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Reynolds Confident in Direction of Medicaid Privatization

John Pemble
Gov. Kim Reynolds at her weekly news conference in March 2018

After speaking with all of the Democratic and Libertarian candidates on Iowa's gubernatorial primary ballot, IPR's Clay Masters extended an invitation to Gov. Kim Reynolds to discuss her vision for the state. While Reynolds does not have an opponent in the June 5th GOP primary, the crowded gubernatorial field has criticized her handling of the privatization of Medicaid and funding for mental health care services. Masters spoke with Reynolds about those and other issues. What follows is a transcript of the conversation.

Disclaimer: We spoke with Gov. Reynolds by cell phone between campaign appearances. The audio was not broadcast quality. We've done our best to transcribe the conversation as accurately as possible. Some portions of the conversation are unintelligible, and we've indicated those places where we couldn't make out the governor's exact words.

So first of all I'm curious why do you want to continue to be governor of Iowa?

Well, first of all, I love this state. I love the opportunities that exist within our borders. I’m a fifth generation Iowan and I truly do believe that if you work hard and dream big anything is possible. And my story reflects that. I want to continue to build on the great work that we've done the last couple of years. My vision is to unleash opportunities in every single corner of the state. And we're doing that by cutting taxes while maintaining our priorities, and really working to grow jobs and wages and opportunities. Investing in our children, which is by far our greatest asset. I’m proud of our commitment to K-12 education. My daughter is a teacher so I know how hard they work every single day to make sure that our students are prepared for the best possible future that’s available... I believe in Iowa. I believe in Iowans and the capacity that exists. And I want to continue building on the momentum that we've seen happening over the last couple of years.

In your Condition of the State address you said that mistakes were made with privatization of Medicaid in Iowa. It's been almost six months. What has been done to show those mistakes were addressed?

Well we've done a lot and I'm really proud of that and it's something that we're working on every single day because it's so important that we have a sustainable system in place that can take care of Iowa, some of our most vulnerable Iowans. There's over 600,000 people that are in the Medicaid system, and we want to make sure that it's sustainable, that it’s (unintelligible) that it's proactive, and that we’re getting the outcomes that we expect. I brought in a new director of the Department of Human Services, Director Foxhoven, he brought in Director Randol to really lead the Medicaid (transition?). He has the expertise and background. I've talked to a lot of the providers. I’ve talked to the MCO’s. They have a lot of confidence in Director Randol. It's been a game changer. This is a partnership. We need to make sure that all are successful in helping to provide these services to vulnerable Iowans. We have a new actuary that we’ve hired. We’re bringing on another MCO so we can continue to provide choice for Iowans. In addition to that we are entering into contract negotiations. That is an opportunity for us to make sure that our providers that are providing services to Iowans are getting paid for what they're doing, they're getting paid in a timely manner, that we're.  streamlining the process. So we're spending a great deal of time talking with the providers,  understanding where some of their frustration and concerns are and addressing them. And I have great confidence in Director Foxhoven. I've talked to multiple people and legislators and they have confidence in Director Foxhoven. He’s the right person for the right time. And so, you know, we're still working on it. This is something that you know we’ll continually be analyzing, and looking for opportunities to make it better. So, it doesn’t stop. It’s something we’ll continue to work on, but we’ve made a lot of positive changes. And it's just, it’s really important for me to be able to look Iowans in the eye and tell them that we'll have a good system in place and it's sustainable. Fee-for-service, the old system was not sustainable. When the other side says we need to go back, they need, we need to ask them how they're going to do it, and how they're going to fund the other priorities that are important like K-12 education, public safety, health care. So you know we have to balance our budget, and we have limited resources. And there's no way that that system was sustainable. And there’s 39, 40-plus states that are doing managed care. That's how they're delivering services to Medicaid recipients. And so that is, I think that is the correct path. And we're going to continue to improve, and do everything we can to make sure that it's sustainable for Iowans.

You bring up Director Randol, recently in Kansas, which is where he's from, after a year of work auditors there released their determination that the state's data was so bad that there’s no way to know their privatized Medicaid system was working effectively. Can you speak confidently about the direction that Iowa is going with Medicaid?

Yeah I can. I just did. I think I laid it out. I feel confident in what we're doing. We're not Kansas it's not the same very same system. We need to look at it. We need to make sure that we're comparing apples to apples that he's willing to sit down with anybody to walk through. You know how we’re figuring the savings that we have, and I do feel confident that we're moving in the right direction. The Legislature added a little more oversight this legislative session and that's fine. But I do believe that the team is the right team, along with the new actuary. People didn't have any confidence in the numbers from the various one. So we, you know we took care of that. And there is confident in the new firm that we're working with, and so I think we're making a lot of positive steps in the right direction, and we're going to continue to work on it. I am not kidding when I say we're dealing with this on a daily basis because it’s that important. It’s that important to me and to Iowans that we get this right. And that I can say to them this is patient- focused, proactive. We want to make sure that we're getting the outcomes that we,  that they deserve and that we have a system that's sustainable. And it's all of that. You can't just pick that one-off. It’s all of that. And the other thing with fee-for-service it was a pay and chase. And you know, that's just really hard to do. I think The Register just did an article on that. Those were all examples of fraudulent payments that happened under the fee-for-service program. It's really hard to (unintelligible) that money back once it's goes out. There were over (300?) million dollars in fraudulent payments that went out. And what managed care kind of does, it does that match up on the front end. So, again it's about making sure it's sustainable, and we're providing the services that vulnerable Iowans deserve and need.

Another topic, officials recently said publicity around high profile child abuse cases in Iowa have caused a surge in reports. This comes at the same time that you've cut $4.3 million from the Department of Human Services. How can you assure Iowans that DHS has enough resources to adequately follow up on those reports?

Well again, I have complete confidence in Director Foxhoven, who has spent his entire career advocating for children, and children's services. So, he's the person. He's the right person. He has the passion and the compassion to get this done. One of the first things that Director Foxhoven did was to sit down with the frontline caseworkers and see, you know, what they could do to make their jobs easier. They were operating under some very antiquated systems. They didn't even have smartphones. They, the system and the process needed changing and it was a reflection of him spending time with our phenomenal workers our state workers that are out there on the front lines doing a great job every day. And so they've changed a lot of processes and they've changed some policies and are continuing to take a look at how we can do things better. And again, and even I think in the legislature (unintelligible) would say this also, you know, no child… I am a mother and a grandmother. And for heaven's sake no child should have to live in the circumstances that those two children were living under. And we felt, part of that is when you have a high profile like that, (unintelligible) cases like that, horrific cases like that, it does raise awareness. And that's OK, you know. So people are watching their reporting. And then we're looking at the processes, the system, and we're working with the frontline workers to make sure that we're not making their jobs harder. But we're looking for opportunities to streamline and make their, and help them do the great job that they're doing.

And finally here I know we're limited on time. There was a bipartisan support for a mental health bill this legislative session. And we've had sheriffs on our air talking about having to spend more time helping people with mental health concerns. What kind of assurance do you have for these law officers that change is going to happen, especially when the biggest criticism for the bill has been that there's not enough funding for it.

Well there will be funding. So first of all I think law enforcement supported it. I have tremendous amount of law enforcement that was at the bill signing. A lot of, you know, components of the legislation that passed unanimously, by the way, in both the House and the Senate, unanimously, which means every single legislator voted for it. And I signed it. And it was really the output of the complex needs study report that had all the right stakeholders at the table. It really identified a gap that was in the mental health system and addressed it. And we, a lot of the components in there were actually suggestions that were made, you know, again, from the law enforcement. So the access centers, so that we can get people the treatment that they need closer to home. And it's really about, you know, stabilizing Iowans and then getting them the services that they need, so we can get them back home with their families and into their communities. And then having a support system in place that can take care of them 24/7. A statewide hotline, we found that people didn’t even really know where to go or where to start when they had a loved one with symptoms of experiencing mental health issues. That was a step in the right direction. So a lot of positive things. And it build on the good work that was done in 2013, so we had to start from a different place. (unintelligible) acknowledge that there were a lot of good things that have been done, but like any other system, you'd never say one and done. You continually analyze it and look for opportunities to make it better and where some of the issues and gaps were. And that’s what this comprehensive mental health care bill does. So, the commitment is there. The commitment is there from the legislators. The commitment is there from myself to make sure that we get this implemented. You know, so we’ll have people that will need, we removed the cap for (unintelligible) beds, so people aren't stuck in emergency rooms and stuck in hospitals. So, it was never a bed problem. There were always beds available. They were just the wrong type of beds and they weren't in communities where Iowans needed the services. And this bill addresses all of those. So I would say, I would tell you that when a bill passes unanimously like that, the commitment will be there to make sure that we can fund it and do the right thing. And we will.

All right, Governor Reynolds safe travels. Thank you.

Thank you. Bye.

Note: An earlier version of this transcript misspelled Director Michael Randol's last name.

Clay Masters is Iowa Public Radio’s Morning Edition host and lead political reporter.
Clay Masters is Iowa Public Radio’s Morning Edition host and lead political reporter.