Reynolds Talks About Medicaid Changes, Economy, And Mental Health

Oskaloosa News sat down with Iowa Governor Kim Reynolds to talk about issues facing Iowans.

Oskaloosa, Iowa – After her initial Condition of the State Address, Iowa Governor Kim Reynolds took her message from the Iowa House of Representatives to the main streets and coffee shops of Iowa.

Reynolds had lots of time to prepare her remarks to the Iowa Legislature and Iowans, as she had spent the Friday and Saturday before her speech participating in the governor’s deer hunt. “While waiting for the buck to come out of the timber,” joked Reynolds. “Which he did too late so I couldn’t shoot him.”

That tour landed Reynolds inside Smokey Row on Saturday, January 20th, 2018,  where a group of approximately 100 people came out to hear her vision for the state and to also ask questions of Iowa’s leader.

Oskaloosa News sat down with Iowa’s first female governor and spoke about subjects that are impacting Iowans.

Medicaid privatization in Iowa has been a point of conversation since its implementation.

U.S. Congressman Dave Loebsack had been in Oskaloosa the previous week, where he visited with representatives at Mahaska Health Partnership.

Loebsack asked the hospital administration about Medicaid privatization and the experience and concerns they have about the program in Iowa.

“Huge administrative burden,” said one of the panel members from MHP. “Understanding the rules.”

Those rules can vary greatly, and little is standardized, “they all three have different approaches to things” one MHP administrator said about the companies administrating the Medicaid program for the State of Iowa, otherwise known as Managed Care Organizations or MCO’s.

“Layers of additional overhead requirements on us to figure it out,” added Jason Feucht, Chief Financial Officer for Mahaska Health Partnership.

Loebsack told the MHP representatives he understands that the privatization is a state issue, but “I get involved because it’s a federal program.”

Reynolds addressed some concerns about the Medicaid privatization problems. “Honestly, when I say we’re thinking about this and working on it every day, I mean that literally.”

Reynolds said she is working with Jerry Foxhoven, director of the Iowa Department of Human Services, as well as the MCO’s to “really get the system corrected and sustainable and doing what it’s supposed to do.”

Reynolds says that the Medicaid privatization, “is the right thing”, and points towards the program that is “in 39 other states”.

“You know, we made mistakes in the way that it was rolled out. It was rolled out too quickly, and so I got a new team together. I brought director Foxhoven in. He hired a new director for Medicaid, Mike Randall, who has the experience and the expertise, the financial background. He turned it [Medicaid] around in Kansas and I believe he’s already done a great job in reaching out to our caregivers,” said Reynolds.

Reynolds said that Randall is bringing together representatives from within different segments of the medical field to sit down and talk about “what the problems are and what we can do going forward to really fix them.”

Reynolds also said that the problems with the system are what is normally heard. “There are still some good things going on, where people are having their care managed. They’re getting an annual physical. They’re taking their medication. They’re not going to four or five doctors and getting four or five different prescriptions and then ending up in ER because they [prescriptions] are conflicting with each other.”

“So, there are good things going on, but there’s a lot of room for improvement, and we’re working on it every single day,” said Reynolds.

Reynolds agreed that the different ways of administrating the program from each MCO is an issue she and her staff are working on.

Reynolds also said that there are opportunities to streamline the process involving the MCO’s and providers like MHP. “We need to pay in a more timely manner. It appears that sometimes there are things that can delay the payment, instead of paying it and paying what they said they would.”

“The old system fee for service, there was no accountability, and so we were covering things we shouldn’t have been covering. And it’s hard, once you’ve had something covered even though it shouldn’t have been, to say, it never should have been and we can’t do that anymore,” said Reynolds. “That is part of the problem.”

Reynolds said that the state was paying out about 300 million dollars annually in fraudulent claims under the old system. “And it was just growing at an unsustainable rate.”

“Even though it’s not all about dollars, it is about people. But if I can’t sustain a program, I can’t take care of the people,” added Reynolds.

“Hospitals will be a part of this so we can understand their concerns,” said Reynolds.

When it comes to the state’s budget, and her opponents pointing towards deals with companies like Apple as reasons the budget is coming up short, Reynolds disagrees.

Reynolds says that her opponents are just “mischaracterizing the whole incentive program. And it’s just false. It’s flat-out false.”

“It’s not a check or cash that we hand over to these companies,” said Reynolds. “I don’t say come to Iowa and I’m going to give you 19 million dollars. It’s a pay for performance. It’s a credit.”

Reynolds said that it is a bipartisan board comprised of a cross-section of Iowans that look at the incentive package and they vote it up or down. “It’s not all Republicans; it’s a bipartisan board.”

Reynolds said companies like Apple are required to invest a certain amount of capital, hire a certain amount of Iowans, and pay a certain wage to qualify for the credit. “They actually have to break ground and build a facility before they can exercise a tax credit,” said Reynolds. “It’s not a check, and if they don’t build, so they are not there, nothing goes out the door. So not one dime has gone to Apple yet. Nothing.”

Reynolds said Apple has five years to exercise the incentive. “If they don’t, it goes away. A lot of times they don’t utilize all of it.”

“Then when you look on the flip side, when they do come, they do build, they hire Iowans that are at a certain wage. They have to invest a certain amount of capital, money, in order to get the credit.

Including the investment by companies like Apple, Reynolds points towards the construction and those workers and the supply chain as an additional benefit for such incentives.

Reynolds also noted the increase in the tax base for local governments. “They didn’t give them a one hundred percent tax break; they gave them eighty. Reynolds said that instead of the property tax being collected on undeveloped land, the local governments are now collecting on a facility that has higher valuations.

“For them to say that right now that has an impact on the budget is just disingenuous, and it’s just not true because they [Apple] haven’t even exercised it,” said Reynolds.

Reynolds said that growing the economy in the state is the quickest way to solve the state’s revenue.

Reynolds says she wants to reduce taxes, and help Iowan’s gain skills to fill needed worker shortfalls. “This is about opportunities for Iowans to have a great career, to be able to take care of their family, have health insurance, buy a home, send their kids to school. And that money starts to turn over in the economy, and we’ll see the numbers going up.”

“I believe that the federal tax reform, we’re going to see that turn over in our economy in Iowa,” added Reynolds.

Reynolds said that she has to balance the budget, and she builds that budget based upon information given to her administration in December. “I don’t get to print new money like they can in Washington D.C., where they don’t have a balanced budget requirement.”

“I have to balance the budget, so I can only operate within a certain amount of revenue. And so what I do is, we take a look at the priorities that I believe are important, and that’s reflected in my budgets,” said Reynolds. “I said, I support K-12 education. It’s really important that we’re making sure that we’re graduating kids to be successful, to have a great career and to have that here in Iowa. I have money in my budget that’s a priority fact.”

“Jobs, jobs, jobs,” is something else Reynolds says she sees as a priority. “I have money for the future ready Iowa initiative because that’s a priority.”

“Healthcare. That’s a priority,” added Reynolds.

“When we entered into this fiscal year, when we entered into ’18, we said to all of our department heads, ‘this is probably going to be another tough budget year,'” said Reynolds, who believes that this could be the last tough year on the state’s budget.

“So they’ve been very judicious with their budgets because they knew that potentially there could be another deappropriation,” said Reynolds.

Mental health in Iowa has also been a topic with great debate in Iowa.

Mental health regions have changed the landscape for service to Iowans, and Reynolds said that county supervisors were “anxious” about the move from a county by county system to a regional system.

“So they still kind of have that individual county thought process, where this is my money. They need to look at it from a regional perspective and think about funding from that perspective also,” said Reynolds.

Reynolds said she believes there “may be too many regions. I think probably if we reduced the number, I think that’s beneficial in the long run, but that’s a decision they’re going to have to make.”

“When I talk about the residential crisis centers, I think the only way that some of the regions are going to be able to do that is if they coordinate between three or four of them,” said Reynolds.

“By going to a regional system, it really has ensured that Iowans all have access to the same coverage. We’re seeing some do really good things, and some are struggling,” said Reynolds of mental health regions in Iowa. “It’s a matter of trying to maybe share those best practices with some of the others, because I’m seeing some that already have the residential crisis centers. They’re already identifying where the barriers are at and they are using the funding that they have to address the barriers. I’m not seeing that consistently across the state.”

Reynolds believes that the state mental health institutions are not the answer, and points towards states like Minnesota that closed down approximately a dozen state facilities.

Reynolds says that some individuals need “substantial care, so that’s why we still have a couple [facilities] open. But really the best place is in home and community-based services.”

“It’s not about the number of beds, it’s about the type of beds,” said Reynolds, who said that over 60 beds a day are open, “but they’re not the right kind of bed.”

Finding a solution that keeps those patients close to home is something Reynolds says is important. “Our law enforcement can’t be on the road. We don’t have the manpower in these local governments to do that [transporting].