Alerts
Medicaid Managed Care Bill Introduced
01.10.18
Iowans receiving Medicaid long-term care services and supports have faced a lot of uncertainty since the transition to managed care.  Two Senators -... Read More...
Governor Gives First Condition of the State Speech
01.09.18
Today the Governor outlined her budget and priorities for the coming year.  Gov. Reynolds outlined her plans for tax reform, water quality, mental... Read More...
Video Available: Health Policy Oversight Committee
12.21.17
If you missed the December 18 meeting of the Legislative Health Policy Oversight Committee and its discussions about Medicaid managed care, you can... Read More...
Governor Sets 6th Special Election of Year
12.21.17
Governor Kim Reynolds has set the special election for House District 6 for Tuesday, January 16, 2018.  Jim Carlin, who had represented this Woodbury... Read More...
Every Vote Counts (Here’s the Proof)
12.20.17
We all know every vote counts - on December 19 in Virginia it really did. One vote (11608 to 11607) turned this Virginia House seat from Republican... Read More...


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2018 Issue #1

Issue 1, January 19, 2018

Articles in This Issue:


FAST START TO 2018 LEGISLATIVE SESSION

The Legislature is back in session, and it's been a very busy two weeks despite the snowy ultra-cold conditions blanketing the state.  Your elected officials hit the ground running with a passionate Condition of the State speech from Iowa's first woman Governor Kim Reynolds and intense committee meetings focusing on recent child foster care deaths and the mess that is our Iowa Medicaid program.

Legislators are in for a short session this year - only 100 days.  Legislative leaders say they want to shorten that to just 90 days, which means your state legislators are going to be instructed to get their priorities set and work fast in order to wrap things up by early April.

We've already had one legislative deadline pass (January 19 was the last day legislators could ask for bills to be drafted).  Another one is coming up soon (February 16) - the so-called "first funnel" when bills need to make it out of their first assigned committee.   So look for a lot of subcommittee and committee work on bills over the next two weeks.  If you want to weigh in on the issues with your legislators: 

  • Check out the list of bills being considered in our Bill Tracker.  
     
  • Email your legislators using our brand new Grassroots Advocacy Center.
     
  • Go to a local forum and ask for support/opposition for the bill (list of local forums).
     
  • Always reference the bill number you are talking about & explain why and how it will impact you (or why you like/dislike it).
     
  • Request changes if you have an idea to make the bill better.  You'd be surprised how many legislators get great ideas from advocates - and those ideas may end up in Iowa Law!

You've heard us say how important it is to get involved and advocate.  Now is the time to speak up; your story might be the one that changes everything.  In the words of Dr. Martin Luther King Jr., "Our lives begin to end the day we become silent about the things that matter."

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GOVERNOR OUTLINES BUDGET & POLICY PRIORITIES

Every year the Governor presents their policy priorities and budget to the Iowa Legislature on the second day of session.  More Iowans tuned in this year to hear the historic Condition of the State speech from Governor Kim Reynolds, Iowa's first woman to hold that office.  While she laid out an aggresive policy agenda, her budget told a different story.

Policy Priorities:

  • Water Quality (she wants it to be the first bill that she signs as Governor) 
  • High-Speed Internet (she wants more access in rural Iowa).
  • Tax Reform (wants tax reform for the middle class and study of business taxes).
  • Medicaid Managed Care (she still supports it but said mistakes were made and they will "make it right")
  • Mental health (more doctor training on mental illness while in school and regional access centers for those in crisis)
  • Opioids (iimplementing some of the recommendations of the Opioid Task Force)
  • Education (allowing 529 college savings plans to be used for private K-12 education) 

Governor's Budget:

  • Cuts $30 million out of this year's budget, including Medicaid ($10 million) and Vocational Rehabilitation ($55,000).. 
  • Adds back only $55 million for Medicaid in next year's budget ($10 million below the estimated need).
  • Shifts $1.3 million from the Community Mental Health Block Grant to pay for children's services cut at DHS.
  • Reduces funding for vocational rehabilitation by $54,472 (so they will not draw down all federal funds available).
  • Adds $2.2 million for a new Des Moines University/NAMI doctor training program in mental illness.

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MEDICAID HEATS UP AT CAPITOL

Legislators say they hear more about Medicaid from people back home than any other topic.  This year more legislators seem ready to take some type of legislative action. But that's not to say they all agree.

Some want to give the Governor a chance to correct the problems, now that she has a new team in place with a new DHS Director and Medicaid Director.  Some want to spell out expectations for managed care companies in law.  Others want to end managed care entirely and go back to a state-managed system.   Democratic Senators have all sponsored bills (SF 2013, SF 2032, SF 2058) to pull long-term care supports and services (LTSS) from managed care - the services Iowans with disabilities depend upon to live independently in their communities. 

Legislators are also getting hit with questions about the decision by one MCO (United) to pull low-intensity individuals out of current integrated health homes (IHHs) and manage their care internally.  According to DHS Director Jerry Foxhoven, there are 36-37 integrated health homes around the state, "but only 6-7 are meeting all their performance standards."  

While testifying to the Senate Human Resoures Committee, Foxhoven said that they were working with United so that they "don't throw out the ones that are working well" and are evaluating the others to determine what needs to change, and work with them to be successful.  He said that United would step in for those that cannot turn themselves around, but said the department was trying to minimize changes in this area.  But to date, nothing about any of this plan has been put into writing, and it seems this issue changes course daily.

Integrated health homes were created by Magellan, the state's original managed care provider.  They are community-based teams that work to address the needs of individuals with serious and persistent mental illness, but United says they duplicate services provided by others.  This decision was made with no notice to providers or people, and caught legislators and department officials by surprise.  So far, one bill (SF 2055) has been introduced to address this situation, and more are coming. 

  • You can watch the video of Director Foxhoven's presentation, and the questions coming from legislators at: www.youtube.com/watch?v=umtR3kMP6KM.   
     
  • If you are in an integrated health home or have comments to make about Medicaid, contact your legislators and let them know what you think!  Use our Action Center, go to a local forum, or find other ways to advocate.  What you do isn't as important as doing something.

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COMPLEX NEEDS REPORT URGES ACTION

In response to legislation passed in 2017, the Iowa Department of Human Services put together a work group to look at the services and supports available now for Iowans with complex mental health, disability, and substance use disorders, and make recommendations to fill the gaps and better serve these Iowans.  These recommendations include:

  • Expanding and improving Iowa’s mental health and substance use disorder services array to fill gaps for individuals with the most complex service needs by developing and implementing in strategic locations throughout Iowa:
    • Six access centers.
    • 22 Assertive Community Treatment teams.
    • A full array of mental health crisis response and subacute residential services.
    • Intensive residential service homes (nicknamed IRiSH homes) to serve a minimum of 120 individuals.
    • Tertiary care psychiatric hospitals, including the mental health institutes and other hospitals.
To do this, the work group is asking that the Governor and Legislature make the following changes:
  • Require mental health and disability services (MHDS) regions to establish, implement, and maintain the following services as required core services: 
    • Access centers
    • Assertive Community Treatment.
    • Comprehensive crisis and subacute services.
    • Intensive residential service homes (IRiSH)
       
  • Direct DHS to establish a single set of provider qualifications and access standards that are used for mental health services provider accreditation (chapter 24), Medicaid enrollment (DHS), MH/DS region standards, and MCO utilization review standards.
  • Direct DHS to establish access standards that allow and encourage multiple MH/DS regions to strategically locate and share intensive, specialized services among and between MH/DS regions to best serve Iowans in the most efficient manner possible.
  • Eliminate the cap on subacute care facility beds.

  • Encourage the 2018 Legislative Interim Committee on MH/DS funding to consider these recommendations.

  • Request that DHS work with the courts to discuss how Iowa's commitment laws (Chapters 125 and 229) could be amended to make the best use of these changes and include precommitment screening.

The Governor highlighted one of these recommendations (access centers) in her Condition of the State speech, saying "In many cases, Iowans suffering from mental illness don’t need hospitalization. But they also can’t get the care they need at home. They need a safe place to stay that offers professional services and a watchful eye.  We need to establish residential access centers that will provide short-term care for those in crisis. A place with the resources necessary to get these Iowans stabilized and back home to their families."    

While she called out the Access Centers specifically, she was clear that more must be done. "To improve our mental health system, we can’t just focus on the sheer number of beds; we must identify the gaps in our system." Governor Reynolds went on to say, "I am asking the mental health regions and our stakeholders to work with me to create a long-term and sustainable funding structure to establish these much-needed crisis access centers. Creating a mental health system is complex and it won’t be solved overnight. But no parent, child, friend or neighbor should suffer in silence when it comes to mental health."

The full report is available at www.legis.iowa.gov/docs/publications/DF/865801.pdf.

 

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BOSSMAN ELECTED

Jacob Bossman was elected on Tuesday (January 16) as the new State Representative in House District 6 in Woodbury County.  He replaces Jim Carlin, who was elected as Senator last month.  

Bossman is a Republican who lives in Sioux City. He is a graduate of Morningside College, with a degree in Economics. He and his wife, Carmen, live in the Morningside area of Sioux City with their twin daughters.

Representative Bossman has served on the staff of U.S. Senator Chuck Grassley for 12 years He is a
 longtime member of Morningside Lutheran Church, serves on the Morningside College Alumni Board,  coaches YMCA youth soccer, and volunteers for Siouxland Youth for Christ and the Big Brothers Big Sisters of Siouxland's Every Classroom Counts program.  

He has been assigned to the following House committees:  Education, Judiciary, Veteran's Affairs, and Justice Systems Budget Subcommittee.

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2018 LEGISLATIVE GUIDE (FINALLY) AVAILABLE

We know you've been waiting for it.  Our updated 2018 Guide to the Iowa Legislature is now at the printers, and will be arriving in your mailboxes sometime in the next two weeks.  It is also available online here.  

Committees have been updated, and the three new legislators elected since session adjourned in May 2017 have been added.  Check it out, and get to know more about the legislative process, deadlines, legislators, and committees. 

Watch for it, and if you didn't get it in the mail, it's probably because we don't have your address.  Register with ID Action, and ask for a copy of the Guide!  

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ADVOCACY CHALLENGE 2018

Advocacy alone is rewarding - but we thought we'd add an extra incentive this year to tell your story.  Remember, you can alwasy get tips on telling your story here.  Here's what to do:

  1. When you go to the Capitol, take a picture with your legislators or their staff.  Email it to us at: infonetiowa@gmail.com with your name.  We will put it in infoNET or on social media, and enter your name in our drawing.
     
  2. When you go to a local legislative forum, take a selfie with your elected official.  Email it to us at: infonetiowa@gmail.com with your name.  We will put it in infoNET or on social media, and enter your name in our drawing.
     
  3. Participate in the #IamMedicaidIowa movement by tagging #IDAction or @idaction when you post to Facebook or tweet.  
     
  4. Send your legislator a video advocacy message.  Use your phone or other mobile device to video your advocacy message to your legislator.  Talk about the issue you care about, how it impacts your life, and what you want them to do.  Send it to your legislator or email it to us and we'll post it on our YouTube channel.  Again, send us your name and we'll enter you into our drawing!
     
  5. When you use our Action Center, make sure when asked that you save your name in the system, and we'll be notified that you took action.  We'll enter your name into our drawing! 

If you do all of these things, you'll get multiple entries.  We'll draw for prizes at the end of the legislative session, and then have another challenge issued for the months leading up to the fall elections.  So what are you waiting for? Get started!

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BILL TRACKER

We work hard to make sure you know the issues your legislators are working on each year at the State Capitol.  There are a number of issues we know that our readers care about - transportation, Medicaid, community-based services, access, and more.  

We read every bill, translate all that legal talk it into plain English, and track them in our infoNET Bill Tracker. It is updated at least once each day, so you can always rest assured that what you are reading is up-to-date.  

Click here to look at the new bills introduced (so far) in the 2018 session.  

Right now, only bills that are new or actively moving are on the "Active" list.  If you change that to "Inactive," you will find all the bills that are still alive from 2017.  If legisltators decide to take action on those older bills, we'll move them to the "Active" list.  Legislators can discuss any of these bills right now, but they better hurry.  
 
To stay alive, bills must get out of their first assigned committee before Friday, February 16.  So take action if you see something you like, dislike or want changed.  You can use our Advocacy Center to let your legislators know!

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PUBLIC FORUMS

Do not miss out on the best way to advocate - in person, in your own area.  Iowa's elected officials are really good about getting back to their districts and talking to the people they represent.  That goes for our members of Congress as well as your state legislators, and Governor Kim Reynolds, who is continuing the Branstad tradition of getting to all of Iowa's 99 counties each year.

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GET THIS IN PDF FORMAT

Click here to read, print, or download this as a PDF.

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