You've heard the expression - March comes in like a lion, and goes out like a lamb. The same could be said for the 2016 legislative session. March came in like a lion, with legislators having very little time to spare for a lunch break or to catch up on emails. And it defintely went out like a lamb, with no bills debated in the Senate and only a dozen in the House during the final week of March.
This slow-down is a clear sign that the end of session is near. Legislators have a lot of time on their hands these days, unless they are involved in end of session budget and tax negotiations. Most legislators are waiting for final budget agreements to be hammered out between the leaders of the House and Senate. This is also a time when legislators, who may now have more time on their hands, work on issues they'd set aside earlier in session because they were too controversial or needed more time than was available.
So it's beginning to feel like the end of session is near. Whether legislators end on the 100th day (April 19) is yet to be seen, but most legislators and lobbyists say an April end to session is very likely. Since the end is near, this will be our final bi-weekly session update. We may send out alerts via email or post them on this site for urgent issues - but our next issue will be sent out after session ends. So watch our "breaking news" to stay updated, or follow us on Facebook.
While session may be winding down, the Legislature still has a lot to do.
School funding. Legislators increased funding for local schools at 2.25%. By law, the Legislature is to set this increase within the first weeks of session, but has been unable to reach agreement until nearly the end of session for the past several years. This is now done, so they can check this off their "to do" list.
Supplemental. Medicaid doesn't have enough money to get through this year. That's because every year legislators have to guess how much money will be needed, and sometimes it costs more to provide services because there are more people eligible for those services. The managed care delay until April also cost the state about $6 million per month, or $18 million total. The Senate passed a bill that gave Medicaid an extra $80 million; the House changed that to $67 million and used other unused funds in the Department of Human Services to make up the difference. Look for this bill to pass (probably as the House passed it) once there is a budget deal.
MH/DS Regional System. The future of the regional Mental Health and Disability Services (MH/DS) system is uncertain, because the Legislature has never updated the way it is funded. Without state funding or a permanent fix to the funding system, at least one region will be cutting services to as many as 1,600 people, and at least one other region will be breaking apart. Legislators have a choice - spend at least $10 million to help two counties maintain services (Polk and Scott), give county boards of supervisors the ability to adjust their levies within current $47.28 per person cap, or do nothing and allow thousands of people to lose their services.
Water Quality. Legislators and the Governor all agree - something needs to be done about Iowa's water quality. But that is as far as the agreement goes. There are several approaches to funding water quality - shifting money around in the state budget, using a part of Iowa's 1 cent sales tax that currently goes to schools, adding a new sales tax, or using more of the state's infrastructure fund (gambling money). This doesn't have to be resolved, but there are a lot of groups working to keep this alive and get it addressed this year.
Gambling. While it is uncertain whether something will or will not be done this year, there is a big push to legalize fantasy sports leagues and cut taxes on free promotional games offered by casinos in Iowa. One appears to be an expansion of gambling, while the other cuts money available for various infrastructure projects, so both are tough sales in the waning days of session. But anything can happen when legislators have time on their hands.
Budgets. These are an absolute "must do." The one and only thing legislators have to do each year is set a budget (if they don't - government shuts down). This year legislators need to pass 9 budget bills - Administration/Regulation, Agriculture/Natural Resources, Economic Development, Education, Health/Human Services, Infrastructure, Justice Systems, Transportation, and Standings. None of these have been drafted yet. House and Senate leaders and their budget chairs have been meeting multiple times a day trying to find agreement on joint spending levels for each of these budget bills. If that happens, bills could be drafted and begin moving very quickly. The problem is - many of these budgets will be magnets for policy bills that died earlier in the year. There won't be much time to object to those being included if budgets begin moving quickly. The Health/Human Services Budget will likely include a lot of information on Medicaid managed care, and may be the place any language on oversight of the system is added.
It has been some time since we have reported on budgets, since not much has happened since mid-February. Here is a quick refresher on where we are at now.
As you can see, the Governor and Senate used earlier estimates to set their budgets, so they must drop their levels to stay within Iowa's 99% budget law (we can only spend 99% of the money our state takes in during the year). The Governor announced his revised budget on March 31. Legislators continue to work on a joint budget, and have $176.7 million in new money to spend. However, you will recall that above we mentioned the Legislature has decided to increase school funding by 2.25%. The pricetag for that was $153.8 million. So legislators really have only $22.9 million left to allocate among all the budgets. That's why it's taking a little more time to come to agreement this year.
The Senate has passed a comprehensive (some would argue too comprehensive) Medicaid oversight bill intended to hold the three managed care organizations (MCOs) accountable for the promises made in their proposals to the state, and make sure the Medicaid system continues to meet the needs of the Iowans it serves. That bill passed with bipartisan support in the Senate (you can see how your Senator voted here).
After the bill died in the second legislative funnel deadline, the Senate Government Oversight Committee introduced an identical, "funnel proof" version of the bill to keep the discussion going. To date, the House has not yet put out its version of oversight, but is said to be working on one that reflects best practices in other states. One legislator indicated they used information they got from expert testimony during the Health/Human Services Budget subcommittee to develop their plan.
Rep. Lisa Heddens (D-Ames) tried to force a House debate on the Senate's oversight plan, but her amendment to the Supplemental Appropriations Bill was ruled not germane (that is, it addressed a different subject). So no vote was allowed at that time. Rep. Patty Ruff (D-MacGregor) also tried to amend the bill to require MCOs to pay out-of-network providers at full rates if they have an existing relationship with the Medicaid member, including providers that are out of state (like Mayo). That amendment was also ruled not germane, as was Rep. Bruce Hunter's (D-Des Moines) amendment to end the MCO contracts.
Both House and Senate agree that some type of oversight is needed of the new Medicaid managed care system, and that it include a way for stakeholders to provide feedback, legislators to see and act on relevant data, and DHS to do course corrections as needed. How that looks is yet to be seen - but watch the website (www.infonetiowa.org) and Facebook (www.facebook.com/infonetiowa).
Dubuque native Bill Stumpf was in Des Moines two weeks ago advocating for oversight of the Medicaid managed care system. He is pictured here with his Senator Pam Jochum. Both are parents of children with disabilities who are affected by the change to managed care.
Three managed care organizations (MCOs) started managing the care to 560,000 Iowans on April 1, as the state made the transition to what supporters call "Medicaid modernization." Changes this big are challenging, so everyone expects that there will be issues that arise. What is important is that you communicate those issues, so they can be addressed quickly. Here are some resources and information that can help.
Managed Care Organizations (MCOs) will offer health coverage to most Medicaid recipients and work directly with them regarding their coverage beginning April 1.
Medicaid Member Services will assist Medicaid recipients with questions and concerns about health care coverage, MCO enrollment, and which MCOs their health care provider has signed up with.
Iowa Medicaid Provider Services will enroll health care providers with Iowa Medicaid and assist with eligibility and MCO questions. Providers must contract with MCOs to be reimbursed for health care services to Medicaid members.
MCOs also have provider services hotlines to answer questions from Medicaid providers.
Do not forget about your legislators. They can be your best advocates if you are not getting the responses you expect from Medicaid or your MCO. They have the power to make changes in Iowa law to make the system work better for you, and they can sometimes get answers quicker because of this power. And don't forget to let them know when things work well! You can find out who your legislators are here, and communicate with them here.
You may have heard the term "ombudsman." Ombudsman is Swedish for "representative" - but in America it is the word we use for a government official appointed to investigate citizen complaints against government agencies and officials. In Iowa, we have a special type of ombudsman that helps Iowans living in certain types of long-term care facilities. The Office of the State Long-Term Care Ombudsman created a Managed Care Ombudsman program to help Medicaid members who:
The Managed Care Ombudsman Program can act as an advocate for these two groups and can:
All services provided by the Managed Care Ombudsman Program are confidential and free of charge. This is yet another resource for Iowans receiving long-term care supports and services through Medicaid. You can find more information on the Managed Care Ombudsman Program here. To contact Iowa’s Managed Care Ombudsman, please call 866-236-1430 or send an e-mail to: ManagedCareOmbudsman@Iowa.gov.
The Senate Human Resources Committee continues to meet weekly to get updates on the Medicaid managed care transition, and push for strong oversight of the system. One Senator expressed concern of the April 1 roll-out of managed care, saying he was worried that session would end soon and legislators would no longer have the platform to help resolve issues for their constituents. Several Senators announced this week that they will be hosting Medicaid managed care meetings around the state, starting April 8. Here are the ones scheduled to date. More will be added here as they are announced.
FRIDAY, APRIL 8, 2016
FRIDAY, APRIL 15
Three years ago, the county-based mental health and disability services (MH/DS) system was redesigned. Nearly everything about the system changed. Redesign made the system more efficient by forming regions, created better access to services by making a basic (core) set of services available throughout the state, and made sure stakeholders had a say in the system and there was good state oversight.
In the three years since redesign, Iowa's property taxpayers have seen their tax bills reduced by $35 million, while seeing access to core services expand. The state also saved money in redesign. In 2009 the state's total investment in the system was $244 million; last year it was $2 million. This year, the Governor recommends no funding. Unfortunately, while the system was improved, its funding was not.
This year, a broad coalition of counties, providers, and stakeholder advocacy groups are supporting a change to allow counties to fund their systems entirely with property taxes, breaking the need for state funds that have never been reliable. Their bill (SF 2236) would allow county boards of supervisors to increase levies up to the existing $47.28 per person cap. Right now counties locked into a lower per capita rate rely on state funds to make up the difference, and those state funds have dried up. Doing this will allow at least 73 counties to lower their property taxes by $22.9 million, and allow 8 counties that are in trouble to raise theirs by $15.4 million. That's still an overall statewide $7.5 million cut in property taxes.
Supporters of this change say it is unfair to expect regions to pay for 2016 services with 1996 funds. Supporters also say doing nothing will mean property taxes will increase, as the law requiring counties that were collecting above the $47.28 cap to lower their tax levies ends on June 30, 2016. They also say that doing nothing also means thousands of Iowans will lose services, at least one region will break apart, and the taxpayer money spent to date on efficiencies would be wasted as the system starts to collapse. Supporters also are quick to point out that elected county supervisors will be the ones to decide whether or not to raise taxes, and they must answer directly to the taxpayers who keep them in office.
Opponents say its a property tax increase, and they can't support it. Groups like the Iowa Farm Bureau say that property taxes should only pay for property-related items (like fire, police), and should not be used for services like these. There are many legislators that are caught in between - they know that the services are needed, they know there are no state funds to pay for them, but they do not want to vote on a bill that may increase property taxes.
If you receive services from your MH/DS region, now is the time to let your legislators know what you think should be done and why the services you receive are important to you. Many legislators do not know what services are paid for by the regions, so take some time to explain what those services are and why you need them.
Here are two examples from counties in immediate trouble:
Transportation has always been a challenge for Iowans with disablities, even in urban areas that have bus service and taxis. Uber is now spreading throughout the country, taking its social media transportation network car service to places like Ames, Cedar Rapids, Des Moines, and the Quad Cities. That's got traditional taxi services upset, because they have to comply with more regulations and need commercial insurance to operate their cars. Now Iowa's banking industry is taking notice.
In early March, the House unanimously passed a bill (HF 2414) that would require Uber drivers carry liability insurance. During debate, an additional requirement was added to require comprehensive and collision coverage insurance for drivers, a change that Uber says will drive them out of the state. Kansas passed similar legislation, and Uber did leave the state until its Legislature reversed its decision.
Iowa's banking industry was behind the addition. Banks loan people money to purchase their cars, so they want to make sure everyone's cars have adequate insurance until they are paid off. Banks want to see the additional coverage so they aren't left with a worthless (crashed) car and no insurance (since most personal auto insurance won't cover commercial activity like Uber driving). The bill is now in the Senate, and Sen. Tod Bowman is the floor manager.
Legislators will have to find a way to balance the safety of people using Uber, protection of car owners and Uber drivers, and the need for expanded transportation options like this in the state. Nobody said policy-making was easy!
Keep track of bills that may impact the lives of individuals with disabilities in our Bill Tracker. Status is updated daily.