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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...
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11.06.17
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10.31.17
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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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April News 2013 (Issue #6)

Issue 6, April 04, 2013

Articles in This Issue:


Advocating Change Day Draws Crowd of 600 (Plus)

Advocating Change Day has always been about breaking barriers. But this year, it may have been about breaking records.  More than 600 Iowans with disabilities came to the Capitol for Advocating Change Day 2013, held on Wednesday, March 27.  Some years, advocates have been content to hang around the first floor and wait for their legislators to come down and join them for lunch.   Not so this year!

Hundreds of advocates flooded the second floor rotunda, where the House and Senate are located.  Doorkeepers said they'd never seen so many people pulling out their legislators, and never seen legislators get so excited to see people.  Legislators spent far more than the typical 2-3 minutes with their constituents, and many took their advocates inside the House and Senate chambers for photos (a privilege that you can only experience if your legislator takes you in).  At one point, the Speaker of the House delayed debate so people could have their pictures taken in the "well" (the place where the Speaker sits during debate).

The hot topics with advocates this year were Medicaid Expansion and funding for the newly redesigned MH/DS system.  But there were other issues - funding to reduce or eliminate Waiver waiting lists, funding for transportation and affordable housing, support for their providers, and making fuel pumps accessible to Iowans with physical disabilities.  So if you attended Advocating Change Day - congratulations on a successful day!  If you didn't, don't worry! There are other things you can do to talk about these and any other issues you care about.

Whether you attended Advocating Change Day or not, what you do now is what is important.  Keep in touch with your legislators - don't just disappear for two years when the next Advocating Change Day is planned.  Here are some ideas:

  • Call, write, or email your legislators and/or Governor (click here).

  • Write a letter to the editor.

  • Plan a meeting with your legislators or invite your legislators to a community event.

  • Attend a local forum (click here for a list).

  • Organize others to call, write, email, or go to a forum.

  • Speak to civic and other community groups about your issue.

  • Contact ID Action for more ideas!

You can see our Advocating Change Day training presentation here.

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Advocate of the Year Announced

If you look up the definition of tenacious or tireless, you might just see a picture of Cambridge native Angie Plager.  This year, Angie was named the 2013 ID Action Advocate of Year, an award presented each year to an outstanding individual who has advocated to improve the lives of Iowans with disabilities.

Angie is a dedicated advocate who according to Easter Seals, the organization who nominated her, is their “Mission in Action!” She “advocates, volunteers, lobbies and speaks to others about inclusion and accessibility for all people with disabilities so they can Live, Learn, Work and Play in their communities.”

Life changed very quickly for Angie when she was 20. As the result of a car accident, she is paralyzed from the chest down due to a spinal cord injury and uses a wheelchair. Since then, Angie has been determined to raise awareness and advocate for people with disabilities. She is the President of the Spinal Cord Injury Association of Iowa and has been a mentor to others who have similar injuries.

Angie is a frequent visitor to the Iowa State Capitol having been involved in the Lobbyist Apprentice program through the Iowa Developmental Disabilities Council. She recently spoke to legislators on behalf of the Easter Seal’s Rural Solutions program to raise awareness of the unique needs of rural Iowans with disabilities. Angie helped mark the 20th anniversary of the American’s with Disabilities Act at the Iowa State Capitol with a passionate speech about the lives of people living with disabilities.

This year, Angie worked on a bill that would have required all Iowa gas stations have accessible fuel pumps and a large red call button so that persons with physical disabilities would be able to safely fuel up. 

In June, Angie will travel to Washington D.C. to take part in the "United Spinal Association/NSCIA Roll on Capitol Hill". She will represent the Iowa chapter of the National Spinal Cord Injury Association. This event will help raise awareness of issues impacting those with spinal cord injuries including health and accessibility. 

In a recent speech at the “Walk with Me” kickoff event Angie said “just because someone has a disability does not mean they do not have dreams, goals or aspirations. People with disabilities are just that…people.” Angie is dedicated to helping others have the opportunity to reach their dreams by being an advocate for accessibility and inclusion for all Iowans. 

And we know it doesn’t end here.  Angie’s already got more ideas in motion, so we know this won’t be the last time we hear from this advocacy star.

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Lifetime Achievment Award Announced

 It's common for long-time advocates to 'burn out,' getting tired of the roller coaster ups and downs of advocacy.  Then there are those advocates who never seem to lose their enthusiasm, no matter how long they've been at it.  Their excitement seems to grow year after year, and it is a contagious joy that spreads quickly.  That's Dave McCalley.

ID Action selected Dave McCalley, a long-time Cedar Falls advocate, as the recipient of the 2013 ID Action Lifetime Achievement Award. The ID Action Lifetime Achievement award is presented annually to an individual who has dedicated their life to improving the lives of Iowans with disabilities.

Dave McCalley, a retired biology, science and environmental education professor at the University of Northern Iowa, has been a leader in advocating for Iowans with disabilities for a number of years. He played an integral part in the establishment of the People First program with the Arc of Cedar Valley. He believed this group was an important component of the advocacy effort to raise awareness of the issues that affect those living in the county with disabilities.

Over the years, Dave has developed strong partnerships with organizations to help support a variety of initiatives. He has written a number of grants that have helped support projects that support advocates in their efforts to increase public awareness surrounding disability related issues.  For example, prior to the 2012 election, Dave organized a tour for candidates running in Black Hawk County for the Iowa Senate and House of Representatives of agencies that provide services for persons with disabilities. This tour provided an opportunity to discuss issues and policies that affect Iowans with disabilities living and working in Black Hawk County to a captive audience. 

An issue that has always been important to Dave is ensuring that all Iowans have the opportunity to exercise their right to vote. He has been dedicated to raising awareness that Iowans with disabilities are full citizens and as such should be provided with accessible polling places that fully accommodate those with disabilities.

For many years, Dave has collaborated with ID Action to provide voter education trainings that focus on rights, responsibilities and the voting process. This year, he also worked to help establish a satellite voting location that was set-up by the Black Hawk County Auditor’s office at a local provider agency. Trained staff were available to provide assistance through the voting process to those that needed additional support.

Dave hopes that elected officials will recognize that Iowans with disabilities are full citizens who vote and who will hold them accountable for decision-making that impacts their daily lives.   Dave could not be present to receive the award, but his son (pictured) and daughter accepted it for him.

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Session Review

The Legislature wrapped up its 12th week of work this week, leaving only four weeks left to negotiate complex issues like education reform, property tax rebalancing, ongoing mental health and disability services redesign, Medicaid expansion, and a two-year budget.  Now legislators can go longer than these four weeks, but they won't get paid.  That can be a very powerful incentive - many legislators live in hotels while they are in Des Moines, and those bills can add up quickly.

On Thursday (April 4), State Auditor David Vaudt announced he is resigning to take a job as the Chair of the Governmental Accounting Standards Board, a position he'll keep for seven years.  The Governor will appoint someone to fill the remainder of Auditor Vaudt's term (which runs through 2014). 

The House and Senate have not been able to agree on ways to reform the state's education system - so the bill (HF 215) has now been sent to a conference committee.  A conference committee is a small group of legislators from both parties, both House and Senate, who meet to hash out differences on a bill and decide on a compromise.  Their "report" cannot be amended and must either be voted up (pass) or down (fail).  The legislators on this conference committee are: Rep. Ron Jorgenson, Rep. Cecil Dolecheck, Rep. Quentin Stanerson, Rep. Sharon Steckman, Rep. Frank Wood, Sen. Herman Quirmbach, Sen. Tod Bowman, Sen. Mary Jo Wilhelm, Sen. Joni Ernst, and Sen. Amy Sinclair.  Some of the areas of difference include:

  • The Senate version has four optional career ladder models for teachers; the House version has two.
  • The Senate version raises starting minimum teacher salary from $28,000 to $35,000; the House raises it to $32,000.
  • The Senate version includes 4% increase in allowable growth funding. That’s the formula used to determine how much school districts can increase their budgets and how much they get in state aid per student. The House bill calls for a 2% increase.

The House Appropriations Committee voted out the Medicaid Expansion Bill (SF 296), but only after they replaced all language with a single amendment that included a few lines saying this bill would create the Healthy Iowa Plan.  This is what people call a "shell bill" - it simply states what the bill is about, but doesn't provide details.   Republicans want to amend the Governor's Medicaid Expansion alternative (called the "Healthy Iowa Plan") into the bill, but the proposal was not yet ready when the bill was debated. Democrats on the committee were upset that the plan wasn't yet available, and that time is running short for such a complicated discussion. However, since that time, the Governor's plan was released.

House Republicans plan to amend the committee amendment (the "shell") to include the Governor's plan or a hybrid of it.  House Democrats are frustrated by this strategy, as it limits their ability to debate the bill as passed by the Senate. You see, House rules do not allow "third degree" amendments - that is, an amendment to an amendment to an amendment.  So, if the House Committee "shell" amendment is the first amendment, the Governor's Healthy Iowa Plan would be the second amendment.  No "third" amendments are allowed to that amendment.  What legislators do agree on is that they want to get the bill moving and into conference committee as soon as they can, so legislators can begin the lengthy process of negotiating a compromise on this politically charged issue.  Just don't expect a short debate!

Finally, the House has moved all its assigned budget bills except Infrastructure to the Senate (Administration/Regulation, Education, Federal Block Grant, and Transportation).  The Senate is working on it's list, but only Economic Development has been passed out.  Agriculture/Natural Resources is on the calendar ready for debate; Justice Systems and the Judiciary budgets are ready for committee action next week; and Health/Human Services is still being drafted.  The Standings budget will also start in the Senate, but you usually won't see it until the final week of session.  Work on budgets will pick up next week.

So hold on to your hats, this ride is likely to get pretty bumpy over the next few weeks.

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Legislature Making Progress on Redesign

It is clear that redesigning the state's Mental Health and Disability Services (MH/DS) system is a multi-year process.  While the Legislature passed MH/DS Redesign in 2012, there are a number of transition recommendations that require legislative action this year, and of course, lawmakers need to make good on the funding promises made last year.

Here is a quick rundown of those MH/DS "must-dos" for this session:

  1. Transition Fund (Signed): The Legislature promised up to $20 million last year to help counties having trouble making ends meet during the transition year (July 1, 2012 to June 30, 2013).  The Legislature has addressed this need by appropriating $11.6 million to 26 counties (House File 160).  The bill became law on Thursday (March 28).

  2. MH/DS Redesign Technical Corrections Bill (Sent to Governor): It is pretty common for the Legisltaure to fix technical issues with bills passed, particularly when the issues involved are as complex as the MH/DS system.  Senate File 206 fixed a few issues that came up, like allowing a qualified mental health professional (rather than a psychiatrist) to oversee the newly authorized subacute facility programs, and allowing federal block grant funds that go to community mental health centers be used for training staff (rather than "evidence based practices").  Nothing controversial here; the bill has been sent to the Governor and will become law immediately upon signing.

  3. Judicial Work Group Recommendations (Survived Funnel; Ready for House Action): The Judicial Work Group made a number of recommendations, the most significant is moving the Mental Health Advocates to an independent state agency, and allowing them to be aligned with the new regional system.  The bill (Senate File 406) passed out of the House Judiciary Commitee this week, and beating the final legislative deadline.  It is now ready for debate in the House.

  4. Fiscal Viability Committee & Other Work Group Recommendations (Survived the Funnel; House & Senate Appropriations Committees): The recommendations of the work groups that met last summer (Children's Mental Health Work Group, Fiscal Viability Committee, Transition Committee) were drafted into a pair of bills (House Study Bill 229 and Senate File 415) that are currently being discussed in the House and Senate Appropriations Committees.  They are slightly different - but both address the transition from legal settlement (and how those dollars get distributed); grandfathering in of non-target populations currently served by some counties; an end date for Medicaid to stop billing counties for services provided prior to July 1, 2012; data sharing between the state and regions; creation of a Children's Cabinet.  

  5. Per Capita Equalization Funding (House & Senate Appropriations Committees): Last year, the Legislature promised to "equalize" local spending on non-Medicaid services, so that every county is allowed to budget $47.28 per person living in the county.  Counties currently collecting more than that amount must lower their property taxes, and they receive no state funds.  Counties collecting less than this amount from property taxes will get a "per capita equalization" payment to bring them up to that level.  The state cost to do that this year is $29.8 million.  That appropriation is currently in Senate File 415 and House Study Bill 229, which are still in committee.  They are safe from the funnel deadline because they are appropriations bills, and therefore are exempt from all deadlines.  While it is good news that both Republican-led House and Democratic-led Senate both include this $29.8 million in their bills, there does appear to be some disagreement over how the money should be distributed.  There are a few Senate Democrats who want to distribute the funds in a different way.

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Governor Signs Transition Bill

Governor Terry Branstad quietly signed a bill that will quickly get $11.6 million out to 26 counties having trouble maintaining services as the county-based mental health and disability services (MH/DS) system moves toward regions.  The "Transition Fund Bill" (House FIle 160) was signed into law on Thursday, March 28. The following counties will receive their transition fund checks in the next two weeks:

  • Adair ($140,478)
  • Adams ($150,742)
  • Calhoun ($27,386)
  • Clarke ($22,347)
  • Delaware ($89,618)
  • Dickinson ($56,565)
  • Guthrie ($122,708)
  • Jackson ($508,580)
  • Linn ($2.2 million)
  • Lyon ($158,780)
  • Madison ($311,109)
  • Marion ($366,429)
  • Monona ($136,657)
  • Osceola ($247,991)
  • Plymouth ($217,140)
  • Poweshiek ($12,667)
  • Sac ($372,522)
  • Scott ($2.4 million)
  • Sioux ($1,817)
  • Story ($752,700)
  • Taylor ($318,252)
  • Union ($597,792)
  • Warren ($1.4 million)
  • Wayne ($53,237)

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Mental Health Advocates Bill Moves Forward

The Senate Judiciary Committee made sure that an important piece of the ongoing redesign of the MH/DS system survived today's (April 5) funnel deadline.  Senate File 406 makes the changes recommended by Department of Human Services/Judicial Work Group, including streamlining the involuntary commitment process, moving oversight of the state's 43 Mental Health Advocates to the state, and directing DHS to develop recommendations for a real-time tracking system for inpatient psychiatric beds.

Mental Health Advocates.  Mental Health Advocates are currently hired and employed by the courts, but paid for by the counties.  The DHS/Judiciary Work Group felt it was very important for the Mental Health Advocates to be free of conflict, and, since counties, DHS, and the courts all are part of that hospitalization process, the Work Group suggested moving them to an independent state agency. Senate File 406 addresses this by making Mental Health Advocates employees of the Department of Human Rights, which already has advocacy as a part of its mission. However, the House decided to change this to the Department of Inspections and Appeals, as recommended by the work group. During committee debate this week, it was pointed out that currently, because of legal settlement, Mental Health Advocates travel all over the state because they are required to appear in the county of legal settlement (not necessarily the county where the person is being hospitalized).  With the end to legal settlement, the Work Group thought the timing was right to realign the Mental Health Advocates with the new region.

Psychiatric Hospital Bed Tracking.  It's no secret that Iowa has a shortage of psychiatric inpatient hospital beds.  Stories like the two that were told during the subcommittee meeting on Senate File 406 are all too common.  A sheriff's deputy reported driving a patient 720 miles in one day, driving city to city trying to find an open bed, all while the person in crisis was in the backseat of the car.  Another person told of two sheriff's deputies coming from two different areas of the state, both headed for Woodbury County where there was one hospital bed available.  Others told of the hours spent on the phone trying to find an available bed.  Senate File 406 directs the Department of Human Services to make recommendations on the development of a real-time psychiatric inpatient hospitalization bed tracking system that would show how many beds the state has, where those beds are at, what types of beds they are, and their availability in real time.  It would allow a sheriff to log into a system, find the nearest bed, call to have a hold placed on it, and deliver the person, saving time and allowing sheriffs to concentrate on other public safety matters.

While the bill has survived the funnel, there is still some uncertainty about the bill because it does create new state employees (which cost money) and funds for this have not yet been identified.  Rep. Chip Baltimore, Rep. Dave Heaton and Rep. Mark Smith are the key legislators on this issue.

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Governor's Healthy Iowa Plan Released

The Governor's long-awaited Medicaid expansion alternative was released on Thursday (April 4).  Below is a very quick review of this "Healthy Iowa Plan" (House Study Bill 232):

  • Makes Iowans earning up to 100% of the federal poverty level eligible for this plan (Medicaid expansion covers up to 138% of the federal poverty level).

  • Requires co-payments and deductibles for those covered by the plan, with penalties of up to one year suspension of coverage for those that fail to make their contributions.  Medicaid does not allow contributions below 150% of the federal poverty level, so the expansion would not include this. It is unclear as to whether the federal government would allow this.
  • Establishes multiple “accountable care organizations” to administer the program regionally. All services are directed through these orgaizations, and someone covered by the plan would be required to pick a primary care doctor (a "medical home") from this organization's list of providers. If they do not choose one, DHS will assign them to one.  The Senate Medicaid Expansion plan (SF 296) includes an Accountable Care Organization Pilot program to test the performance of that model in Iowa.

  • Allows the program to be limited to the extent there is funding (so it is not an entitlement; if enrollment grows faster than the money to pay for it, "...enrollment in the healthy Iowa plan may be limited, closed, or reduced and the scope and duration of services provided may be limited, reduced, or terminated..").  Medicaid expansion becomes an entitlement, so government is obligated to pay for it.

  • Requires the following "essential benefits" be covered by the plan: preventive health, health home services, physician services, inpatient and outpatient services, emergency transportation, prescription drugs, diagnostic services, durable medical equipment and medical supplies, rehabilitative services, home health services, podiatry, and mental health and substance use disorder treatment.

  • Allows choices to be limited if the accountable care organization a person is assigned to believes it is in the person's best interest ("member choice may be limited by the accountable care organization, with prior approval of the department, if the member's health condition would benefit from limiting the member's choice of heathy Iowa plan provider..."). 

  • Requires participants to pay monthly premiums that are placed into a "My Healthy Rewards Account" for use by the person to pay for things like smoking cessation, nutrition counseling or other healthy lifestyle services. People who have an annual health risk assessment, physical, and other preventive services will have additional funds deposited into it as a reward.

  • The plan is paid for with a combination of $20 million state appropriation (in the bill), the Polk County Broadlawns levy, and one-third of all county MH/DS property tax levies.  There is no repayment of those levies in this bill, and no state payment to make up for the loss, so the regional MH/DS system appears to lose 30% of its funds.

Stay tuned for more on this - follow us on Facebook and online for alerts and more indepth analysis.

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Final Deadline Hits; Few Bills Survive

The second and final legislative deadline (called a "funnel") hit on Friday, April 5, and with it went hundreds of bills that failed to make it through all committee processes before the clock ran out.  To "beat the funnel" a bill needs to have been voted out of one chamber, and ready for debate in the other.  Bills that spend money or deal with taxes are exempt from the funnel, so they can be discussed at any time.

By all accounts, this was the slowest funnel many have witnessed in two decades.  Very few committees met, and even fewer bills emerged. What that means is the list of bills left to be discussed is very, very small.  But the list of bills still alive includes some very complicated and politically charged issues - like education reform, Medicaid expansion, property tax reform, expanding the bottle bill, ongoing MH/DS reform, and a handful of bills addressing Iowa's sex offender laws. 

Here are a few issues from our Bill Tracker that remain alive (and are not yet signed into law):

  • Implementing MH/DS Reform recommendations & providing funding for regions (SF 415 & HSB 229)
  • Implementing DHS/Judiciary Work Group recommendations, including Mental Health Advocate changes (SF 406)
  • Allowing up to five individuals on ID or Habilitation waivers to live together without affecting licensing laws (SF 351
  • Expanding Medicaid as allowed by the federal Affordable Care Act (SF 296)

Here are a few issues from our Bill Tracker that didn't make the cut this year, and are no longer eligible for debate:

  • Requiring fuel pump accessibility (SF 401)
  • Allowing nursing homes and residential care facilities to refuse to accept sex offenders, even if court-appointed, and requiring resident notification and safety plans if admitted (HF 552)
  • Establishing an Iowa "Health Benefits Marketplace" as allowed under the Affordable Care Act - however Iowa has chosen to have a partnership exhchange with the federal government, so this wasn't necessary at this time (SF 375)
  • Requiring teacher continuing education on trauma-informed care and suicide prevention (SF 337)
  • Creating a special olympic lottery game (SF 328)
  • Requiring schools to have anti-bullying policies that go beyond school buildings (HF 593)
  • Requiring voters to show ID in order to vote (HF 
  • Creating new penalties for people that misuse temporary accessible parking passes (HF 493)
  • Protecting information between peer support counselor and peace officer (HF 224)

You can see the full list of active and inactive bills in our Bill Tracker here.

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