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Iowa DHS leader defends decision to close state mental health facilities, changes to Medicaid


DES MOINES, Iowa — The head of the Iowa Department of Human Services on Thursday defended the decision to close two state mental health facilities and switch the state's Medicaid program to private management, saying the changes will save money and offer people better care.

DHS Director Charles Palmer told the Senate Human Resources Committee that the department was facing budget shortfalls when he recommended closing the facilities in Clarinda and Mount Pleasant.

"All of those recommendations were difficult," he said.

Palmer spoke to the committee as part of a confirmation process requiring approval from the Democratic-controlled Senate for him to continue on the job. Palmer took over DHS in 2011 after Gov. Terry Branstad returned to office and also ran the department years ago.

The facility closures have led to complaints that patients won't be able to get the care they need. But Palmer said patients still have plenty of options because many do not require treatment at acute psychiatric facilities.

He also said there needs to be a better system in place for tracking available beds for certain services.

"I think the larger question is how does that local emergency room, how does that local sheriff, how does that local provider ... identify if there is a bed that is available on an immediate basis that will be available when they arrive at the door and how can they do that in an efficient manner?" he said.

Palmer has been criticized since funding for the state mental health facilities was removed in Branstad's budget proposal that was released in January. Some lawmakers were also critical when it was announced recently that the Medicaid program would be turned over to private managed care. Palmer said the new system will offer patients better care and create efficiency.

Iowa's Medicaid program provides care to poor children, families and disabled people, as well as some low-income adults. It is funded with $4.2 billion in state and federal dollars.

Palmer's nomination requires a two-thirds approval vote in the Senate by April 15. Senate Majority Leader Mike Gronstal, D-Council Bluffs, said Thursday that Senate Democrats had not yet discussed any of the governor's appointees. Senate President Pam Jochum, D-Dubuque, said she was unsure how the Senate would vote.

"It's mixed right now, on both sides of the aisle," she said.

Jochum and other lawmakers on the committee expressed reservations about how the changes were announced and how quickly they were expected to take place. They asked Palmer for more transparency moving forward, though he said after the meeting that he has made every effort to be open and available to lawmakers.

"I hope my confirmation is based on my track record and my experience of being able to effectively, on a day-to-day basis, manage a very large department," he said.

In the meantime, lawmakers in the Senate passed legislation earlier this month that would keep the facilities in Clarinda and Mount Pleasant open until DHS developed a clear transitional plan. A bill passed Wednesday in the Senate would create a commission to oversee the planned changes in Medicaid.

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