Kevin Concannon, director of the Iowa Department of Human Services, says the state's largest agency is on track to give Iowans better choices in services.
That includes keeping more kids out of state custody and providing better in-home health care as a way to keep seniors out of nursing homes.
"The more you move in that direction, the more you will be able to support people's choices," said Concannon, whose department has a $2.9 billion budget and each year serves more than 700,000 Iowans - about a quarter of the state's population.
Concannon, 64, who served as commissioner of Maine's Department of Human Services and director of the Oregon Department of Human Services before coming to Iowa, said the state's growing Medicaid program, now serving more than 300,000 Iowans daily, presents some of the greatest challenges.
He admits there are problems with the way the state operates its program, but doesn't hesitate to place a bit of the blame with federal officials.
"We don't have a policy nationally, a vision of what should be the U.S. health care system," he said during an interview with The Associated Press. "Medicaid ends up being sort of the catcher of a lot of these populations."
DHS officials were hit this year with nearly $200 million in Medicaid losses after rule changes ended an accounting mechanism that boosted federal matching money to states.
Iowa officials negotiated waivers that will allow the state to replace the funding and expand Medicaid benefits, Concannon said.
"In it, we embedded a whole series of what we consider to be good policy ideas," he said.
"I think Iowa, to its credit, said 'We're not going to cut people off,'" Concannon said.