Iowa Medicaid oversight chief to be governor's new health policy analyst

Elizabeth Matney, who has led the Iowa Medicaid Bureau of Managed Care since the state began privatizing nearly the whole program in 2015, is leaving the Department of Human Services to become Governor Kim Reynolds’ health policy advisor, Matney’s LinkedIn profile shows. Her starting date is unclear; the governor’s office has not announced Matney’s hiring or responded to Bleeding Heartland’s inquiries on the subject. A DHS organizational chart dated June 17 still shows Matney as bureau chief for MCO Oversight & Supports, the state’s leading official for overseeing the private companies picked to manage care for more than 600,000 Iowans on Medicaid.

When the new fiscal year begins on July 1, the governor’s office will receive additional funding for staff, so Matney’s work for Reynolds may formally begin at that time. The governor’s previous health policy advisor, Paige Thorson, appears to be staying on as deputy chief of staff, meaning that new funds would be needed to pay Matney (the governor’s staff have not clarified that point).

Matney has vastly more experience with Iowa Medicaid than Thorson did. Her LinkedIn profile shows she was bureau chief of Medicaid Managed Care from October 2015 to June 2019 and describes an

Innovative and highly motivated leader in the Medicaid space with over seven years of state Medicaid experience in starting novel programs, managing oversight activities, and developing strategic policy. Successful at building and integrating collaborative teams accountable for implementing progressive and complex concepts, contracts, and policy. Positive track record of high optic implementations, negotiating political landscapes, and building stakeholder trust for the Iowa Medicaid program.

Many stakeholders (Medicaid patients, caregivers, and health care service providers) would dispute that privatization has been implemented well or that trust in the program has improved. That said, Matney’s hiring is consistent with official comments this week that Reynolds is “assembling a new team, from top to bottom, to carry out her vision” at DHS. Reynolds has refused to provide specific reasons for pushing out DHS Director Jerry Foxhoven on June 17.

State Senator Liz Mathis is among the Democratic lawmakers most involved with Medicaid policy and serves on the joint Health Policy Oversight Committee, formed to “provide continuing oversight for Medicaid managed care, ensure effective and efficient administration of the program, address stakeholder concerns, monitor program costs and expenditures, and make recommendations to the General Assembly.” Mathis spoke to Bleeding Heartland by phone on June 20 about her impressions of Matney.

She mainly was the person who delivered the data. It was–you know, most of her reports back to our oversight committee were very heavily data-borne and analytical.

What I kept asking, you know, Liz in the meetings was about really deliverables. So, are the MCOs delivering what they are supposed to be delivering, and is it of quality? You know, is it a quality service? Are we saving money? And sometimes, with all that data, Liz would gather a lot of it, and there would be pages and pages, we’d be awash in data, but it didn’t always tell the story of, is this actually working? Are patients getting better outcomes, and are we saving money?

So even though, you know, she would be very diligent about addressing any kind of numbers that we wanted to see, the numbers that we truly wanted to see were the two big questions of why [Governor] Terry Branstad said we were moving into a manged-care system: to improve, you know, to improve the quality of service and to save money. And really, none of those numbers ever showed that, I don’t believe.

Mathis said representatives of the MCOs were not able to answer legislators’ straightforward questions like, “How do we know this is working?” and “What does success look like?”

When she would take such questions to Matney, she would hear back, “They’re answering their calls in this amount of time,” or “This many paid claims went through.” But Mathis said lawmakers couldn’t get answers to global questions like, “How are we improving the system that we left, from fee for service to managed care?” While Matney “delivered numbers to us, she always got back to us on what it was that we needed,” when addressing bigger topics like “is this system better because of managed care, and are we saving money, I didn’t get the answers that I wanted.”

At the same time, Mathis noted, the governor’s office “need someone who is knowledgeable about managed care, they really do.” Branstad’s adviser Michael Bousselot helped write the original request for proposals when Medicaid privatization began in 2015, and he had very little background in health policy.

Mathis speculated that Reynolds is “making a strategic move, bringing Liz over into the office of the governor and saying, this is where we need to be leading part of this.” She thought Matney “could give the governor good advice.”

Final note: When requesting funding for two new staff positions earlier this year, the governor’s office told key Republican lawmakers they planned to hire analysts for tax policy and health policy. Reynolds’ communications director Pat Garrett has ignored Bleeding Heartland’s repeated questions about whether anyone is coming on board to handle tax policy. The only new position the governor’s office advertised in recent weeks was for a public relations manager.

UPDATE: The Iowa Department of Human Services listed the position of Bureau Chief of Managed Care on June 18. Applications will be accepted until 4:00 pm on June 28. You can read the job description and minimum qualifications here or here.

Top image: Photo of Elizabeth Matney from her LinkedIn profile.

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