On July 2, the 2015 legislative session officially came to an end when Governor Terry Branstad took action on several bills. The 2015 Legislative Session will be remembered as a difficult one, with disagreement about how much to increase education spending driving session into overtime. Ultimately schools went home with an increase of 1.25%. Gas taxes were increased to pay for road maintenance and construction. Iowa's limited medical marijuana laws were not expanded, fireworks were not legalized, and fantasy sports betting remains illegal. Kids under 14 are not allowed to use handguns after an NRA-backed bill failed to get support in the Senate.
The biggest news this session came from two actions taken by the Governor early in session, both of which did not require legislative approval but certainly got legislative attention. When the Governor presented his budget during the first week of session, he rolled out a plan to close two of the state's four Mental Health Institutes (Mt. Pleasant and Clarinda). Legislative attempts to keep the facilities open failed, and both are in the process of being shut down and patients are currently being transferred.
The second action to send shock waves through the Legislature was the Governor's move to turn over the state's Medicaid system to private managed care companies. The Department of Human Services issued an RFP during session, hoping to award a contract to 2-4 managed care organizations (MCOs). Eleven companies submitted proposals, and DHS hopes to have an announcement sometime late summer. Some legislators were upset that they were not consulted, and that the timeline is too fast (managed care companies will need to be up and running by January 1, 2016). As a representative from one managed care company said, "Yes it can be done this quickly, but it can be done better with more time."
With all the issues that legislators were faced with this year, what may be the most remarkable is that they were able to find a middle ground at all. Legislators will be battle-worn after this session, so now would be a great time to remind them how much you appreciate the work they do.
At the start of session, your lawmakers were faced with an $80 million shortfall in Medicaid for the current year and a $200 million increase needed for the next year. This caused some legislators to refer to the Medicaid budget as the "Pac Man" of the state budget, gobbling up all available funds just to keep services at current levels. Ultimately, the Governor signed the following into law last week:
The Governor did not approve (he vetoed) the following that prohibited DHS from:
These vetoes mean the Governor can move up the transition from Consumer Directed Attendant Care (CDAC) a year early, starting July 1, 2015. It also means that DHS can implement "cost containment" strategies to limit how much can be spent on HCBS waiver funded transportation. The vetoes mean DHS can also reduce the number of HCBS waiver slots they have in anticipation of managed care, which could have the affect of increasing waiting lists.
Six months after a federal law paved the way for tax-free savings accounts for people with disabilities, the IRS is providing details on how they expect the new program to operate. These guidelines are expected to help states create their ABLE (Achieving a Better Life Experience) accounts.
Each state must take action to create these accounts (if they want them to be available to their citizens). The Iowa Legislature did that in Senate File 505. The Governor signed the bill into law, so these federal fules give Iowa the green light to start creating its program.. You can read more about the IRS rules here. You can read more about the ABLE Act here. Follow us on social media and at www.infonetiowa.org to watch for updates on the ABLE Act implementation.
The following update comes from the Department of Human Serviices. 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 route for Iowa as it modernizes its Medicaid program. This collaboration makes DHS confident that CMS will approve Iowa’s upcoming waiver applications.
Iowa plans to move forward with concurrent 1915(b) and 1915(c) waiver authority. 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 transition service delivery to managed care organizations. The seven 1915(c) home and community based services waivers will also be amended to transition service delivery to managed care organizations.
There will be a formal public notice and comment period before submitting the documents to CMS. 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 anticipates posting the application and amendments for public comment in July 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.
You can read more about the bills that passed the Legislature in the infoNET Bill Tracker here. The bill tracker lists all bills that were signed or vetoed in the "Active" list, and all the bills that didn't make the cut this year in the "Inactive" list. Those bills that didn't make it this year become alive again when the 2016 Legislative Session begins on January 11, 2016. So if you see a bill in that "Inactive List" that you want to become law - let your legislators know! Now is the best time to get started on your advocacy - when legislators are back home with more time to consider the issues their constituents bring to them.
You can also see a complete list of bills signed into law this year here.