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ISSUE WATCH: HCBS WAIVERS

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Legislators this week also began discussions about the growing waiting lists for Medicaid Home and Community Based Services (HCBS) waivers.  Iowa currently has seven HCBS waivers; only two of those waivers do not have waiting lists at this time.  Number of people served and waiting list size as of 1/23/15 is listed in () below.

  1. AIDS/HIV Waiver (30 served; none waiting)
  2. Brain Injury Waiver (1,209 served; 1,199 waiting)
  3. Children's Mental Health Waiver (731 served; 1,950 waiting)
  4. Elderly Waiver (8,615 served; none waiting)
  5. Health/Disability Waiver (2,063 served; 3,480 waiting)
  6. Intellectual Disability Waiver (12,672 served; 369 waiting)
  7. Physical Disability Waiver (724 served; 2,648 waiting)

Each waiver has its own menu of service options.  Individuals who receive waivers also receive Medicaid services. Most individuals on waiver waiting list also receive traditional Medicaid services, although this is not true for children whose parents have incomes higher than traditional income eligibility limits. You can see the Department of Human Services' presentation on waivers here.

The Department of Human Services is planning to begin several "cost containment" strategies to help stretch their Medicaid dollars.  A few of these impact HCBS waiver servcies, and will save the state about $6 million.

  1. Change the reimbursement rates for transportation to Federal IRS rate ($.575/mile) but cap the one-way reimbursement for each trip at $9.79.  The $9.79 cap is based on the current statewide average.  These savings are estimated at $1.1 million.  Several legislators expressed concern that this would more negatively impact rural Iowans, who must travel further to grocery stores, etc.  This cap will not impact transportation for non-emergency medical transportation or medically necessary trips.

  2. Put a cap on the cost of ID Waiver services.  If the Legislature approves this change, the ID waiver will pay for services up to $346.39/day (based on the daily ICF/ID per diem rate). This change will save the state about $1 million.

  3. Carefully review individual requests for exceptions to policy and make sure those exeptions to policy comply with the capped costs for services noted above. The state anticipates they will save about $1 million because of this change.

  4. Utilize the Supports Intensity Scale (SIS) to determine payment amounts for the services provided to adults served in the ID Waiver. The Supports Intensity Scale will base services on a person's level of need; the more you need, the more services will be available.  The state will use a tiered payment system, with the top tier of support (most services needed) limited to the ICF/ID payment rate noted above.  There will be a process developed to address needs of people beyond the capped limit.  Estimated savings is $2.5 to $3 million.

While these discussions have been happening in the Health/Human Services Budget Subcommittee meetings, a three-member subcommittee in the House has been reviewing another bill introduced by the Department of Human Services.  House Study Bill 82 requires the Department of Human Services to develop a process to prioritize people waiting for HCBS waiver services.  The bill does not outline the process to be taken, or the criteria to be considered.  Right now, services are available on a first-come, first-serve basis, and cannot be awarded based on level of need. 

The members of the subcommittee - Rep. Joel Fry of Osceola, Rep. Sandy Salmon of Janesville, and Rep. Lisa Heddens of Ames asked that advocates provide them with criteria they would like considered.  They plan to have an amendment that will require DHS to work with stakeholders in the development of the criteria and process before doing rules, and they may list some of the criteria to be considered.  If you have thoughts on this, let them know!

  • Rep. Joel Fry - joel.fry@legis.iowa.gov or call 515.281.3221
  • Rep. Lisa Heddens - lisa.heddens@legis.iowa.gov or call 515.281.3221
  • Rep. Sandy Salmon - sandy.salmon@legis.iowa.gov or call 515.281.3221
  • You can email your legislator using our Grassroots Action Center here.