Gov.-elect Rob Sand Announces Plan to End Medicaid Privatization

Gov.-elect Rob Sand announced on Monday that he plans to begin unwinding Iowa’s privatized Medicaid system on his very first day in office, setting up a major structural shift for the state’s healthcare administration.

The transition will take careful coordination, Sand told KCCI in an interview. He pointed to former Gov. Terry Branstad’s initial push to privatize the program, recalling how federal officials cautioned that the state was moving far too quickly.

“This is not a thing that we can do overnight,” Sand said, according to KCCI. “But my intention is that that process begins on day one.”

During his successful campaign, Sand made rolling back Medicaid privatization a central platform, arguing that his time as state auditor exposed a troubling pattern of wrongful denials of care under private management.

The privatization of Medicaid in Iowa has driven up your costs & decreased the quality of your care. pic.twitter.com/rdNekcJPAs

— Post by @RobSandIA on X

To steer his incoming administration, Sand announced that Abe Rakov will serve as chief of staff in the governor’s office. Rakov has advised Sand since his initial run for state auditor and brings prior experience from Missouri state government, where he worked as deputy secretary of state.

“He’s got experience working across the aisle, and I’ve known him and kept in touch with him since then,” Sand said, as reported by KCCI.

Sand also named a bipartisan pairing to guide his transition steering committee. Former Iowa Republican Party Chairman Mike Mahaffey will serve as the Republican co-chair, while State Rep. Brian Lohse—who was elected as a Republican in 2018 and is now a registered independent—will serve as the independent co-chair. Both figures endorsed Sand during the final week of the race.

Gov.-elect Rob Sand Announces Plan to End Medicaid Privatization

Mahaffey noted that the incoming administration should maintain a broad focus, prioritizing pressing local concerns such as water quality, rural revitalization, and agriculture.

With Republicans retaining control of both chambers of the Iowa Legislature when Sand takes the oath of office, the incoming governor acknowledged that passing any legislative package will demand direct negotiation and compromise. He added that any lawmaker who votes in favor of a bill he ultimately signs will receive an invitation to the formal signing ceremony.

As the transition moves forward, cabinet positions remain open. Sand stated he intends to meet face-to-face with current agency leaders to discuss their futures, noting that many are waiting for clarity on whether they will retain their roles.

Those conversations will likely include Larry Johnson, whose confirmation as director of Iowa’s Health and Human Services was blocked by Senate Democrats over transparency concerns. Johnson subsequently stepped down as director and continues to serve as the agency’s principal deputy director. Sand remarked that communication broke down entirely during that contentious confirmation fight.

“It sounded like to me, in that situation, there wasn’t communication going any direction,” Sand said, per KCCI. “And there needed to have been.”

Meanwhile, transition co-directors Elisabeth Buck and Morgan Miller have already opened lines of communication with Gov. Kim Reynolds’ administration to facilitate a smooth transfer of information. Sand praised Reynolds for securing federal funding designated for cancer screening and expressed confidence that her office will pursue additional opportunities before he formally takes command.