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The nearly $2 billion Health and Human Services Budget (House File 2463) passed out of the House Appropriations Committee this week, and is ready for debate by the full House.  House leaders say they would like to debate the bill on Tuesday, April 8. The bill will get a new House File number soon.  Here are a few highlights from the bill:

  • Adds $35 million to Medicaid (total $1.3 billion) to make up for the change in federal matching rates.  This additional funding is needed to replace lost federal dollars after hte Medicaid match rate was lowered.  An additional $13.4 million was added to Medicaid as well to pay for the increased demand for Medicaid mental health services.

  • Adds $4.8 million to take about 1,500 people off the HCBS waiver waiting lists.  There are currently 7,590 individuals waiting for Medicaid waiver services (2,793 waiting for Health and Disability Waiver services; 914 waiting for Brain Injury Waiver services; 2,239 waiting for services from the Physical Disability Waiver; and 1,644 children are waiting for services offered through the Children's Mental Health Waiver).

  • Increases funding for Regional Mental Health/Disability Services (MH/DS) by $735,435.  This is the "Equalization Formula" that gets money out to 54 counties to bring their levies up to the $47.28 per person spending limit.  This increase was needed to reflect increased population - the total funding for regions is $30,555,823.  The  bill also continues the "Equalization Formula" for another year, through June 30, 2016.  This funding was set to expire June 30, 2015 (but that doesn't give the Legislature time to come up with a new formula for funding before counties must begin the process to certify their budgets right after the first of the year).

  • Continues the Medicaid offset, which cuts funding to MH/DS regions who "save" money because of the Iowa Health and Wellness Plan, which made people earning up to 138% of the federal poverty level eligible for Medicaid or subsidized health insurance.  Counties would have to give back 80% of the savings that is calcuated using a formula that looks at the county-funded services people actually received prior to signing up for the Iowa Health and Wellness Plan. Since the county (because regions are not operational until July 1 of this year) had been paying for these services but is no longer paying for them to these individuals, they are considered a "savings" and the county would have to send back 80% of those savings.  Unfortunately, this formula can only work for one year, and it does not reflect unmet demands for services.  Savings is put into a strangely titled "property tax relief fund" which the Legislature can then decide how best to use (for property tax relief, for reinvestment in the system, for core or core plus services, for services to non-target populations (DD/BI). 

  • Eliminates county auditor approval of the Medicaid offset amount, and replaces it with the State Auditor review.  This is of concern to counties, as DHS is calculating the offset then the State Auditor is reviewing them for accuracy (and counties want to have some say in whether these figures are accurate).

  • Allows MH/DS regions to maintain a reasonable ending fund balance each year (no more than 25%) for cash flow purposes and can be used to expand core servcies and make progress on additional core plus services.

  • Clarifies that "activities leading to employment providing an appropriate match with an individual's abilities" is considered a core service under the "support for employment" category.  There continues to be a lot of concern that work services are not a core service, but legislators wanted to continue to keep this category flexible to support the work choices of all Iowans with disabilities.

  • Adds $1 million to the Autism Support Program that was created last year to provide Applied Behavioral Analysis and other treatment options to children with autism that do not qualify for Medicaid or private insurance autism coverage ($3 million total funding).

  • Adds $1 million to the medical residency training program ($3 million total) with preference to be given to new medical residencies and psychiatric residencies, and allocates an additional $100,000 to the University of Iowa to provide psychiatric training to its primary care physician residency program.
  • Adds new funding ($250,000) to establish a mental health advocate division in the Department of Inspections and Appeals (and includes language making mental health advocates state employees, transfrerring them from the courts which currently provide their supervision).  The Governor vetoed this change last year.

  • Allows community mental health centers to choose between cost-based reimbursement and an alternative reimbursement methodology developed by Magellan.   This change is cost-neutral overall, but some CMHCs will get a little more money, some a little less, and some will opt to stay the same.  This change is retroactive to July 1, 2013.

  • Decreases funding for the Community Circle of Care/System of Care pilots in Polk County by $116,075, Northeast Iowa by $250,000, and Linn and Cerro Gordo Counties by $50,000.  These coordinated networks of community-based services and supports are organized to meet the challenges of children and youth with serious behavioral or mental health needs and their families.

  • Increases funding for the state's Mental Health Institutes to meet current needs, and increases funding for the Glenwood and Woodward State Resource Centers to make up for lost federal funds.

  • Eliminates $25,000 funding for the Prevention of Disabilities conference that was held last year (but not planned again this year)

The following programs will be funded at current levels:

  • University of Iowa College of Dentistry program to provide dental care to underserved populations ($25,000)
  • Funding for Youth Suicide Prevention initiatives ($50,000)
  • Grants to assit with the costs of special foods for children with phenylketonuria (PKU) ($159,932)
  • Brain injury funding for resource facilitator services ($891,644)
  • Epilepsy support, education, and programming ($99,823)
  • Child health specialty clinics ($785,114) and their regional autism assistance program ($400,000)
  • Mental health professional recruitment and retention efforts at Cherokee MHI ($99,904) and University of Iowa ($110,656)
  • Funding for post-doctoral psychologist internships, including a new child psychologist in Cerro Gordo County ($50,000)
  • Continuation of direct care worker initiatives ($429,775), including outreach, education, and conference scholarships.
  • Autism spectrum disorder services at Four Oaks in Cedar Rapids ($25,000)

If you want to dig deeper into this budget, there are a number of resources that are very useful. 

Watch for breaking budget news at www.infonetiowa.org or on Facebook. We will let you know when the bill comes up for debate, how you can watch or listen to it on your computer or other mobile device whether live as it is happening, or later when you get home.