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2015 INFONET #7

Issue 7, April 24, 2015

Articles in This Issue:


MEET TAMMY NYDEN, ID ACTION ADVOCATE OF THE YEAR

More than 400 advocates attended the ID Action "Advocating for Change Day" on Wednesday, April 22, talking to legislators about funding, waiting lists, education, Medicaid managed care, medical cannabis, ABLE Act, staff support, home modification tax credits, accessible fuel pumps, and more. Thanks to all that took the time to come to the Capitol and take action on these and other issues important to you. 

As philosopher Lao Tzu famously said, "The journey of a thousand miles begins with one step."  Last spring, the 2014 ID Action Advocate of the Year took her first step after becoming frustrated with our state's mental health system for children. 

Tammy Nyden of Iowa City was named the 2014 Advocate of Year on Wednesday, April 22. The Advocate of the Year award is presented each year to an outstanding individual who has advocated to improve the lives of Iowans with disabilities.

After years of struggling to navigate the children’s mental health system in Iowa, Tammy Nyden decided to take action. She, along with two other parents, formed Parents Creating Change, an advocacy group focused on providing resources to families as they work towards creating changes in the children’s mental health system.

Over the last year, Tammy has built relationships with organizations and decision-makers to raise awareness of the unique mental health needs of children and youth in Iowa. The relationships she built with NAMI Iowa have led the two organizations to collaborate and create the NAMI Iowa Children’s Mental Health Committee. The committee formed a statewide coalition to redesign children's mental health and to educate and inform decision-makers. 

Tammy is currently leading this group of organizations, individuals, parents, and professionals to review previous redesign efforts, research new data and best practices, and write a proposal for a comprehensive redesign of the children's mental health system. The group intends to have a proposal available in May.

Nancy Hale, executive director of NAMI Iowa commented,  "Tammy Nyden is a remarkable individual. She is the epitome of what an advocate can be. She has been the driving force behind the NAMI Iowa Children's Mental Health Committee from the onset. She is an invaluable asset to NAMI Iowa and those for whom she advocates."

We congratulate Tammy Nyden on her nomination and selection as the 2014 ID Action Advocate of the Year. With Tammy leading the charge, we are sure to continue to see positive changes for children and families in Iowa.

To learn more about Parents Creating Change click here.   You can follow them on Facebook here.

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LEGISLATORS ADDRESS ADVOCATES FOR CHANGE

Advocates attending Advocating for Change Day 2015 heard from the two women who chair the Senate and House Human Resources Committees about the importance of advocacy.  Many of our readers have asked for copies of the comments given by Senator Liz Mathis and Representative Linda Miller, so we thought we would print them here for those that were unable to make the trek to the Captiol this year.  

__________________________________________________________________________________________________

Senator Liz Mathis

Thank you all for being here today.  It’s challenging to take days from work, come long distances, navigate through this building.  We appreciate your advocacy and effort to make it here.

You have been learning about advocating for issues that are of great importance to you.  Most of you went through a training today to learn about the process that goes on here… and how to effectively make your point to legislators. May I just say the word “relationship.”  It isn’t just about one day in one year.  It’s about an ongoing conversation with your legislator. 

            • Drop an email every so often to connect.
            • Send an article of interest
            • Send an invitation to attend something that might be informative to the legislator.
            • Have meetings back home, in more casual settings - summer and fall are good times to talk about upcoming policy and the amount of money it will take to do the important work.
            • And certainly, let your legislator know what you think about policy being discussed and passed while in session.
            • Understand that the legislator's first concern is to the constituent from their area. But by all means, the legislation they pass affects every Iowan.

This is a working legislature – so many of us have other jobs back home.  My job is working for a child welfare and juvenile justice agency.  We see many children with mental health and behavioral issues and quite a few with intellectual disabilities.  One of the programs we’ve developed is for children with Asperger’s syndrome.  We help kids navigate social issues, learn facial cues and body language, and go on job shadows.  It’s been rewarding to see our kids run for student council or be successful in school.

This session, the legislation to watch is the transition from Medicaid into Managed Care.  Medicaid dollars total $4.2 Billion…and help 500,000 Iowans.  There are 18 different managed care organizations (MCOs) that have shown interest in bidding for the Medicaid work.  It is important that there is managed care oversight by the legislature – certainly because of the large amount of taxpayer money involved – but, more importantly, about the access to services and care to those who need it most.  I encourage you to contact your legislator about this necessary policy that needs to be passed before the end of this session.

My new role as Chair of Human Resources has given me a greater perspective on your life.  I will never take that for granted.  I look forward to working with you and for you in the future. Thank you for coming to YOUR HOUSE… the State Capitol. 

Senator Liz Mathis is from Robins, and represents Senate District 34, which includes the North and East sides of Cedar Rapids, including the communities of Bertram, Ely, Hiawatha, Marion, and Robins.  Senator Mathis currently is the Chief Information Officer for Four Oaks, and its affiliates, the Affordable Housing Network and Iowa KidsNet. Senator Mathis is a former news anchor, reporter and producer at KCRG-TV (1998 to 2007) and spent 16 years at KWWL-TV in Waterloo,

_________________________________________________________________________________________________

Representative Linda Miller

(please note we have only a partial recording of Rep. Miller's speech, our apologies for not having more of her inspirational speech to share with you)

Thank you for sharing your stories with us today.  I know many of you already from your local advocacy efforts, and met many of you when you came to my local coffees at the Hy Vee on Devil's Glen where you told me what you needed, which I really appreciated. That's advocating for your position. As we go forward with a change in how we deliver services to you, and as we go forward with community based services rather than institutions, we will need to hear from you.  Because your voice is what will make a difference - and make a difference in all communities. 

Because you need to tell people that you can live in an apartment, and you want to make those choices for yourselves.  You need to tell us what you want the system to look like, so we can make sure we are representing you.  So thank you for coming today, and continue the good work.

Representative Linda Miller lives in Bettendorf and represents House District 94, which includes the Northern part of Davenport and the communities of Bettendorf, Panorama Park, Pleasant Valley, and Riverdale.  Representative Miller is a Registered Nurse and has six children. Representative Miller has been honored as Legislator of the Year by the Iowa Medical Alliance, and received the Chairman's Award for Outstanding Service from her chamber.

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HOUSE RELEASES BUDGET TARGETS

This week, leaders in the Iowa House of Representatives released their budget targets.  These targets show two things - how much they plan to spend next year and how they will divide it up among the state budget categories.  As you will recall, Senate leaders released their targets a few weeks ago, planning to spend the same as the Governor but dividing up the pot a bit differently.   The House plans to spend about $166 million less than the Governor and Senate, much of that difference ($104.4 million) coming from the Health/Human Services Budget which funds Medicaid, home and community based services, and services and supports for low-income families and older Iowans.

Below is a chart showing the areas of difference between the current year and the House, Senate, and Governor. 

 

Current (FY15)

Governor (FY16)

Senate (FY16)

House (FY16)

House v. Senate

 Administration/Regulation

$ 51,795,769

$ 53,176,922

$ 51,892,994

$ 49,800,000

$ 2,092,994

 Agriculture/Natural 
 Resources

$ 43,111,995

$ 44,611,995

$ 43,111,995

$ 42,000,000

$ 1,111,995

 Economic Development

$ 42,581,886

$ 44,500,763

$ 44,275,763

$ 41,400,000

$ 2,875,763

 Education

$ 986,136,365

$ 1,022,443,864

$ 1,025,960,305

$ 977,600,000

$ 48,360,305

 Health/Human Services

$ 1,858,603,019

$ 1,930,649,292

$ 1,904,413,758

$ 1,800,000,000

$ 104,413,758

 Justice Systems

$ 731,462,920

$ 744,346,090

$ 742,213,713

$ 728,000,000

$ 14,213,713

 Transportation

$ 0

$ 0

$ 0

$ 0

$ 0

 Standings (Other)

$ 3,280,635,350

$ 3,501,290,912

$ 3,545,281,310

$ 3,536,200,000

$ 9,081,310

 Savings (early retirements)

$ 0

$ 0

($16,130,000)

$0

($16,130,000)

 Total

$ 6,994,327,304

$ 7,341,019,838

$ 7,341,019,838

$7,175,000,000

$ 166,019,838

Budget subcommittee chairs got right to work after the targets were announced, and budget bills are being drafted.  You can see a list of budget bills and where they are at in the process as of April 24, 2015 below.  You can also find non-partisan legislative staff explanations of each budget here.

Appropriations Bill

Senate Bill #

House Bill #

Status

 Administration/Regulation

SF 498

HSB 248

 SF 498 on Senate Floor; HSB248 in House 
 Appropriations Committee

 Agriculture/Nat, Resources

SF 494

 

 Senate Floor

 Economic Development

SF 499

 

 Senate Floor

 Education

SF 493

HSB 247

 SF 493 on Senate Floor; HSB247 on House Floor

 Health/Human Services

 

 

 

 Judiciary

SF 496

 

 Senate Floor

 Justice System

SF 497

 

 Senate Floor

 Transportation

 

HF 637

 Senate Appropriations Committee

Other Budget Bills

 

 

 

 Federal Block Grant

 

HF 630

 Senate Floor

 Infrastructure (RIIF)

 

HF 650

 House Floor

 Standings

 

 

 

Now is the time to advocate for the programs and services you think are important.  Both the House and Senate are funding Health/Human Services Budget below the Governor's requested level, so much advocacy will be needed to maintain services at current levels. 

  • You can contact your legislators now using our Grassroots Advocacy Center here.  
  • You can attend a local legislative forum here.
  • You can get tips using our new Advocacy Toolkit and Guide to the Iowa Legislature.

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MEDICAID MANAGED CARE UPDATE

As you have been reading, Governor Branstad has decided to hire up to four private companies to run our state's Mediciad program.  This is what he is calling "Medicaid Modernization" or the "High Quality Health Care Initiative."  Most people call this "Medicaid Managed Care."  While managed care may be frightening to some, managed care is not foreign to Iowans.  Iowa has had managed care in part of its Medicaid system for decades - Magellan Behavioral Health manages the behavioral health services for the state. 

Under the new system proposed by Governor Branstad, almost all services in Medicaid would be managed by 2-4 managed care organizations who will try to make money by making people healthier (and therefore needing fewer services).  They may also work harder to give people additional community living options, since those tend to be cheaper than institutionally-based options.  But we won't know much about who these people are, and what their plans will be, until the companies submit their proposals in May, and the state makes a decision in July.  You can read more in the Medicaid Modernization Fact Sheet.

There have been a number of changes since the state first issued its RFP in February.  The state has gone through two rounds of questions, posted answers to those questions, and issued two different amendments to the Request for Proposals.  It's now in the process of answering a third round of questions.  The state has also told people how it intends to ask the federal government for permission (through 1915 b & c waivers, and an amendment to our Iowa Health and Wellness Plan 1115 waiver, for those who know what that all means). 

Right now, the state has extended the due-date for the proposals to May 19 (originally May 8).  They will still have until the end of July to make a decision.  Here are some quick updates:

  • The Iowa Department of Human Services has released an updated version of the Medicaid Modernization Frequently Asked Questions (FAQ) document. More than 50 new questions and answers have been added. Click for the Updated FAQs.
  • On Wednesday, April 22, 2015, the Iowa Department of Human Services released the second amendment for the Iowa High Quality Health Care Initiative Request for Proposal (RFP). Access the updated RFP and other supporting documents on the Bid Opportunities web page.

  • The Iowa Department of Human Services (DHS) is working very closely with its federal partners at the Centers for Medicare & Medicaid Services (CMS) on the best way for Iowa to modernize its Medicaid program. Iowa plans to move forward with concurrent 1915(b) and 1915(c) waiver authority to get approval for the state's managed care contract. This means a new 1915(b) waiver application will be submitted to include physical health, behavioral health and long-term care services in the Medicaid managed care program. In addition, existing Section 1115 Demonstration waivers (Iowa Wellness Plan and Family Planning) will be amended to move service delivery to managed care organizations. The seven 1915(c) home and community based services waivers will also be amended to move service delivery to managed care organizations.
  • CMS requires that the state give the public notice about these waivers before they are submitted, including holding public meetings around the state to get public comment. The waiver application and waiver amendments will be posted on the website and stakeholders will be encouraged to review the documents and offer comments. At this time, DHS plans to post the application and amendments for public comment by the end of June 2015. After reviewing the public’s input, DHS anticipates formally submitting the waivers at the end of summer. Watch the Medicaid Modernization web page for more information in the coming months about the federal approval process.

 
 

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PUBLIC COMMENT: NON-EMERGENCY MEDICAL TRANSPORTATION WAIVER

The Iowa Health and Wellness Plan (which began on January 1, 2014) is a Medicaid program created to provide comprehensive health care coverage to low-income, uninsured Iowans ages 19 to 64.  It was created as the state's response to the Affordable Care Act, which allowed more people to qualify for Medicaid. 
 
The Iowa Health and Wellness Plan is one program that includes two separate coverage options. Eligibility is based on household income.
  • Iowa Wellness Plan: Covers adults ages 19 to 64 whose income is at or below 100% of the Federal Poverty Level. The Iowa Wellness Plan is administered by Iowa Medicaid. Members have access to the statewide Medicaid provider network which means they have access to care from providers and hospitals in their local communities.

  • Marketplace Choice Plan: Covers adults age 19 to 64 with income from 101%-133% of the Federal Poverty Level. The Marketplace Choice Plan allows members to select from participating commercial health care coverage plans available through the Health Insurance Marketplace. Medicaid pays the premiums to the commercial health plan on behalf of the member. Members have access to the network of local health care providers and hospitals served by the commercial insurance plan.
Benefits of the Iowa Health and Wellness Plan are based on the state employees’ commercial health insurance plan and do not contain the extensive benefits traditionally associated with Medicaid under the State Plan. This approach specifically excluded non-emergency medical transportation (NEMT).  The Centers for Medicare and Medicaid Services (CMS) granted the state a waiver of NEMT through December 31, 2014, with possible extensions based on an evaluation of the impact on access to care.  On December 30, 2014, the CMS approved the extension of the NEMT waiver from January 1, 2015 through July 31, 2015.

The Iowa Department of Human Services has requested to extend the Non-Emergency Medical Transportation (NEMT) waiver for the Iowa Health and Wellness Plan after July 31, 2015. DHS is currently taking comments about the extension. Comments are due by May 24, 2015, at 4:30 p.m.  You can submit your comments in the following ways:

  • Click here to review documents on this waiver renewal request.  Please note that DHS has said this change will not impede EPSDT eligible individuals from having access to the full EPSDT benefit.

  • Written comments must be received by May 24 (4:30 pm) and should be addressed to: Nick Peters, Department of Human Services, Iowa Medicaid Enterprise, 100 Army Post Road, Des Moines, IA 50315.

  • Comments may also be emailed by May 24 (4:30 pm) to: DHSIMEHealthandWellnesPlan@dhs.state.ia.us. 

In addition to the written comments, DHS will accept public comments during the upcoming Medical Assistance Advisory Council meeting that will be held on Thursday, May 28 (1-4 pm) at the State Historical Building (Rooms A&B), 600 E. Locust in Des Moines.

 

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NEW ADVOCACY TOOLS

People attending Advocating for Change Day 2015 were given a new Advocacy Toolkit that includes lots of helpful information to hone your advocacy skills.  For those that were unable to attend, you can find the new resources made available to participants at the links below:

Again, these tools are given to ID Action registrants that sign up to receive infoNET.  So if you know of others that would like to directly receive these and other ID Action benefits, have them join ID Action now!

Make sure you mark your calendar for Advocating for Change Day 2017 - April 5, 2017!

Rep. Kevin Koester of Ankeny speaks with a constituent at Advocating for Change Day.

President of the Senate Pam Jochum of Dubuque has lunch with her constituents.

Advocates lobby their legislator, Representative Chris Hagenow of Windsor Heights.

Senator Amanda Ragan of Mason City, who chairs the Senate Health/Human Services Budget, gets tips from advocates from her district.

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PUBLICATION NOTE

Friday (May 1) is the 110th day of the legislative session.  That is the final day that legislators will get an expense check to help pay for the cost of traveling to Des Moines and staying in Des Moines (mileage, hotel, meals).  They also lose their staff allowance.  Legislators probably won't be done by Friday, but they will be trying to get as much wrapped up by then as possible. 

During the legislative session we publish infoNET every other week. Since we are getting close to the end, we may delay publication if it appears legislators will finish session soon.  Watch for social media posts (Facebook) and news alerts at www.infonetiowa.org.

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BILL TRACKER

Keep track of bills that may impact the lives of individuals with disabilities in our Bill Tracker.  Status is updated daily, so you can always find out where your priority bills are at in the process.

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