The Iowa Legislature passes eleven budget bills each year to fund parts of state government. The state budget year (called a "fiscal year") starts on July 1. The 2019 Legislature approved fiscal year 2020 budgets, which funds state government from July 1, 2019 to June 30, 2020.
Many Iowans with a disability cannot live safely in their homes, and may be forced to move into residential long-term care facilities rather than stay at home. There are a few local programs to help pay for needed home modifications, but these programs do not currently serve the whole state. There is funding for home modifications available through the Medicaid program, but it is only available to Medicaid members.
Organizations that support older Iowans, individuals with disabilities, and those with serious health conditions have been working together to advocate for a statewide home modfication grant program to help fill this gap. They have formed the Livable Homes Coalition.
The Coalition supports the creation of an infrastructure program to help low income Iowans living with a disability caused by age, chronic disease, or injury to modify their homes to increase accessibility, safety, and to remain independent. The Coalition is asking for $1 million to fund grants of up to $5,000 to help offset the costs of modifying homes of persons who are over the age of 65 or living with a disability. To be eligible, the person must own their home and must not earn more than 300% of the federal poverty level.
On April 1, 2016, Iowa moved almost all of its Medicaid program to managed care, including the long-term supports and services that Iowans with disabilities depend upon to live, work, and recreate in their communities. The six-month transition was difficult on Medicaid members, providers, legislators, and those managing Medicaid. Three years into the new system, some would say the path to managed care continues to be rocky. As of February 1, 2019, the state has two managed care providers (Amerigroup and United), with a third (Centene/Iowa Total Care) coming onboard July 1, 2019.
In addition, United moved to end the state's Integrated Health Home program for individuals who are not on habilitation or the children's mental health waiver in 2018, but was stopped by lawmakers. A work group met twice in the fall of 2018, reviewing the IHH program and its goals, and making recommendations that would maintain the local connection while meeting expectations of MCOs and the state. You can read the IHH report here.
There are three groups that have been charged with watching over the Medicaid managed care system, hearing concerns from Medicaid members and providers, and making recommendations to make the system operate more efficiently while meeting the needs of Iowans.
Legislators continue to introduce bills to end prior authorization for services, streamline administrative process, and improve reimbursement for providers. 60 of Iowa's 150 legislators have sponsored a bill this year (2019) to pull long-term supports and services provided to Iowans with disabilities out of managed care and return it to the state-run fee for service system. Basically return it to the way it was before managed care.
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Mental health and disability services for individuals who are not eligible for Medicaid, or who need services that Medicaid does not cover, are managed by a regional system and are 100% funded by county property taxes. This system started as a 99-county system and has undergone many redesigns - beginning in 1996 and most recently in 2012. In the 2018 legislative session, legislators expanded the list of core services provided by regions to include ACT teams, Access Centers, and Intensive Rehabilitation Service Homes. They also made many of the "optional" crisis services a part of that core set of services.
Throughout all these redesigns, including the "complex needs" service expansion in 2018, legislators have never addressed the need for sufficient and sustainable funding for the regional system. They have talked about allowing counties to raise propety taxes, giving regions with fund balances more time to spend them, and raising the sales tax to help supplement property taxes. But neither the House, Senate, or Governor has taken action to fix the funding for the system.