Between tragedy within the foster care system that has left two teenagers dead due to starvation, and a highly controversial shift from state management of the Medicaid system to a privately managed care system, Iowa's Department of Human Services has been in the news a lot this year.
Des Moines attorney and new DHS Director Jerry Foxhoven took over for former Director Charles Palmer in mid-June. During this River to River conversation, he talks with host Ben Kieffer.
On the transition to managed care:
"I think it has saved money, and in the end it is more efficient. I will say that anytime you do a big transition like that, it is bumpy... Before managed care, I never realized it ran that well because we had a lot of complaints back then. Nobody remembers the bumps we had back then.
Part of moving to the managed care system was to save money, but part of it was to make the program sustainable over the long term."
On reform of the foster care system:
"Anytime a tragedy happens, we have to step back and say 'what could we have done differently' and 'what can we do differently in the future.' So, we've done a number of things, and we've got a number of things in the works. The first thing we did, right away, was to change some of our training for our child abuse investigators to basically prioritize complaints from mandatory reporters from people with special training, a doctor or a nurse or a teacher. If they have expertise in an area, those should be given a bigger weight...
When we get a child abuse complaint, we now treat it as a new one. So that two years from now if we get some concerns about someone, we can look back and see that we actually had four complaints and not one. Some of the commonalities with those cases were that these were both kids who were adopted from the foster care system and were given a subsidy for that.
We don't do anything to monitor or do anything once an adoption has occurred unless we get a child abuse report or have something that causes us to take a look. So we have started the process to redo our contracts with the adoption subsidies and work with the federal government to require that people who receive a subsidy to take their adopted child to the doctor once a year."
On access to mental health care:
"What we need to start looking and what I'm trying to drive for changes is not just 'is this a piece that should be funded by Medicaid or is this a piece that should be funded by the county/region,' but that we start braiding the funding and start looking at all the potential funding sources. We're all in this together. What makes more sense is for me to work with the regions and help them develop a plan about what makes sense and what are the gaps in services that you need."