February News 2013 (Issue #3)

Today (February 22) marks the 40th day of the legislative session.  While we are now one-third of the way through the 110-day session, lawmakers still have no direction from their leaders on budgets, and have sent only one bill down to the Governor.  It's not that lawmakers are paralyzed with partisan differences - there is just a lot of talk and not much action.  Sounds a little like Congress, who recently recessed without making decisions on budgets just 10 days before drastic cuts to federal programs (called "sequestration") goes into effect.

Fortunately, Des Moines isn't Washington DC, and our lawmakers are keeping busy with subcommittees and committee meetings.  But that is about to change.  The first legislative deadline is just two weeks away, on Friday, March 8, 2013.  Any bill that wants to keep moving its way through the legislative process must be voted out of committee by this date.  Any other bills will be tabled until the 2014 session, when by rule they can be reconsidered.

As you review the articles in this issue of infoNET, keep in mind that you, your family, your friends, and your neighbors all have the power to influence the decisions made at the Capitol.  As Senator Daryll Beall of Fort Dodge recently told a group of advocates visiting the Capitol, "I work with (lobbyists).  I work FOR you." 

Remember the following tips when writing, emailing, or talking to your legislators:

• Rule 1:  DO NOT GET NERVOUS
  I know, easier said than done.  But seriously do not get nervous.  We recently heard an advocate say that it's a lot like the Wizard of Oz.  The Wizard of Oz seems so all-knowing and powerful, but when you pull back the curtain, you realize it is just a person like you and me.
  
  
• Rule 2:  KEEP IT SIMPLE and GET TO THE POINT.
  You don't get points for big words and long sentences.  The shorter the note, the more likely it will be read.
   
• Rule 3:  TELL YOUR STORY. 
  Your stories make the issue real. You are not a number or a statistic. You are a person, and your story puts a face on the issue for your lawmakers.  They will remember your story when they are pushing that button to vote.
  
  
• Rule 4:  ASK FOR THEIR HELP. 
  Ask them to help resolve your issue, vote for (or against) a bill, or just keep you updated.  They work FOR you!
  
  
• Rule 5:  KEEP IT LOCAL. 
  Sure you can join us at the Capitol, but the most effective way to advocate is locally.  Go to a local public forum - if you don't want to speak, that's okay.  Just introduce yourself and listen until you feel comfortable asking a question.  Click here to find a forum near you.
  
  
• Rule 6:  BUILD & GET STRONGER.  You can only email, mail and call your legislators so much.  Once you have, turn your efforts into finding others to do the same. Legislators really take notice when they hear from lots of people (and we define "lots" as 5-6 people).

Consider using our new Grassroots Advocacy Center to send an email to your lawmakers and the Governor.  You can also email your federal officials and the President on federal issues like gun control, budget cuts, immigration reform, and other hot topics they are discussion right now.

We can all learn a lot from Dr. Seuss, "Unless someone like you cares a whole awful lot, things aren't going to get better, they're not."

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Over the summer, a group of legislators, county officials, advocates, providers, and others met to discuss issues related to the transition to the new regional system for funding and managing non-Medicaid mental health and disability services.  This group, called the Transition Committee, recommended the state spend $20 million to help counties make this transition and make sure no Iowan, adult or child, would lose services as the changes were made. 

The Department of Human Services recommended three funding options, ranging from $1.5 million to help three counties, $3.8 million to help eleven counties, and $11.6 million to help twenty-six counties.  Six counties that applied for funding were not included in these recommendations.  The Governor recommended $3.8 million, but lawmakers (both Republican and Democrat) didn't think that was enough to address the needs of counties. 

Last week, the House passed House File 160, which used $11.6 million in one-time federal dollars to help twenty-six counties struggling to get through the next six months without cuts to services.  The House debated the bill well into the night, with many lawmakers fighting to get the entire $20 million needed to help all counties in need. Those legislators were ultimately unsuccessful in getting those additional dollars, but were able to remove some language that could have forced counties to cut services immediately. 

The bill also fixes an issue for one region.  It allows regions to request a waiver to allow a county that is not contiguous (that is, doesn't share borders with other counties in the region) to join a region.  Right now a region that includes Story County wants to include Madison County because they have a long history of working together. The problem is Dallas County, which is in between them, has joined with another region.  This change would allow that region (and any others with such problems) to ask for a waiver from this requirement.  DHS still has the final say on the matter.

This week, a Senate subcommittee decided to move the bill forward.  Senators said they wanted to spend the entire $20 million but felt that helping 26 counties was better than helping none, since they would be unable to get agreement from the House and Governor for more money. 

The bill is still not without controversy.  The Iowa State Association of Counties has said they are worried that the source of the funding (one-time federal funds) cannot be used for Medicaid match or to replace other public funds.  Some of the counties owe money to the state for Medicaid services provided before July 1 of this year.  They will not be able to use these funds to pay those bills.  Counties used to receive money for services from the state, but didn't this year, so they worry that may be considered "replacing public funds."  So there is some concern counties will get this $11.6 million, but won't be able to use it.  Some legislators would like to see state tax dollars used for this fund, instead of federal funds.

The Senate Appropriations Committee plans to take the bill up early next week, and hopes the bill will be debated by the full Senate. If they don't make changes, it will be sent to the Governor, and if the Governor signs it into law, counties will get the checks two weeks later.  Click here to find out which counties receive money, and how much.

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The legislature may be able to reach consensus soon on transition funding for the non-Medicaid services system, but there are still many other unresolved issues.  They include:

• Target Populations.  Redesign only requires counties to serve people with an intellectual disability or mental illness. Those with other developmental disabilities and brain injuries are not included in this first wave of populations served, despite the fact that counties do pay for some services now.  Iowans with brain injuries can apply for services under the Medicaid Brain Injury Waiver, but the waiting list is very, very long.  There is no waiver for people with developmental disabilities, so there is simply no other option for publicly-funded services.  Some legislators would like to correct this, and require all counties serve all populations, to the extent funding is available.
  
  
• Core & Core Plus Services.  Counties must provide all core services to the "target population" before they are allowed to serve others, and before they can move on to the list of "core plus" services.  Core plus services often save money in the system, and include things like mobile crisis, crisis intervention, jail diversion, and other justice-involved programs.  Because they save money, counties say this decision is penny wise, but pound foolish.  Since counties (and later regions) are only required to pay for core services "to the extent funding is available," some legislators would like to combine the core and core plus services into one single core services list.  They say if everything depends on funding, then just have one list and let regions decide which services are the most important.
  
  
• Ongoing Funding.  Last year, legislators set up a new structure to "equalize" property taxes throughout the state.  Under their plan, counties would be able to collect and spend up to $47.28 per person living in that county.  Counties that currently collect less than that in property taxes would be given state money to make up the difference.  Counties collecting more than that would have to lower their taxes and just spend less.  Lawmakers hoped that as a region, some counties may gain, others may lose, but together it would even out.  Legislators predicted it would cost about $30 million to pay for this "equalization formula."  Some legislators want the state to live up to this commitment, and others want to distribute the money differently.  Some think counties need far less than the $30 million. 
  
  Counties, providers, advocates, and others are starting to express concern about ongoing funding. Counties need to know soon how much they will have to spend, because the new funding year starts on July 1, 2014 and their tax revenues don't start coming in until October.  Some legislators want to spend less. Some want to spend more. And some want to make sure that whatever level of funding is needed, that it gets to the counties that really need it.

There is currently no bill to address ongoing funding, changes to targeted populations, or merging the core/core plus service lists.  Keep watch for them on our Bill Tracker here.

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The Governor has released his budget, and it does not include funding for the regional non-Medicaid mental health and disability services system.  No money for the $47.28 "equalization formula" and no alternative plan to help maintain these non-Medicaid services.  This makes things tough for legislators, who will have to add to their spending or make cuts to other priorities.  Here is a quick review of how legislators go about making budget decisions:

1. Legislative leaders in the House (Republicans) and Senate (Democrats) set budget targets. This is how much overall they want to spend for the next fiscal year, which begins July 1, 2013.  When Governor Branstad was elected, he began setting two-year budgets, and we expect that to happen again this year.  So legislative leaders will be setting budget targets for the budget year that begins July 1, 2013 and the budget year that begins July 1, 2014. 
   
   
2. Legislative leaders decide how much of their target will be used by each budget subcommittee - Administration/Regulation, Agriculture/Natural Resources, Economic Growth, Education, Health/Human Services, Justice Systems, and Transportation.  They will also reserve some for automatic appropriations that are required by law (called "Standing Appropriations") and special projects (like education reform, property tax relief, or MH/DS funding). 
   
   
3. Each budget subcommittee decides how to distribute the amount of money they are given. You can see each subcommittee's budget documents and information presented to them by various groups below (just click on the budget area you are interested in, and then click on "committee documents":
   
   
   • Administration and Regulation Appropriations Subcommittee
   • Agriculture and Natural Resources Appropriations Subcommittee
   • Economic Development Appropriations Subcommittee
   • Education Appropriations Subcommittee
   • Health and Human Services Appropriations Subcommittee
   • Justice System Appropriations Subcommittee
   • Transportation, Infrastructure, and Capitals Appropriations Subcommittee
     
     
4. The recommendations of the budget subcommittee get drafted into a bill, which is then passed (and often amended) by the full Appropriations Committee.  It then goes through the process like any other bill - except it is funnel-proof (that is, it doesn not have to be out of committee by certain deadlines).

Usually, legislative leaders have set their targets by now.  We hear the Senate Democrats may have their targets ready by early next week.  House Republicans say theirs will be ready soon as well.  Budget subcommittees say they are done meeting until they can start crunching numbers.  Sen. Jack Hatch of Des Moines says the Senate will start the Health and Human Services Budget this year, and they should begin the process as early as next week.  They are currently getting their bill ready for subcommittee discussion.

Follow us on Facebook, or watch the website for Alerts on breaking budget news.

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Legislators have not yet made any progress on a Medicaid supplemental appropriation this session.  Medicaid didn't get enough money last year to make it until June 30 this year, so lawmakers must pass a "supplemental" funding bill to give them the extra $20-30 million they need.  We have not yet seen a bill to do this.

Senators have been meeting weekly to discuss Senate File 71, which expands Medicaid to anyone earning under 138% of the federal poverty level (that is, a family of four earning less than $32,499).  This expansion was allowed under the Affordable Care Act (also known as "ObamaCare"), and is funded entirely by the federal govermment in the first three years.  The state will need to kick in money after that - 5% in 2017, 6% in 2018, 7% in 2019, and 10% 2020 and after.  Normal Medicaid match is 40% state, 60% federal, so some lawmakers think the 10% state and 90% federal match over the long term is a pretty good deal.  Others worry that the federal government, which is facing its own budget problems, won't live up to that promise.

Senate President Pam Jochum of Dubuque is chairing the subcommittee working on this bill, along with Senator Jack Hatch of Des Moines and Senator Nancy Boettger of Harlan.  This week the subcommittee decided to move the bill forward to the full Senate Human Resources Committee for action next week. It is expected to pass, but probably won't move much further until some agreement is worked out.  The Governor has said publicly he opposes expanding Medicaid, but has not yet presented an alternative plan to make sure very low income Iowans have some access to affordable health care.

Again, watch the website and follow us on Facebook for breaking news and alerts on Medicaid expansion.  You can read Iowa Medicaid Enterprise's presentation on Medicaid expansion, how it affects, services covered, and more here.

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The Iowa Developmental Disabilities Council, ID Action and Polk County Health Services invite you to participate in Advocating for Change Day 2013.

Advocating for Change Day is a day specifically for Iowans affected by disability to become skilled at communicating with their legislators and other elected state officials.  As a participant you will have the opportunity to learn how to develop and deliver an effective message, visit with available legislators and other elected officials and lobbyists, and watch the legislative process from the galleries (when the Senate and/or House are in session).  The event is free, and a free lunch will be available for all registered participants.

Fill out the online form to get registered for the event. Register to attend by March 13, 2013  to guarantee your free lunch. You can register up to 30 people per form. If you need to register more please contact ID Action atcontactus@idaction.org or 866-432-2846.

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Local advocacy is the best advocacy. Your legislators come home to their legislative districts on Fridays-Sundays during the legislative district, and many hold open public forums during that time. They call them by many names - public forums, town hall meetings, listening posts, Eggs & Issues, Pizza & Politics, legislative breakfasts, legislative forums.   But they all give legislators a chance to talk to the people they represent, answer their questions, and hear their concerns.  They are great and highly effective ways to advocate.

To find a forum near you, click here.  
For tips on going to a forum, click here.

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You can find bills of interest to Iowans affected by disability here.  We update our bill list daily, adding new bills and changing them as they move through the process.  Check back often as this changes daily.

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