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.”

Members of the Iowa House and Senate begin the work of the 2020 legislative session this morning. Speaking to journalists last week, GOP leaders described plans to work on a wide range of issues in the coming months, including workforce development, taxes, child care, and medical cannabis.

But top statehouse Republicans aren’t planning any oversight hearings on what’s been happening at the Glenwood Resource Center for Iowans with severe intellectual disabilities.

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.

Jerry Foxhoven will pursue legal action claiming retaliation and wrongful termination as director of the Iowa Department of Human Services, Ryan Foley was first to report for the Associated Press on July 31. His attorney, Tom Duff, told the AP

that Foxhoven objected to a request to continue to have his agency fund most of the salary of the governor’s deputy chief of staff, Paige Thorson. Duff says that Foxhoven believed the arrangement made sense when he approved it in 2018. But he said that, by June, Foxhoven believed Thorson was no longer furthering the agency’s interests.

Duff plans to release a more detailed statement at an August 1 news conference, his office told Iowa reporters today.

As Bleeding Heartland discussed here, Thorson had handled health policy for the governor’s office since late 2017, but Governor Kim Reynolds brought Liz Matney over from the DHS this spring to be her health policy advisor.

Jerry Foxhoven has shed more light on the disagreement that preceded his forced departure as Iowa Department of Human Services director last month. On July 24 he told David Pitt of the Associated Press “that he declined to approve paying the salary of Elizabeth Matney, who left DHS on May 17 to accept a job as Gov. Kim Reynolds’ adviser on health policy.”

Staff for Reynolds disputed Foxhoven’s account, saying he never raised concerns about covering Matney’s salary and wasn’t fired for that reason. They also noted that for many years, state agencies including DHS have occasionally paid employees working in the governor’s office.

Foxhoven’s aware of that precedent, having signed some of the relevant documents himself. So why would he question the legality of this arrangement? The former director’s comments to reporters and records obtained by Bleeding Heartland provide some clues.

Editor’s note: Bleeding Heartland’s coverage of this story continues here and here.

Governor Kim Reynolds didn’t want the public to learn why she forced out Jerry Foxhoven as director of the Iowa Department of Human Services. The vague official narrative about Foxhoven’s unexpected departure remained intact for a month.

But the ground shifted last week. As further details emerge, the governor and her top staff will have more explaining to do.

A Polk County District Court has ruled that transgender Iowans must exhaust all administrative remedies before challenging in court a new state law designed to prevent Medicaid from covering gender-affirming surgery.

In a July 18 order dismissing the ACLU of Iowa’s lawsuit on behalf of Mika Covington, Aiden Vasquez, and the LGBTQ advocacy group One Iowa, Judge David Porter wrote that the plaintiffs seeking surgery “have an adequate remedy at law” and that their case “is not ripe for judicial consideration.”

In other words, Covington and Vasquez must jump through hoops that will take many months, possibly years, before any court can consider their claim that denying Medicaid coverage for medically necessary procedures violates their constitutional rights.

Porter’s decision ignored evidence pointing to the law’s discriminatory intent as well as its impact on the plaintiffs.

State Auditor Rob Sand warned the Iowa Department of Human Services on June 26 that service cuts to two quadriplegic Iowans indicate that Amerigroup and UnitedHealthcare “have failed to comply” with their state contracts. Sand said the managed-care organizations (MCOs) have pushed both Medicaid recipients to move into assisted living, rather than meeting their contractual obligations to ensure members have access to covered benefits and adequate health care services.

Jerry Foxhoven has resigned as Iowa Department of Human Services director, effective today, Governor Kim Reynolds’ office announced on June 17. The news release did not give a reason for Foxhoven’s departure. Staff for DHS and the governor did not immediately respond to questions including:

Two Iowa state agencies announced on May 31 an intent to award Planned Parenthood of the Heartland sex education grants for the fiscal year beginning on July 1.

Republican lawmakers approved and Governor Kim Reynolds signed legislation seeking to deny Planned Parenthood access to the federally-funded Community Adolescent Pregnancy Prevention and Services Program (CAPP) and the Personal Responsibility Education Program (PREP) grants. However, a Polk County District Court put that provision on hold this week, saying Planned Parenthood was “likely to succeed on the merits of its equal protection claim” under the Iowa Constitution.

The Iowa Department of Human Services will not audit a practice that could be inflating costs for Medicaid prescription drug payments by millions of dollars a year.

State Representative John Forbes raised concerns after finding discrepancies on bills for some prescriptions his Urbandale pharmacy filled for patients served by Amerigroup, one of Iowa’s Medicaid managed-care providers. Earlier this month, House members unanimously approved Forbes’ amendment to the health and human services budget, instructing DHS to “audit all prescription drug benefit claims managed by a pharmacy benefit manager under the Medicaid program.”

However, House and Senate Republicans dropped that section from the final version of House File 766.

State Senator Mark Costello, who floor managed the health and human services budget in the upper chamber, claimed Iowa’s Medicaid director Michael Randol and an Amerigroup representative had told him the audit was unnecessary.

John Morrissey is a longtime Des Moines resident who has investigated state spending increases, financial anomalies, and payment disruptions associated with Medicaid privatization in Iowa. -promoted by Laura Belin

The “he said/she said” controversy between an insurance company CEO and Iowa’s governor about why UnitedHealthcare decided to leave the state’s Medicaid program might make entertaining copy, but it doesn’t address who is going to manage the care of 420,000 Iowans left in the lurch.

Nor does it address whether the remaining company (Amerigroup) is adequately prepared to handle more members, and whether a new player poised to enter our state’s Medicaid market (Iowa Total Care) has the expertise to handle special populations in Iowa such as the elderly, disabled, and very ill.

It also doesn’t consider whether the state’s traditional fee-for-service Medicaid offering has the financial wherewithal to shoulder an even larger share of the enrollment and cost. Fee-for-service was held over from the old state-run program when most of the Medicaid program was privatized in 2016. The fee-for-service program pays the claims of Iowa’s sickest and most frail Medicaid members, which the for-profit managed care organizations (MCOs) don’t want or can’t handle.

The Iowa Deparment of Human Services (DHS) did not respond to a request for comment on these issues.

Only three months in, 2019 is already the most significant year for transgender equality in Iowa since 2007, when state lawmakers and Governor Chet Culver added sexual orientation and gender identity to the list of protected classes in the Iowa Civil Rights Act. That 1965 law hadn’t been significantly amended in decades.

The crucial Iowa House and Senate votes on the civil rights law happened during the first year since the 1960s that Democrats controlled both legislative chambers and the governor’s office. Support for LGBTQ equality is often taken for granted now in Democratic circles, but the issue was seen as more politically volatile twelve years ago. The bill amending the civil rights act came late in the 2007 legislative session and could not have passed without some Republican votes.

Iowans affected by UnitedHealthcare’s impending exit as a Medicaid managed-care provider should be aware that they have rights under the contract the state signed with the insurer, State Auditor Rob Sand announced at an April 1 news conference.

Sand reviewed the company’s 287-page contract with the Iowa Department of Human Services before news broke on March 29 that UnitedHealthcare will not continue to manage care for Iowans on Medicaid in the coming fiscal year, which begins on July 1. That development suddenly made the contract’s termination provisions “very important and relevant.”

When a government press release arrives at 4:45 pm on a Friday, you know it’s not bearing good news. UnitedHealthcare will soon pull out of Iowa’s Medicaid program, the governor’s office announced on March 29. The company “manages health care for more than two-thirds of Iowans on Medicaid,” at least 425,000 people, Tony Leys reported for the Des Moines Register.

The official spin portrayed Governor Kim Reynolds as a hero who resisted a for-profit insurer’s “unreasonable” and “unacceptable” demands.

The real story is that nearly three years into our costly Medicaid privatization experiment, Iowa’s dominant managed-care organization (MCO) still can’t handle normal business practices like paying health care providers on time.

Matt Chapman closely follows Iowa legislative happenings, including bills affecting Iowans on public assistance. -promoted by Laura Belin

Iowa Senate Republicans on March 19 approved new work requirements for tens of thousands of Iowans on Medicaid or receiving food assistance. Senate File 538 would instruct the Iowa Department of Human Services to request a federal waiver for the Iowa Health and Wellness Plan, our state’s version of Medicaid expansion. Approximately 170,000 adults receive Medicaid through that plan, and roughly 61,000 of them also receive Supplemental Assistance Nutrition Program (SNAP) benefits.

If the waiver were approved, Medicaid recipients would face new reporting obligations for “community engagement.” If not part of an exempted group, they could lose coverage due to paperwork errors, even if they were working the requisite number of hours per week. Nonpartisan analysis estimated this bill would cost the state budget nearly $5 million the first year after the waiver and nearly $12 million each subsequent year.

During floor debate (beginning at 11:53:20 of this video), Republicans characterized the bill as a way to hold Iowans accountable. Democrats offered two amendments that would have extended that accountability to large employers and the for-profit insurers known as managed-care organizations (MCOs), which oversee Iowa’s privatized Medicaid.

Matt Chapman has closely followed this year’s legislative proposals affecting Iowans on public assistance. He previously reported on a separate bill with a $40 million price tag. -promoted by Laura Belin

A Republican bill seeking to impose new work requirements on some 170,000 Medicaid recipients in Iowa would cost the state budget nearly $5 million more the first year and an additional $12 million every year thereafter, according to analysis by the nonpartisan Legislative Services Agency. Any savings to the state would be “minimal.”

For weeks this fall, the Iowa Department of Human Services stonewalled a journalist’s request for easily accessible public records that would have cast an unflattering light on management of the state’s Medicaid program.

Three days after Governor Kim Reynolds won the election, the department sent a copy of one key document to Ryan Foley of the Associated Press. DHS released other relevant files on December 6, allowing Foley to confirm Director Jerry Foxhoven had cut a deal in April allowing UnityPoint Health affiliates to keep nearly $2.4 million they had been overpaid for services provided to Medicaid patients.

The settlement agreement came shortly after UnityPoint agreed to remain part of the network for Amerigroup, one of the private companies DHS picked to manage care for Medicaid recipients.

John Morrissey delved into a little-noticed financial report by AmeriHealth Caritas. -promoted by desmoinesdem

Although it left the Iowa Medicaid program more than seven months ago, AmeriHealth Caritas Iowa, Inc. continues to string along claims payments due to Iowa providers.

AmeriHealth – which is owned by Independence Blue Cross of Philadelphia – reported $14.6 million in unpaid liability for claims submitted last year by Iowa Medicaid providers, according to the company’s most recent quarterly financial filing with the Iowa Insurance Division. Meanwhile, the managed-care organization has racked up more than $6 million in administrative costs so far this year to manage the now-closed operation.

A two-decade-old state administrative rule “clearly discriminates against transgender Medicaid recipients on the basis of gender identity by excluding coverage for medically necessary gender affirming surgery” while covering the same surgeries for non-transgender Iowans, a Polk County District Court ruled on June 7. Chief Judge Arthur Gamble found the rule violates both Article I, section 6 of the Iowa Constitution, which guarantees equal protection, and the Iowa Civil Rights Act, which has prohibited discrimination on the basis of gender identity since 2007.

The Iowa Department of Human Services “cannot ensure the accuracy, completeness, or reliability” of data released to the public about any programs administered by Iowa Medicaid Enterprise, including the managed-care system for some 600,000 Iowans on Medicaid.

When responding to all requests for information about Medicaid or related programs, the DHS also warns users that “there may be errors, omissions, or inaccuracies in the data provided.” Leading Iowa Senate Democrats were unaware of the disclaimer, which they described as “odd,” “troubling,” and “unacceptable.”

Republican lawmakers made big promises last year that Iowans would have “more access” to family planning services under a new state program that excluded Planned Parenthood.

As anyone could have foreseen, the opposite was true. In the first nine months of the State Family Planning Program’s existence, the number of Iowans enrolled dropped by a third. The number who obtained at least one reproductive health care service fell by more than 40 percent from the first quarter to the second quarter the program was operating. The number of health care providers billing the program also declined by 40 percent during the same time frame.

Republican lawmakers don’t want to hear how poorly the new system is serving their constituents. Even worse, GOP state senators voted unanimously last week to compound the mistake by blocking Planned Parenthood from participating in sex education programs.

Complaints to the Iowa Office of Ombudsman regarding privatized Medicaid increased by 157 percent last year, reflecting “systemic frustration” over cuts to health services for patients and unpaid bills for providers. Ombudsman Kristie Hirschman has “yet to be convinced” that the Department of Human Services is providing “adequate oversight” of the private insurance companies that control access to care and reimbursements, she wrote in a report released on April 2. The three outrageous examples she recounted resemble too many other tragic cases since Iowa shifted to a managed-care model for more than half a million Medicaid recipients.

Hirschman has assigned a full-time staffer to handle Medicaid-related complaints. The same issues come up again and again, more than a year after she, the state’s Long Term Care Ombudsman, and the advocacy group Disability Rights Iowa informed the DHS director about recurring problems with Medicaid managed-care organizations.

Although the ombudsman praised the legislature for “taking steps to correct some of the problems we and others have identified,” Senate Republican leaders haven’t brought up a Medicaid oversight bill that passed the Iowa House unanimously last month.

The Iowa Senate confirmed Jerry Foxhoven as director of the Iowa Department of Human Services in an unusually close vote on March 21.

Most of Governor Kim Reynolds’ appointees have won unanimous confirmation, as has typically been the case in Iowa for many years. Foxhoven’s nomination was controversial because of how privatized Medicaid has been managed, along with several tragedies involving abused children. Senate Democrats asked to defer consideration on the DHS director last month “until we can fully assess his leadership.”

A personal commentary by Matt Chapman to coincide with the “Day on the Hill” for our state’s National Alliance on Mental Illness chapter. NAMI Iowa’s “mission is to raise public awareness and concern about mental illness, to foster research, to improve treatment and to upgrade the system of care for the people of Iowa.” -promoted by desmoinesdem

In the last few years I have found myself politically active and seem to be trying to make up for years of not having the right to vote and taking it for granted when I did participate. I would like to share where my focus is and relate how I came to feel so intensely about these issues. You never know when you may find your voice, and if it took me until my 50s, so be it.

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.