Iowa Medicaid Director Michael Randol and Iowa Department of Human Services Director Kelly Garcia met with the House Government Oversight Committee on March 11, 2019.
The Iowa Department of Human Services is embarking on a new effort to institutionalize fewer intellectually disabled people and provide them with services that better integrate them into their communities.
Like many states, Iowa has long aspired to provide more community-based services to people with intellectual disabilities so they don’t have to live in congregate, institutional settings. The major hurdle has always been the lack of providers — particularly in rural areas — that offer disabled Iowans the necessary assistance in housing, medicine, daily living skills, transportation and other matters.
It’s not clear how the state intends to clear that hurdle, but DHS Director Kelly Garcia told the Iowa House Government Oversight Committee on Wednesday that the framework for a new plan will soon be unveiled at a series of town hall meetings in Iowa. At present, the design of that framework is expected to be completed by the end of April.
Garcia offered few details about what the new system might look like but spoke at length about the need to include all stakeholders in the discussions. She characterized the effort as a “call to action” for agencies that provide services to vulnerable Iowans, but added that Iowa’s managed care organizations, which tend to focus on cost containment, are playing a key role in developing the new system.
“We have asked our managed care organizations to come to the table with an intensive planning effort, marrying their perspective with our perspective, on what barriers exist to serving individuals in the community,” Garcia told committee members. “And so all of that is in a deep-level assessment to ensure that we understand what those barriers and challenges might be going into unveiling our plan and starting these robust conversations about how we move forward.”
Garcia’s announcement comes in the midst of an ongoing U.S. Department of Justice investigation of the Glenwood Resource Center, one of two DHS-run institutions for people with intellectual disabilities.
The DOJ’s Civil Rights Division is looking into allegations that former Glenwood superintendent Jerry Rea was planning to conduct sexual-arousal experiments on the residents and had begun questionable hydration therapy on some residents. The DOJ is also reviewing patient deaths and other issues at Glenwood.
Garcia made no mention Wednesday of the DOJ investigation — that’s likely to come up at the next Government Oversight Committee meeting, currently scheduled for March 16 — but said DHS is rethinking its approach to serving people with disabilities.
“At the heart of this effort is a reinvigorated approach, from our perspective at DHS, to really have a vision around how we provide services to individuals with intellectual disabilities in this state,” she said. “And that over-arching framework, in my mind, starts with us setting intentional admission criteria at our (state) facilities. Those are going to be challenging conversations. I’ve already started some of those conversations in meetings with family members of residents of our two resource centers in Glenwood and Woodward, Iowa. And, you know, they’re tricky, they’re difficult, because these are emotional decisions.”
She said family members of the Woodward and Glenwood residents are meeting with the parents of people with disabilities who are being served in the community so the two sides can “talk about what that looks like for them.”
Garcia acknowledged there are residents at the resource centers who have indicated they want to relocate into the community but the state presently lacks the community-based resources to meet their needs.
“Those individuals will be the first on our list to tackle,” she said, “and (we will) bring them to the table about where they’d like to live and what that looks like, and we are going to be moving forward with those individuals first and foremost.”
She said that whatever shape the initial plan takes, it’s expected to change as people react to it and voice “thoughts, concerns and recommendations” of their own.
“And we will adjust accordingly,” Garcia said. “What we produce in terms of a framework on day one, I envision that being a dynamic document that may change as we move forward.”
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