former senior legal counsel Sam Langholz are named defendants in addition to the state of Iowa.

Foxhoven’s court filing says the events leading to his ouster centered on a dispute over payments from DHS for work done by Reynolds’ deputy chief of staff Paige Thorson. The DHS director agreed in early 2018 to have the agency pay 69 percent of Thorson’s salary and benefits, as she assisted Iowa’s new Medicaid director Mike Randol. Foxhoven signed a similar agreement for the next fiscal year, which ran through June 2019. (Several of the governor’s staffers are mostly paid by other state agencies; the longstanding practice helps Reynolds keep more staff on payroll than her budget appropriation could support.)

Foxhoven says that in February or March 2019, he told Craig Gongol in a telephone conversation “that Randol was now adequately familiar with Iowa’s health care network,” adding that “Thorson was no longer performing duties that furthered the mission of Iowa Medicaid and that he did not believe DHS could legally divert federal Medicaid dollars to pay her salary.”

In the spring of 2019, Republican lawmakers approved an extra $200,000 for the governor’s office, supposedly for health and tax policy analysts. Foxhoven says he “believed that the issue was resolved,” and spoke with Craig Gongol in early June “hoping to confirm that DHS would not continue paying any portion of the Thorson’s salary with Medicaid funds in the next fiscal year.”

However, the governor’s chief of staff indicated that she expected the agency to keep compensating Thorson. Foxhoven “questioned the legality of such an arrangement” and asked Craig Gongol to consult with legal counsel Langholz, but she refused.

According to Foxhoven, he told Craig Gongol “that he intended to ask the assistant attorney generals assigned to DHS for a legal opinion” on June 18, after the expected conclusion of a federal trial they were working on. But he wasn’t able to send that email, because Craig Gongol and Langholz asked for his resignation on June 17. Foxhoven says during that meeting, the governor’s senior staff “demanded the immediate return of all of Foxhoven’s state issued equipment and told him not to return to his office.”

The lawsuit alleges that the defendants terminated Foxhoven:

• “in order to prevent him from enforcing his statutory right to disclose information he reasonably and in good faith believed constituted a violation of the law, mismanagement, a gross abuse of funds or abuse of authority […]”;
• “in order to prevent him from disclosing information he reasonably and in good faith believed constituted a violation of the law, mismanagement, a gross abuse of funds or abuse of authority […]”;
• “because he refused to engage in illegal activity; that is committing Medicaid fraud and misuse of federal monies by continuing to pay Thorson’s salary despite the fact that she was no longer providing any duties relating to Medicaid or otherwise furthering the mission of DHS […]”; and
• interfered with and prevented him from consulting with the Iowa Attorney General’s office about his agency continuing to pay Thorson’s salary.

Foxhoven told journalists in 2019 he would not have objected to using Medicaid funds to support Thorson’s compensation if legal experts determined the practice was still allowable. But he wanted a letter from the Attorney General’s office. That way, in case state or federal auditors questioned the payments later, “There might be a difference of opinion between the auditor and the AG’s office, but it isn’t a matter of Foxhoven diverting funds.”

State agency directors are at-will employees, who serve at the pleasure of the governor. But one exception to the at-will doctrine is firing someone in violation of public policy–for instance, because they refuse to engage in illegal conduct. Foxhoven’s lawsuit alleges that his “termination violates well established public policy of the State of Iowa as defined by statute, regulation, and judicial decision.”

The court filing notes that Foxhoven has suffered “substantial loss of earnings, insurance benefits, retirement benefits and other employee benefits” as well as “emotional distress and damage to his reputation.” It also argues that he’s entitled to punitive damages against Reynolds, Craig Gongol, and Langholz, because their termination of his employment “was willful and wanton and done in reckless disregard of his rights.”

The governor’s office did not immediately respond to Bleeding Heartland’s request for comment on the lawsuit. The Iowa Attorney General’s Office had no comment. Langholz has worked there since late last year, representing the Reynolds administration in several high-profile cases.

Reynolds said in 2019 that “many factors” influenced her decision to ask for the DHS director’s resignation. (The agency has faced lawsuits and investigations over its management of the State Training School for Boys and the Glenwood Resource Center for the intellectually disabled.) In early 2020, the governor told reporters “she was ‘not happy’ with the response she received” about an increase in deaths at Glenwood.

Reynolds also claimed Foxhoven “never raised concerns with me or my staff about the salary agreements in question, and he never asked my staff for a legal opinion or said he would be reaching out to the Attorney General’s office for one.”

Final note: Records I received while investigating the governor’s office spending indicated that DHS did not end up paying any portion of Thorson’s salary during fiscal year 2020, which began in July 2019. However, DHS did pay 100 percent of the salary and benefits of the governor’s new health policy adviser Liz Matney from July 2019 through mid-March 2020. Thorson and Matney were among 21 permanent staffers in Reynolds’ office who had about 62 percent of their compensation from mid-March through June 2020 covered through federal COVID-19 relief funds.

Appendix: Petition filed in Polk County District Court on June 9

Kyla Claussen is one of some 16,000 Iowans on waiting lists for disability services. -promoted by Laura Belin

My name is Kyla Claussen and I’m from Avoca, Iowa. I have an unknown progressive neuromuscular disorder that has been slowly taking skills away from me over the past five years. By March 2020, I was unable to walk independently anymore or work. Last August, I went on Social Security Disability Insurance (SSDI) and then applied for the Physical Disability Waiver and the Health and Disability Waiver.

I’m now waiting for services in my home, along with 15,956 Iowans on the waiting list for one of the waivers for people with disabilities. Most likely, I will be waiting for one to three years.

A longstanding effort by Iowa Senate Republicans to reduce the number of Iowans receiving various forms of public assistance got a quiet boost last week from Governor Kim Reynolds.

For the first time, the governor’s draft human services budget included provisions that would create asset tests for federal food assistance and require the Iowa Department of Human Services to establish a new “eligibility verification system” for Medicaid and several other public assistance programs.

State Senator Jason Schultz has pushed similar legislation for several years running. Each session, Senate Republicans have approved the bills, which died in the House Human Resources Committee (see here and here).

Ras Smith represents Iowa House district 62, covering part of Waterloo. -promoted by Laura Belin

Christmas, for me, is a season of spiritual tradition, personal reflection, and service to
community. Because my mom is a pastor, I had the fortune of growing up in a faith-filled church community. Today, my own children are blessed to experience a closeness to this family faith that instills in them the importance of loving and serving our fellow humans. This makes the holiday season even more meaningful.

As I reflect upon the year, I think about the thousands of Iowans who stepped up to help one another during a global pandemic. I think about people pouring into communities to clean up, provide food, build shelter, and give moral support in the wake of the devastating derecho. I think about the sacrifices of so many essential workers across the state. This is the unbreakable spirit of Iowa, and why I love living here.

But as I reflect further, my heart also hurts for families across the state who experienced preventable suffering and loss at the hands of poor leadership.

The state of Iowa is looking for a private company to help integrate programs of the Iowa Department of Human Services (DHS) and Department of Public Health (IDPH).

Governor Kim Reynolds indicated this summer that she planned to merge many operations of the departments, which serve a combined total of more than 1 million Iowans. After Gerd Clabaugh announced plans to retire as IDPH director, Reynolds appointed DHS Director Kelly Garcia to serve simultaneously as interim director of public health, saying in a news release, “This is an opportunity to increase cooperation and collaboration between these two agencies to better serve Iowans.”

A Request for Proposal reveals more details about the planned scope of the reorganization, which is scheduled to begin early next year. Notably, control of infectious diseases is among the areas of the IDPH’s work that will be “excluded from the redesign.”

Governor Kim Reynolds directed that nearly $450,000 in federal funding the state of Iowa received through the Coronavirus Aid, Relief and Economic Security (CARES) Act be used to cover salaries and benefits for staff working in her office.

According to documents Bleeding Heartland obtained from the Iowa Department of Management through public records requests, the funds will cover more than 60 percent of the compensation for 21 employees from March 14 through June 30, 2020.

Reynolds has not disclosed that she allocated funds for that purpose, and reports produced by the nonpartisan Legislative Services Agency have not mentioned any CARES Act funding received by the governor’s office. Nor do any such disbursements appear on a database showing thousands of state government expenditures under the CARES Act.

The governor’s communications director Pat Garrett did not respond to four requests for comment over a two-week period.

Matt Chapman closely follows Iowa legislative affairs, especially bills like the one discussed here. -promoted by Laura Belin

Iowa Senate Republicans have approved another bill targeting people receiving public assistance, such as Medicaid or Supplemental Nutrition Assistance Program (SNAP) benefits.

Senate File 2272, which passed along party lines February 26, would require the state to contract for extra screening, looking for evidence of Iowans enrolled in more than one state. Labor and Business Relations Committee chair Jason Schultz introduced and floor-managed the bill. He has been attempting to pass versions of this legislation for years and sponsored five bills in a similar vein in 2019.

The vendor that would receive the contract, LexisNexis, does similar work in other states, often flagging 15 percent of beneficiaries as possibly fraudulent. In the five southern states that have adopted this screening, further checks have confirmed dual participation by just 0.1 percent to 0.2 percent of enrollees, on average.

Matt Chapman closely follows Iowa legislative affairs, including bills targeting people on public assistance programs. -promoted by Laura Belin

Two bills related to oversight of Iowans on public assistance were in subcommittee on January 28 at the state capitol.

Five years ago, I started taking stock of my most labor-intensive posts near the end of each year. Not all of these are my favorite projects, though invariably, some of my favorites end up on these compilations.

Before getting to the countdown for 2019, I want to give another shout out to guest authors who poured an extraordinary amount of work into two posts Bleeding Heartland published last year.

Matt Chapman has closely followed this year’s legislative proposals targeting Iowans on public assistance. -promoted by Laura Belin

A bill requiring more frequent reviews of Iowans’ eligibility for public assistance programs would cost the state an additional $40 million during the first two years alone, according to analysis by the nonpartisan Legislative Services Agency. The federal government would be on the hook for an additional $35 million during the same period.

In a surprising turn of events, Republican challengers are putting an obscure vote on water bottles at the center of their attacks on Iowa Senate Democrats. Follow me after the jump for background on this year’s equivalent to the non-existent “heated sidewalks” of 2010.

Governor-elect Terry Branstad announced today that ophthalmologist Dr. Mariannette Miller-Meeks will run the Iowa Department of Public Health in his administration. A press release noted that Miller-Meeks “has served as the first woman President of the Iowa Medical Society and was the first [woman] on the faculty in the Department of Ophthalmology at the University of Iowa and councilor for Iowa to the American Academy of Ophthalmology.” Miller-Meeks was the Republican nominee in Iowa’s second Congressional district in 2008 and 2010. She worked hard during both campaigns but lost to Dave Loebsack in Iowa’s most Democratic-leaning Congressional district.

Also on December 9, Branstad announced that he will tap Chuck Palmer to head the Department of Human Services in his administration. Palmer did that job during Branstad’s previous time as governor from 1989 to 1999. Most recently he has been president of Iowans for Social and Economic Development, “an asset development organization with the mission of creating opportunities for low and moderate income Iowans to increase income and achieve financial stability.”

Branstad has pledged to reduce the size of state government by 15 percent, and keeping that promise would likely require significant cuts in the departments Miller-Meeks and Palmer will be running. The current budget (fiscal year 2011) allocated $935.5 million from the general fund to health and human services. That’s 17.7 percent of the general fund budget alone, or 15.9 percent of total state expenditures, including federal stimulus money and reserve funds as well as general fund spending. More than $200 million in federal stimulus money supported Iowa’s Medicaid budget in the current budget year, but similar support won’t be forthcoming in future years now that Republicans have a majority in the U.S. House of Representatives.

Branstad administration press releases on Miller-Meeks and Palmer are after the jump.

Governor Chet Culver has named Charlie Krogmeier to head the Iowa Department of Human Services. He has advised Culver for many years in various jobs, most recently as the governor’s chief of staff since January. State Senator Amanda Ragan, a Democrat from Mason City, told the Des Moines Register,

“I think the agency is just like any other that has struggles because of budgetary issues and Charlie’s been very involved in watching where the money’s going to go,” said Ragan, who is vice chairwoman of the budget subcommittee that oversees DHS. “I think he’s very conscious of the needs of the population who needs the services.”

A press release with background information on Krogmeier is after the jump. The Iowa Senate will consider confirming him during the 2010 legislative session.

Senate Republicans blocked Culver’s appointment of Gene Gessow as DHS head earlier this month and rejected appeals from the governor and Senate Democrats to reconsider.

Yesterday Culver appointed to new positions two other nominees whom Senate Republicans refused to confirm.