2019 ISSUE #9

Iowa's budget year ends on June 30 each year, but it takes a few months for the state to pay its bills and balance its books.  Today (September 30), Governor Kim Reynolds announced that the state's savings account (called "reserves") has a balance of $289.3 million.  In contrast, the State's reserve balance last year was only $127 million.  Legislators, who have had to hold the line on spending and make cuts in past years, will certainly breathe a sigh of relief hearing this news, .  

While Iowa legislators congratulate each other on passing balanced budgets, Governor Reynolds urges caution.  "This year we invested in important priorities like education, Future Ready Iowa, and health care so that we can be innovative, grow our workforce and protect vulnerable Iowans.  Going forward, we will continue to invest in Iowans' priorities, but we also must be mindful of the economic headwinds in our agricultural economy and be prepared for whatever the future might hold.  Fiscal responsibility and maintaining our state's fiscal health will remain a top priority for my administration."  Legislators and the Governor will probably be careful about spending in 2020, but at least there is a pool of money that could be used to meet the needs of Iowans with disabilities.  But you'll have to make your case to legislators!

What will legislators do with the extra money?  More tax cuts? Funding for the newly authorized childrens and adult mental health and disability services? Medicaid provider rate increases?  Eliminating HCBS waiver waiting lists? More funding for schools? Workforce initiatives?  You name it, someone probably has a plan to for it.  What is your plan?  Use our Grassroots Action Center to congratulate the Governor and your legislators on a balanced budget, and begin to make the case for spending increases next year in the areas you think are important.  Get started here.

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The special legislative committee charged with overseeing the Medicaid managed care system held a short meeting on September 20 to discuss the departure of one managed care organization (United Health Care) and the arrival of another (Iowa Total Care).  Mike Randol, the state's Medicaid director, said that he has not seen any systemic widespread issues with Iowa Total Care's entry into the Medicaid system.  He added that the MCOs "went above and beyond to ensure continuity of care to Medicaid members."  Here are a few things he brought up:

• The Medicaid population was initially split evenly (each with 50% of the population) between AmeriGroup and Iowa Total Care, but members were given the option to change their assigned MCO.  Some did chose to move MCOs; Amerigroup now has 54% of the population and Iowa Total Care has 46%.
  
  
• Iowa Total Care has created a process for the 68 providers who are still going through the credentialing process; otherwise providers have been credentialed.
  
  
• Medicaid has opened up 112 slots on the children's mental health waiver, reducing the waiting list using funds approriated by the Legislature in 2019.  The additional money budgeted for disability service provider tiered rates was applied evenly across all tiers.

• Rules on a uniform Medicaid prior authorization process will be available in October, with implementation by July 1 2020.  Legislators pressed Randol for an earlier implementation date (legislation said implementation was to be by October 2019 but the rules process takes at least six months).
  
  
• Provider rates did not increase but more than 92% of the MCO contracts is paid out to providers.
   
• Amerigroup reported a 103% increase in the number of individuals receiving long term supports and services that have chosen them. They had to hire 400 new positions to support the increase in membership (288 are based in Iowa, bringing total Iowa staffing up to 640 (incuding 130 "community-based case managers, which is a 110% increase).  Only 11 Iowa-based pharmacies are not in their network.
   
• Iowa Total Care reported that they now have 37,000 providers in their network, meeting their benchmarks for network capacity.  However, there is one area of the state where they are not yet at capacity for the elderly waiver (at 68% and need to be at 75%).  

Responding to a legislator's question, Mike Randol admitted he would like to see a third MCO participating in the Iowa Medicaid program but said that his first priority is to bring stability to the Medicaid program, which has been through two big transitions.  "I do believe there should be a third (MCO), but not any time soon," replied Randol. "We need to stabilize the program and then we can determine the timeline for bringing in a third."   

The group also heard about innovative partnerships between providers and MCOs, and discussed the need to begin to address what people call "social determinants of health."  Social determinants of health are non-medical barriers people have to being healthy, whether it is food insecurity, reliable transportation, or safe housing.  Some states are experimenting with ways to tackle social determinants of health, including using Medicaid funds.  Both Republican and Democrat legislators emphasized the importance of addressing these barriers; it spurred a lot of discussion.

You can see the committee's handouts including info-graphs on Medicaid here.

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Jobs (and people to take the jobs) is a top issue for Governor Kim Reynolds.  Her Future Ready Iowa Workforce Initiative is focused on getting Iowans educated and trained for good paying jobs and careers that meet the needs of employers around the state.  Of course that should include people with disabilities as well.  

One way to bring attention to the importance of diverse community-based employment opportunities for Iowans with disabilities is to take your legislator to work!  October is National Disability Employment Awareness Month and throughout the month, Iowans with Disabilities in Action will conduct the Take your Legislator to Work Campaign. This campaign is intended to increase awareness that every Iowan with or without a disability should have opportunities and choices to have meaningful employment in the community.

Iowans with Disabilities in Action is interested in working with people with disabilities who would like to take their Legislator to Work! The visit will typically last between 30-45 minutes and it is your opportunity to share with your legislator(s) what you do at work and why it is important in your life.

Who Can Participate:

• This campaign is open to any Iowan with a disability who is working in any type of employment. Before you decide to participate, you need to ask yourself two very important questions:
• Do I have great things to say about my job and the impact it has on my life?
• Do I have a message I want to share with my legislator(s)?

If you can answer yes to both of those questions, then you should consider participating in the Take Your Legislator to Work Campaign.  Here's how it works:

• The campaign will take place throughout the month of October. To get started, go to the Iowans with Disabilities in Action website www.idaction.org and download the information form. Send the form back to us by September 12 and we can get started. You will be responsible for talking with your employer to get approval, determining the best times for a visit and contacting your legislator to invite them to participate.
   
• Iowans with Disabilities in Action will provide you with assistance throughout this process.
   
• If you have any questions, please contact us at 866-432-2846 or contactus@idaction.org.

If you are a legislator and interested in being a part of this, let us know as well through the contact information above.

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More than 150 Iowans with disabilities participated in a "mock caucus" on the last day of this year's Make Your Mark Conference in Coralville.  Participants learned first hand about Iowa's first-in-the-nation caucuses, the work that goes into them, how they differ from a primary, and why it's important for everyone to participate. Caucus veterans Kevin Geiken (Executive Director of the Iowa Democratic Party), Trudy Caviness (Wapello County Republican Party Chair), and Dave Price (WHO-TV News Political Director & Host of the Sunday morning who "The Insiders') shared their experiences and insights.

These days you don't see Republicans and Democrats agreeing on much, but they locked arms on stage. They want you to caucus.  Some things to know:

• Both parties will caucus at 7 pm on Monday, February 3, 2020 at more than 1,600 neighborhood locations around the state.  You must be registered as a Democrat to participate in the Democratic caucus, and you must register as a Republican if you want to participate in the Republican caucus. You can change your party affiliation at any time, but you have to be registered as a party member to participate in that party's caucus.
  
  
• You can register, change your registration, or change party affiliation at the door, but it'll be chaotic.  Avoid the mess and get it done ahead of time (www.sos.iowa.gov).   You can always call your county Republican or Democratic party chairs for more information, including information about accessibility.  Unlike an election, you do not need your ID to participate in the caucus.
   
• Democrats are working on a plan for satellite voting and a pre-registration process that will get you through the caucus doors quicker.  Stay tuned for more information on this!

• Click here for our Quick Guide to the Iowa Caucuses and the Candidate Score Card.  Stay tuned for our more in-depth caucus guide.

"Iowans make the candidates better," said Trudy Caviness.  "Iowans ask tough questions and Iowans know the issues."  Whether or not you know about the issues, or have even chosen a candidate to support, all panel members urged Iowans with disabilities to try it out.  "Come and experience it," urged Kevin Geiken.  "Caucuses are all volunteer.  They are excited to see new faces...it's a gathering of neighbors to talk about what's important to them."  That includes the issues.  Caucus goers will not only pick who they want to represent their party as President, but they will also begin the process of creating a "party platform," a list of issues and statements that are important to the party.  That party platform starts to form on caucus night, when you and your neighbors suggest issues to be included.  Best advice from the experts - bring it in writing, even if it's just jotted down on a piece of scrap paper.   

Example: If you think the state should fund public transportation, you might suggest "The Iowa (Republican/Democrat) Party supports public transportation and believes the state should increase funding for both rural and urban public transit systems."

"This is not just about selecting a candidate," Caviness added.  "You have an issue or a story to tell that no one else has...you talk to peope about the issues...you learn so much from peope that bring up issues you've never thought about before."  

Ultimately it's that sharing among neighbors that makes the Iowa caucuses unique.  If you're a Republican, it's pretty straightforward.  You attend, fill out a slip of paper chosing the candidate you support, and you move on to the platform and other business.

Democrats on the other hand have a much more involved process where people physically move to corners of the room with other supporters of a candidate, and try to lure the "uncommitteds" or groups that don't have enough people to be counted (not "viable") to their candidate.  It's a fun and exciting period.

To make it even more fun (and much less confusing since there are still 19 candidates on the Democratic side), our mock caucus participants caucused on their favorite breakfast food, breaking into preference groups with others that liked bacon, sausage, mixed fruit, pancakes, french toast, and scrambled eggs.  And yes, bacon won (it's Iowa after all).  Bacon, pancakes and scrambled eggs all got enough to get two delegates (which in real life are people representing that candidate who move on to the county convention); french toast got one delegate; and the rest were not viable.

The takeaway from the mock caucus - just go, it's fun, it's a learning experience, and you'll meet your neighbors.  And stay tuned to www.infonetiowa.org for more information on the caucuses.

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Over the last few years, Iowa has elected its first woman to US Senate, it's first female Governor, and its first Speaker of the Iowa House.  Rep. Linda Upmeyer (R-Clear Lake) was elected Speaker in 2015, but 2020 will be her final year as a legislator.  Rep. Upmeyer met with her Republican colleagues at the Capitol on September 30 to tell them she would step down as leader later this year, and would not run for re-election in 2020.  She will finish out her term, so the 2020 session will be her final one.  

House Republicans will now have to select a new leader, and rumor is there are three contenders (Rep. Pat Grassley, who chairs the House Appropriations Committee; Rep. Chris Hagneow, the current House Majority Leader; and Rep. Matt Windschitl, the current Speaker Pro Tempore).  There may be others in the mix, but leadership battles are usually tough and devisive.  House Republicans will select a new leader before session, so stay tuned.

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First term State Senator Marianette Miller-Meeks announced today that she'll run for Congress in Iowa's Second Congressional District.  US Rep. Dave Loebsack, a Democrat, announced he will retire at the end of his term in 2020, opening the seat up.  Former State Senator Rita Hart, a Democrat from Clinton and former Lt. Governor candidate, has announced she will run for the seat.  Sen. Miller-Meeks, a Republican from Ottumwa, is an eye doctor and former Director of the Iowa Department of Public Healh.  She currently chairs the Senate Human Resources Committee. Because she is only in her second year of a four-year term, she can run for Congress without giving up her State Senate seat.  If she wins, she will have to resign as a State Senator and there will be a special election to replace her.  She is the second State Senator to announce a Congressional run; Senator Randy Feenstra of Hull is challenging US Rep. Steve King in the Republican primary (but he is not running for State Senate again, so is out whether or not he wins the primary).

Both Hart and Miller-Meeks face primary challenges; so far Osceola Mayor Thomas Kedley has announced he will run for the Republican nomination and Newman Abuissa of Iowa City and former US Rep. Bobby Schilling (who represented Illinois but now lives in LeClaire) will seek the Democratic nomination.  There may be more announcing (or dropping out) before the March deadline to file papers.

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