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Iowa Medicaid to Manage AmeriHealth Members
11.27.17
Iowa Medicaid announced today that it will manage the care of 10,000 Iowans who had chosen Amerigroup as their managed care organization (MCO) before... Read More...
SENATE SPECIAL ELECTION SET: December 12
11.06.17
Last month, Senator Bill Anderson (R-Sioux City) announced he would be leaving the Senate.  Voters in Plymouth and parts of Woodbury County will go to... Read More...
ABLE CONTRIBUTIONS INCREASED
11.02.17
November 2, 2017.  The total annual contribution limit to an ABLE account will be increased from $14,000 per tax year to $15,000 per tax year... Read More...
AMERIHEALTH OUT OF MEDICAID MANAGED CARE
10.31.17
Nothing could be more scary on Halloween than more changes to Iowa's Medicaid managed care system.  Today is Halloween and two bits of bad news hit... Read More...
IOWA PULLS ITS STOP GAP PLAN
10.24.17
October 23, 2017.  As you may have heard by now, the Iowa Insurance Division has decided to pull the Stop Gap Plan proposal to help stabilize the... Read More...


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2017 Special Online Issue #1

Issue 7, April 14, 2017

Articles in This Issue:


BUDGETS ROLL OUT

Legislators worked late into the evening on Thursday (April 13) to get things ready to end session next week.  Much of the work was on budgets, which started coming out on Monday.  As you know, it's a difficult budget year, and the cuts are very deep.  Here is a quick list of where the budgets are in the process - and links to information about what is cut, and what is funded in each budget:

 HF 640 & SF 507 - 
 Administration/Regulation

 House & Senate Floors - www.legis.iowa.gov/docs/publications/NOBA/857358.pdf:
 www.legis.iowa.gov/docs/publications/NOBA/857256.pdf)

 HF 641 & SF 510   
 Agriculture/Natural Resources 

 House & Senate Floors (www.legis.iowa.gov/docs/publications/NOBA/857359.pdf
 www.legis.iowa.gov/docs/publications/NOBA/857342.pdf)

 SSB 1196
 Economic Development

 Senate Appropriations Committee (www.legis.iowa.gov/docs/publications/NOBA/857183.pdf)

 HF 642 & SF 511
 Education

 House & Senate Floors (www.legis.iowa.gov/docs/publications/NOBA/857362.pdf
 www.legis.iowa.gov/docs/publications/NOBA/857386.pdf)

 SF 498
 Federal Block Grant

 Sent to Governor (www.legis.iowa.gov/docs/publications/NOBA/857167.pdf)

 No #
 Health/Human Services

 House Floor (www.legis.iowa.gov/docs/publications/SD/857319.pdf
 www.legis.iowa.gov/docs/publications/SD/857390.pdf)

 HF 643
 Infrastructure

 House Calendar (www.legis.iowa.gov/docs/publications/NOBA/857368.pdf)

 HF 645 & SF 508
 Judiciary

 House & Senate Floors (www.legis.iowa.gov/docs/publications/NOBA/857366.pdf); 
 www.legis.iowa.gov/docs/publications/NOBA/857352.pdf)

 HF 644 & SF 509
 Justice Systems

 House & Senate Floors (www.legis.iowa.gov/docs/publications/NOBA/857364.pdf
 www.legis.iowa.gov/docs/publications/NOBA/857340.pdf

 No #
 Standings

 Not yet available

 SF 497
 Transportation

 Sent to Governor (www.legis.iowa.gov/docs/publications/NOBA/857165.pdf)

 

A public hearing on the state budget has been scheduled for Monday (April 17) at 10 am to Noon.  The hearing will be held in Room 103 at the State Capitol (first floor). You must be signed up to speak, but you can submit comments.  To do that: 

Each speaker has only three minutes to present their case.  Time will be called in order to allow as many people to speak as possible.

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HEALTH/HUMAN SERVICES BUDGET HIGHLIGHTS

It's tough reading through thousands of pages of bills to find out how they impact you, with only a few days before they become final.  Here are a few things you should know about the proposed Health/Human Services Budget (HHS):

  • It does not yet have a bill number, but it will be assigned one soon. Check back here for updates.
  • Services and programs are cut by $27.9 million compared to the current year (FY17, after the earlier round of cuts).
  • The cut is even deeper compared to FY16 - it's $134 million less (but that includes managed care savings).

The one good thing in the budget is that the federal government will increase its match, so that helps state dollars go a bit further.  Some things to note:

  • Aging and disability resource centers ("LifeLongLinks") is cut by $250,000 (25% cut).
  • Long term care ombudsman was cut by $163,921 (12% cut).
  • Child health specialty clinic funding is partially restored ($28,309).
  • Psychiatric medical residency program is suspended for one year ($2 million cut).
  • Cherokee MHI mental health practitioner training program eliminated ($8,000 cut).
  • DIrect careworker association for direct caregiver support and scholarships ($176,104 cut).
  • Office of Minority and Multicultural Health is eliminated ($74,389).
  • Funding for child vision screening is eliminated ($17,000).
  • Specialty health care access network for uninsured is eliminatd ($205,493).
  • Nursing homes received $2 million more to pay for their reimbursement rebase (they asked for $40 million).
  • Implements a number of "cost containment" measures that reduce reimbursement to some providers ($31 million).
  • Autism support program funds are reduced by $1 million (based on use last year & insurance to cover soon).
  • Restores funding for Family Support Subsidy and increases Children-At-Home component by $60,000.
  • Cuts funding to MHIs, but some of that reduction will be paid for since MCO payment to them can be matched by federal funds under new federal regulations.
  • One-time grants to two MH/DS regions (Polk County - $2.5 million and Scott County - $500,000) are eliminated.
  • Requires the Medical Pharmaceutical and Therapeutics Committee and the Medicaid Drug Utliization Review Committee, when considering prior authorization and preferred drug listing for genetically-targeted biological products to treat rare conditions, to consult with experts in the treatment of those diseases.
  • Requires DHS and the Department of Public Safety (DPS) to look into costs for privitizing background checks now done exclusively by DPS (including background checks for direct careworkers).
  • Directs all hospitals with psychiatric beds and the state-owned MHIs use the psychiatric bed tracking system, and update it at least twice daily.
  • Eliminates the cost settlement process for HCBS providers (supported community living, day habilitation, adult day services) and moves to a tiered rate system beginning July 1, 2017.  Requires DHS cost reports to be restructured in checkbox format for better consistency and time savings, and allows some providers to use it (psychologists, community mental health centers, ARNPs, HCBS habilitation providers, behavioral health intervention, case management, HCBS waiver services, behavioral health services, community-based neurobehavioral rehabilitation residential services and intermittent services).

There isn't much time but if you see something concerning in this, or any other budget, contact your legislators now!

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MH/DS BILLS MOVE OUT OF COMMITTEE

The House and Senate Appropriations Committees have passed their bills to address the funding crisis in the state's regional mental health and disability services (MH/DS) system.  The current system of funding regional services ends next year, and two regions have a $10 million shortfall that if unfixed could cause thousands to lose services.  That's why lawmakers are serious about looking at the funding this year.  This is always difficult, because property taxes fund the system, and property taxes will have to increase in some areas to make up for state funding that was pulled two years ago.

Senate File 504 and House Study Bill 194 both equalize per-person ("per capita") levies within a region, so all counties will contribute to their region equally.  This is done by setting a new "per capita" regional rate. This works for many regions, but not for Eastern Iowa MH/DS region (Scott County) and the Polk County region.  Both require regions to spend down excess money in their reserve accounts.  Some regions didn't spend all of the money they collected from taxes, so they have built up large cash balances.  Iowa law currently says regions can maintain 25% ending fund balances, but many have far more than that (but also have plans to use it to roll out additional core services).  You can see a chart showing how each region fares under this plan here.  

While both plans require regions to spend excess reserves, they do it in different ways:

  • SF 504 allows regions to keep 25% in reserves for cash flow, and requires anything above that be spent down over three years, using 1/3 of the reserves each year.  
     
  • HSB 194 allows large regions (over 100,000 population) to keep 20% in reserves, and smaller regions (under 100,000 population) to keep 25% in reserves.  Regions would be allowed to spend down their reserves over a five-year period, in accordance with their regional management plan.  If reserves exist after that time, they would be forced to spend them down before being allowed to collect more taxes.

Both bills also take different approaches to fixing the $6.3 million shortfall in Polk County:

  • SF 504 requires the county hospital (Broadlawns) to give Polk County a total of $13 million in cash and inkind services to fill the shortfall over the next three years, while the Polk County levy increases to $47.28 in that same tme period.  Broadlawns has its own levy and its own board, but also provides $3.5 million of services already to the county (they assumed those costs this year to help Polk County get through its funding crisis).  You can see information about the Polk County fix here.
     
  • HSB 194 requires Broadlawns to give Polk County $6.3 million a year for the next three years in inkind services and cash to pay for services, but their levy rate is locked in at the current $31.40 per capita rate.  That's $18.9 million total from Broadlawns, with no plan for funding after three years.

There is currently no fix for Scott County, which is projecting a $3 million shortfall, in either bill.  However, Scott County does have money in reserves that can help them through one more year, but that leaves them with nothing at the start of the second year.  Legislators say they are working on that.  An interim committee will be tasked with looking at a longer term solution, SF 504 holds that interim during the summer of 2020 and HSB 194 moves it up to the summer of 2018.  

So if you were looking for a fix to MH/DS regional funding this year, the best you will get is a patch.  

SF 504 is currently on the Senate Calendar, ready for debate. HSB 194 will get a new HF number on Monday and be placed on the House Calendar, where it will also be ready for debate.  Both sides will try to come to an agreement before they move their bills - but calls now can help if you prefer one option over the other.  You can do that using our Grassroots Action Center here.

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VOTER ID HEADS TO GOVERNOR

Iowa will become the 33rd state to require citizens to show some form of ID when voting. HF 516 was sent to the Governor this week; a signature is expected soon. The bill will:

  • Require Iowans to show a valid (not expired) Iowa driver's license or non-operator ID, a passport, or a military ID.
  • If a voter does not have these forms of ID, the Secretary of State will send them a voter ID card which does not have a photo but does include a place for a signature.
  • Poll workers could challenge a person's identity if signatures do not match or the person doesn't look like their ID.
  • Iowans could vouch for each other (well, up to two others) - if you lose your license another voter from your precinct can show their ID and sign a form that says you are who you say you are.
  •  Early voting is shrunk to 29 days (instead of 40 days).
  • No more straight party voting - well, you can still vote for all of one political party, but you have to do it by filling in the boxes next to each candidate of that party instead of one checkbox at the top.

Use our Grassroots Action Center to let the Governor know what you think about the bill - should he sign it?  should he veto it?   Let him know your thoughts!  Click here to get started.

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BILL TRACKER

You can see the most current status of bills we are tracking in our infoNET Bill Tracker.  Updates are made daily. 

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