Mary Nelle Trefz

Health Policy Advocate with Common Good Iowa and HealthConnect Fellow

Her work as a HealthConnect Fellow

(October 2019-June 2021)


Improving access and the quality of care available to children in low-income households by promoting improvements to Iowa’s Medicaid and CHIP (Hawki) programs


Mary Nelle Trefz remained focused on this goal throughout her fellowship. Most recently, she centered her advocacy efforts on increasing support for new mothers, recognizing that a mother’s health greatly impacts her child’s health. She advocated with state leaders to extend Medicaid coverage from 60 days to 12 months postpartum to provide continuity of care during a vulnerable time.

Trefz also advocated to prevent Medicaid requirements that would shut people out of the program. She created a non-partisan Medicaid Matters Coalition and, as lead facilitator of that group, coordinated monthly meetings and advocacy events, disseminated policy updates, and developed talking points, a shared agenda, and other materials. The coalition now includes 50 nonprofit organizations across Iowa working together on advocacy efforts. A public education campaign highlighting the fact that kids make up nearly half of all Medicaid and CHIP members also encouraged pediatric-specific improvements.

Trefz prioritizes building relationships with state leaders, acting as a partner and a resource, and participating in conversations about administrative policies. She cultivated “unlikely champions” by working with legislators who serve in leadership roles outside of human services.


Due of her strategic efforts to build relationships, Trefz was appointed by the Governor’s office to the Hawki board and now chairs that board. She participated in interviews to select a new Medicaid director, and the Iowa Department of Human Services (DHS) director approached Trefz on key maternal health policy opportunities.

Other successes include:

  • Legislation that would have taken away health coverage from Medicaid members was defeated.
  • DHS created a pediatric dashboard as part of its quarterly Medicaid report, pulling out child-specific data that will lead to more transparency and accountability regarding children’s outcomes.
  • DHS committed to studying potential pilot sites to receive state dollars for an initial start-up and ongoing costs to implement the evidence-based CenteringParenting model.
  • Legislative support will enable a study on the impact of extending Medicaid coverage during the postpartum period.

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