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We have added some new tools that will save you time and help with your advocacy. Try them out and let us know what you think!  Our brand new,... Read More...
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...
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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...


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2018 Issue #3

Issue 3, February 19, 2018

Articles in This Issue:


FIRST FUNNEL WEEK ENDS, FLOOR WORK AHEAD

Each year, legislators turn their ideas into bills.  Hundreds of these bills are introduced, but only about 10% of them become law.  That's because making laws is a long process.  To keep things moving during our state's short legislative session, legislators have developed a series of deadlines to keep things moving.  
 
The first of these "funnel" deadlines was Friday, February 16.  Bills had to make it out of their assigned committees before that date.  Bills that failed to make the cut are done for the year (although they can always be revived as amendments to other bills).  Bills that spend money (appropriations) or involve taxes (ways & means) are exempt from deadlines, so they can be discussed at anytime.
 
Some of the most controversial bills died during this first funnel - death penalty, educational savings accounts (aka “school choice”), publicizing immigration status of people arrested, bans on new hog lots, constitutional amendments that allow Iowans to carry guns without permits, bible classes in schools, transgender bathrooms, state employee retirement (IPERS) changes, bottle bill expansion or elimination, and more.  Here are a few more examples of bills that did not make the funnel:
  • Eliminating the Department of Public Health.
  • Transferring mental health and disability services to the Department of Public Health.
  • Ending Medicaid managed care (MCO) contracts.
  • Pulling long term supports and services (LTSS) out of MCO contracts.
  • Establishing an MCO appeals process for supports intensity scale (SIS) scores.
  • Various measures that “get tough on MCOs."
  • Creating a home modification grant program for individuals with disabilities and older Iowans.
  • Mandating insurance coverage of pediatric hearing aides.
  • Requiring schools provide parents of children with hearing impairments with language and literacy milestones.
  • Directing telecoil hearing assistance device manufacturers give users detailed information about the device.
  • Making it a crime to mistreat or harm a service animal.
  • Making it a crime for a college employee to sexually exploit an adult student with a disability.
  • Requiring kids riding bikes wear helmets.
  • Creating a central database of direct caregivers, including experience and certification.
  • Increasing in the tobacco tax, including taxes on e-cigarettes (but this could be revived since it involves a tax).
  • Increasing the smoking age to 21.
  • Requiring insurers offer no-deductible prescription copay options. 
There is still a lot of controversy in the bills that survived the funnel - tax reform, sanctuary cities, “heartbeat” abortion ban, Medicaid work requirements, Religious Freedom Restoration Act, cutting back on the number of administrative rules, legalizing fantasy sports and sports betting, and more.  Here are some bills of interest that survived the funnel:
  • Requiring recipients of public assistance to work, go to school, or look for work (more on this in next article).
  • Protecting integrated health homes by prohibiting MCOs from taking them over and slowing the process down.
  • Making it a crime for someone to misrepresent themselves an owner or trainer of an assistive animal.
  • Allowing landlords to ban service animals if a person cannot show need and proof of proper training.
  • Enacting recommendations of the state’s Complex Needs (MH/DS) work group.
  • Requiring acuity-based updates and use of the psychiatric bed tracking system.
  • Requiring school districts integrate annual, evidence-based suicide prevention training.
  • Making change to Iowa’s prescription monitoring program to address opioid abuse.
  • Prohibiting insurers from switching a person's medications if they are doing well on them.
  • Allowing Medical Board to raise cannabidiol THC limit and add treatable conditions to list.
  • Directing the Board of Behavioral Science to license behavior analysts & assistants.
  • Directing a study of mandatory reporter training and certification (including dependent adult abuse).
  • Requiring DHS to figure out what to do about housing aging sex offenders.
  • Changing the name of the state's "Substitute Decision Maker" to the "Public Guardian."
  • Requiring insurers pay for services delivered via telehealth.
  • Allowing Farm Bureau to offer individual non-ACA compliant health plans.
While many of the MCO bills died in the funnel, legislators are still considering changes that would streamline administrative processes and set certain notificiation timelines for changes in law.  So keep talking to your legislators about this; they can make changes through amendments to other bills or by adding things to budget bills at the end of session.
 
Looking ahead, expect a lot of floor work and debate, as legislators prepare for the second funnel deadline on Friday, March 16 (just 25 days away).  By this time, bills must have been voted out of one chamber, and go through committee in the opposite chamber.  So, Senate bills need to be voted out of the Senate, and be approved by a House committee to stay alive after March 16.   House bills would need to be voted out of the House, and then out of Senate committee by that date.  After March 16, committee work will be done (except budget and tax committees).  

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WORK REQUIREMENTS FOR MEDICAID MEMBERS ADVANCES

Earlier this month, Governor Kim Reynolds said she would be open to work requirements for people receiving Medicaid.  That set the stage for a last-minute addition to the House Human Resources Committee. House Study Bill 666 was introduced last Tuesday, had a subcommittee hearing on Wednesday, and was voted out of committee on Thursday.

The bill requires anyone getting public assistance (such as Medicaid or food stamps) to have a job, be looking for a job, volunteer, or go to school at least 20 hours per week.  There are a few exceptions - for those who are pregnant, deemed "unfit for employment," those under 19 or over 64, people caring for an infant (under one year), parents caring for a dependent child with a disability or serious medical condition, those receiving unemployment compensation and meeting the requirements of that program, and those participating in a drug or alcohol treatment program.  

As you can see from the chart, 86% of Iowans receiving Medicaid are working or in a family with at least one parent working (Source: Kaiser Family Foundation, July 2017).  This is obviously a very controversial issue - it does not address access to transportation, resource limitations, access to appropriate adapative technology or personal assistance, job opportunities in rural areas, and employer attitudes and biases in hiring.  Rep. Steven Holt of Denison will lead the debate on the bill.  If you have opinions about this issue, now is the time to share them with Rep. Holt and with your own State Representatives.  Click here to get started.

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INTEGRATED HEALTH HOME DIRECTIVE SURVIVES

There were at least six bills introduced this year dealing with integrated health homes, the intensive care coordination program for Iowans with serious and persistent mental illness or complex mental health and disability services needs.

Integrated health homes (IHHs) were first developed by Iowa's former managed care company, Magellan.  Magellan spent months (years even) working with providers to develop the program and give technical assistance to local providers.  In December, the United MCO made the sudden decision to pull these programs in-house, with no notice and no explanation. 

Since that time the IHH community has been in an uproar, demanding legislators take action. Legislators from both partiies, and in both chambers, have put pressure on DHS and the MCOs to figure out a course of action.  Here's where we are at post-funnel with this issue:

  • Iowa's Medicaid Director (Mike Randol) has "paused" all action on health homes and will bring MCOs and providers together to discuss the futre of the program, look at data collected, discuss improvements, identify corrective courses of action if needed, and outline alternative paths if needed.  He has said this review should take about six months, but added MCOs have the right and ability in their contracts to change the health home program. 
  • Not all legislators were satisfied with this "pause" and fear changes will occur when the session is adjourned, and they will have not ability to stop any further action.  Sen. Mark Chelgren of Ottumwa is leading debate on a bill (SF 2284) that requires DHS submit a report on the health home review to legislators by October 1, 2018, and allows changes only through rule (which takes an average of 6-9 months and must go through the Legislature's Administrative Rules Review Committee before being enacted).  The bill also prohibits MCOs from doing the care coordination in-house, and requires they run the program as required in the state plan amendment in place as of July 1, 2017.  
     
  • Providers say this may all be a little too late - they are losing IHH staff and at least one integrated health home in NW Iowa has closed their doors rather than wait out the program's slow demise. 

We will continue to watch the progress of this issue, but if this is something important to you, contact your legislators while there is still an opportunity to keep this issue alive!

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INSIDE LOOK AT LAWMAKING

State Representative Ashley Hinson of Marion may be new to the Iowa Legislature, but she is definitely not new to the camera. Prior to being elected in 2017, Rep. Hinson was an award-winning news anchor, reporter, and producer at KCRG-TV in Cedar Rapids.  

Rep. Hinson recently combined those skills and made a fantastic video showing Iowans "how a bill becomes a law."  

  1. Take a look at it here.  
  2. It can also be found on our website - www.infonetiowa.org.

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HEARD (& SEEN) AROUND THE CAPITOL

Rumor has it that the Legislature will find savings in the current year by cutting their session short.  Legislative leaders are considering shortening the session to 85 days in order to save money.  That means legislators would lose their expense checks beginning April 2 (although they could keep working without pay until things get done).  That's just a little over a month away, with a lot of work to be done between now and then.  No action has been taken on this - its just a rumor at this point.

The new update of the INFONET Guide to the Iowa Legislature made appearances around the Capitol last week, showing up at an MCO table during Insurance Day at the Capitol, and in a doorkeeper's bag.  Who knows where we'll find it next!  Hopefully you've found yours in your mailboxes too - and you can always find it online here.

 

 

 

 

 

 

 

 

 

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BUDGET NEWS: Current Year Cuts Still Up in the Air

Discussions on cuts to the current year's budget were sidelined this week as lawmakers turned their attention to committee work. However, the deappropriation discussion is is still underway at the highest leadership levels. 
 
The Governor, House, and Senate have not yet agreed on cuts to the current budget year (fiscal year 2018).  The Senate passed its version (SF2117) on February 8; the House passed an amendment with its version out of committee (H-8012) on February 14. Here is a review:
 

Governor: $27.1 million

  • $462,871 from Iowa Department of Public Health (local boards of public health & substance use treatment)
  • $10 million from Medicaid
  • $3.3 million from DHS

Senate : $31.9 million

  • $925,742 from Iowa Department of Public Health (does not say how the cuts are made)
  • $0 from Medicaid
  • $6.2 million from DHS (does not spell out how cuts are made)
  • Adds language prohibiting any benefit cuts in Medicaid, including waivers.

House: $20.5 million 

  • $662,871 from Iowa Department of Public Health (does not say how the cuts are made)
  • $0 from Medicaid
  • $4.3 million from DHS (does not spell out how cuts are made)
  • Keeps language prohibiting any benefit cuts in Medicaid, including waivers.
  • Adds retroactive eligibility back for nursing homes only (this the ability to bill for up to three months of services provided before a person applies for Medicaid; it was eliminated last year for all providers).
The Senate and House each were able to cut $10 million less from their General Fund reductions because their versions both rely on a $10 million transfer out of the Iowa Economic Development Authority’s High Quality Jobs Program (a cut of 60%, from $15.9 million down to $5.9 million).
 
The House held a public hearing on Monday, February 19 to listen to comments about the deappropriation. You can read comments here.  

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ON THE BRIGHT SIDE: Revenues Looking Up

The House’s decision to cut less in this current budget year may be a reaction to the news that the state's revenues were looking better.  The Iowa Department of Revenue said state tax collections increased by over $133.1 million over last January.   However, a major part of this early revenue growth is from a surge in state tax estimate payments, coming in $109.4 million higher for the months of December and January over the same months last year. State officials believe the increase is due to the federal tax law changes that led several people to making big tax payments before the end of the year.
 
What does this mean for the FY 2019 budget? And more importantly, the FY 2018 budget and deappropriations?  
Two things are important to remember about Iowa budgets: 1) our state cannot legally overspend (that is, it cannot spend more than it collects in revenues that year); and 2) the Governor can only legally transfer $50 million from the state's savings account to balance the budget at the end of the year.  Even with the budget cuts made in 2017, the state spent more than it took in.  At first predictions were that the state was $100 milion in the hole; it took state officials three months to balance the books and end with a $13 million transfer from our "rainy day fund."  Legislators and the Governor do not want a repeat of that, particularly just 2-3 months before the November election.  
 
While budgets may look good, legislators will want to hold the line on spending.  We will know more on March 9, when the state's Revenue Estimating Conference is held and new predictions about the state budget are released.  

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ON THE OTHER SIDE: Governor Rolls Out Her Tax Plan

Last week, Governor Kim Reynolds introduced her tax reform package that includes tax cuts totaling about $1.7 billion between now and 2023.  The bills (SSB 3195 and HSB 671) reduce personal income tax rates, eliminate the ability to deduct federal taxes paid from your state taxes, increase the standard deduction, increase small business exemptions, and start collecting taxes for things bought online.  You can view the Governor’s detailed press release about the proposal here.
 
The House and Senate will start sifting through the plan’s details, and working on their own proposals. Some legislators have said they want to increase the sales tax for water quality, and perhaps use other parts of a one-cent sales tax to offset tax reforms and mental health funding. There is clearly a long way to go before lawmakers reach consensus, and we don’t expect to see much more than high level talks until the revenue estimating conference (REC) projections March 9 are released.  

Bottom line: tax cuts take money away from the state budget, so will need to be paid for in some way.  The Governor does not explain how she will pay for these tax cuts, or what programs will see reductions because there will be less money coming into the state.
 

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BILL TRACKER

Check out the full list of disability-related bills that survived the first funnel deadline, using our online Bill Tracker here.  

  • Bills that survived the funnel will show automatically ("Active" list).
  • To see bills that failed to make the funnel, just switch to the "Inactive" list.
  • Remember that you can download a spreadsheet of the bills by clicking "Export."

 The surviving bills now have until March 16 (4 weeks) to make it through committee in the other chamber. So if you see something you want to pass, let your legislators know using our Advocacy Center.


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PLAN A CAPITOL DAY NOW!

After last year's crowds and demonstrations, it's pretty quiet at the Capitol.  This year is a perfect time to organize a group and have your own Capitol Day! 

ID Action will provide eight (8) Capitol Day grants up to $500 each for advocacy training and support to local advocacy groups who are interested in meeting with their legislators and advocating on behalf of disability related issues at the Iowa State Capitol .  There are a few rules - your group must:

  • Consist of at least 10 people with a disability (no more than 20)  
  • Advocate for disability related issues  
  • Schedule a Capitol Day on either Tuesday or Wednesday now through April
  • Participate in an advocacy training at the beginning of the Capitol Day  
  • Set appointments with your legislators (ID Action can assist)  
  • Provide a written recap of your Capitol Day within two weeks after your visit

While not required, we encourage groups to do the following while at the Capitol:

  • Watch a floor debate  
  • Attend a committee meeting  
  • Meet with other state agencies  
  • Meet with ID Action or Iowa Developmental Disabilities Council staff  
  • ID Action Capitol Day Grants cannot be used to attend other organization's lobby days.

To apply for an ID Action Capitol Day grant, please fill out the grant application.  Call 866-432-2846 or email us at contactus@idaction.org with any questions. Grants are available on a first come, first served basis for eligible groups.

 

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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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