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State Budget Approved with 4% Spending Increase

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The Legislature left town without touching the state's $600 billion surpus, and increased spending for the next year by only 4%. Here is a quick review of the state's biggest budget - the Health/Human Services Budget (Senate File 446):

  • Increases funding for the brain injury services in the Department of Public Health by $400,000 - including funding for a new Brain Injury Services Manager ($95,000).  Total funding is $891,644.

  • Adds a new $400,000 appropriation to establish a Regional Autism Assistance Program administered by the University of Iowa's Child Health Specialty Clinic.  Funds are to be used to enhance interagency collaboration and coordination of educational, medical and other human services for persons with autism, their familiees, and providers of services. Services are to include care coordination, family navigation, and integrated services.

  • Adds $2 million for a new Autism Support Program that will begin on January 1, 2014.  These funds will be used to pay for Applied Behavior Analysis for children that do not qualify for Medicaid or whose private insurance will not cover the services.
  • Continues funding at current levels for autism spectrum programs at Four Oaks in Cedar Rapids ($25,000) and at a Dubuque hospital ($25,000).

  • Increases funding for direct care worker recruitment and retention initaitives by $28,875 (total $178,875), funding for the Direct Care Worker Advisory Council by $26,500 (total $175,900), and maintains funding for direct care worker scholarships at the current level ($75,000).

  • Adds $300,000 to pay for the costs associated with House File 198, which allows Medicaid waiver service providers to include staff training costs in their direct costs (which are reimbursed by Medicaid).

  • Requires the Department of Public Health to develop a strategic plan to address health care workforce needs (including cost projections). The plan is to be submitted in a report by December 15, 2013.
  • Adds $8.7 million to reduce the number of people on the waiting list for Medicaid waiver services.  Legislative staffers estimate the cost to clear the waiting lists is about $11.5 million.

  • Requires people with intellecutal disabilities receiving Medicaid services receive a functional assessment (using the Supports Intensity Scale Tool) to determine their level of need, and DHS is to allocate funds for services according to that need.  DHS continues to receive $3 million to help develop and implement standardized assessment tools for persons with mental illness, intellectual disability, developmental disability, and brain injury.

  • Increases Medicaid provider rates by 1-5% depending on the provider type (1% for rehabilitation agencies; 3% for HCBS waiver providers).

  • Requires counties that didn't spend all of their MH/DS risk pool funds by June 30 return the money (it is then redirected to Medicaid).  Polk, Clinton and Scott counties have not yet spent all of their funds, and plan to return about $2 million to the state. These counties had hoped to keep the funds to help make ends meet.

  • Continues funding at current levels for the community circle of care collaboration for children and youth in Northeast Iowa ($1,436,595), Polk County ($327,947), and Cerro Gordo County ($160,000).  Language was added that directs DHS to determine the appropriate allocation of these funds in order to eliminate any duplication of services.

  • Adds $25,000 to the Prevention of Disabilities Policy Council (total $63,543) to pay for a summit with other organizations that advocate for or provide services to people with disabilities.  The summit is to review existing prevention activities, identify cost effective public policy options in preventing disabilities.
  • Includes new $250,000 appropriation to pay for the establishment of a new Mental Health Advocate Division in the Iowa Department of Inspections and Appeals.

  • Directs the Department on Aging, in collaboration with the University of Iowa's National Health Law and Policy Resource Center, to establish three pilot projects to train, recruit, and oversee volunteers to assist the courts in monitoring guardianships and conservatorships, and provide assistance to guardians and conservators.

  • Requires the Department of Human Services and Department of Inspections and Appeals to establish and facilitate a stakeholders group on to make recommendations on options to serve nursing home residents that are sexually aggressive, combative or have unmet psychiatric needs.  A report is due by December 15, 2013.

  • Requests the Department of Public Health and the National Center for Sports Safety conduct a municipal sports injury prevention study to address safety equipment for participants, and training needs of employees and volunteers.  A report is due January 10, 2014.

Because Medicaid runs out of money at the end of May, Senate File 446 also includes $34.3 million in "supplemental funding" needed to to ensure Medicaid services are funded until the end of the fiscal year (June 30).  The bill also includes the "Iowa Health and Wellness Plan" - the compromise that was reached to expand health coverage to 150,000 low income Iowans (covered in separate article).