INFONET 2020: Issue #5

The Iowa Legislature is now one of 20 state legislatures that have suspended their legislative sessions because of the novel coronavirus (COVID-19).  Another 10 states have already finished their legislative sessions and five have not yet started their sessions.  This is new for everyone and is certainly a challenge to advocates who have worked so hard to get bills passed.  In this issue, we want to spend some time providing you with information and resources about COVID-19, explain the actions that have been taken so far by the Governor and Congress, and give you some tips on how to continue your advocacy.

One thing is clear; this public health emergency has shown just how important our direct care workforce is to the lives of individuals with disabilities.  They cannot telecommute even if their kids are home from school and have no day care options; they come to work and work for paychecks far below the value of the work.  We often think of our emergency responders as heros; it's time we also value our direct care workforce in the same way.  All challenges present opportunities; this is an opportunity for advocates to show how important services are to daily living and the people that deliver those services. If provider reimbursements are not raised annually to keep pace with inflation, then those workers do not get raises and may not stick with their jobs.  It's hard for individuals with disabilities to have constant turnover of staff, who often perform intimate tasks.  

So no matter what your issue - workforce, services, access, employment - you have the opportunity now to show why it is important. You'll just have to put on your thinking caps and get creative! 

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The week of March 16 was supposed to be a busy funnel week; instead he Capitol was locked down and legislators met to pass two bills – a resolution suspending the session until April 15th and an emergency package (SF 2408) that: 

• Added funding for:
• COVID-19 test processing at the State Hygienic Laboratory ($525,000)
• Medicaid, including full payment for services delivered via telehealth ($89 million)
• hawk-I children’s insurance program ($1.7 million)
• Glenwood Resource Center ($600,000)

• Waived the requirement that schools make-up the days missed during the four weeks schools are closed during the public health emergency.
   
• Allowed the Governor to use up to 10% of the state's $190 million economic emergency fund to deal with the COVID-19 outbreak (with authority to go higher with approval from the Legislative Council). 
   
• Included a continuing resolution that funds state programs at current levels for the first two months of the next fiscal year (July and August 2020) in case the Legislature is unable to pass a budget before the end of the current fiscal year on June 30th.   

Both bills passed unanimously and the Governor signed the bill into law the next day.  The action puts the Governor solely in the driver’s seat during this crisis and prevents the Legislature from endangering themselves and thousands of Iowans visiting the Capitol every day by putting the legislative session on hold.  In fact, the Iowa Capitol is officially closed to the public until further notice and will undergo a deep cleaning.  Even the Governor's daily press conferences are being held virtually.  

Public Emergency Declared
The same day Governor Reynolds signed SF 2408 into law, she declared a State Public Health Disaster Emergency to help slow or stop the community spread of the disease.  The plan is extensive, so you can check it out in full here.  Some of the highlights  include:

• Closes businesses such as bars, gyms, swimming pools, casinos, and theaters. 
• Restaurants are allowed to conduct business, but only for take-out, drive-through or delivery orders. 
• Activates Public Health Response Teams to help communities prepare for and address outbreaks.
• Prohibits any public mass gathering of over 10 people (including churches, festivals, parades, sports).
• Closes all senior centers (meal delivery is happening around the state to address congregate meal closures).
• Encourages agencies to find ways to get resources out to those in need or experiencing income loss.
• Eliminates all restrictions and limiations on Medicaid services delivered via telehealth.
• Allows doctors, nurses, and physician assistants who licenses expired within the last five years to help with COVID-19 response.
• Gives people whose driver's licenses or vehicle registrations are expiring during the disaster period an extra 60 days.
• Suspension of the requirement that stores accept used bottles and cans for redemption

The Governor also issued more orders (click here for full text) in the past few days that:

• Extend Iowa's income tax filing deadline until July 31 (originally due April 30). The federeal government has also announced it would extend the federal income tax filing deadline until July 15 (originally due April 15).
   
• Temporarily suspend penalties and interest on the collection of property taxes until the end of this proclamation (so no penalties and interest will be applied to late payments on property taxes during the emergency period). 
   
• Temporarily suspend all evictions - including commercial, residential, agricultural, and mobile home.
   
• Change process of getting permit to acquire a gun from in-person to drop-off (so no personal interaction required) and extend expiration deadlines for a permit to carry and a permit to acquire a firearm.
   
• Permits the sale of carry-out, delivery, drive-thru of alcohol for unopened bottles of alcohol.
   
• Allow public meetings or hearings by electronic means to improve the functions of government while maintaining social distancing practices (so your local city council may be done online, versus in person).
   
• Close all salons, barbers, spas, medi-spas, manicure/pedicure, massage, and waxing locations until 3/31.

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There are a lot of people out in the community providing services to help those impacted by COVID-19.  Churches are calling their members, community action agencies are reaching out to people to find out what is needed, and your local boards of public health are trying to connect people with resources. If you need assistance finding food, paying housing bills, accessing free childcare, or other essential services, or you think you have the virus but do not have a doctor, you can call the state's 211 number or go to www.211.org/services/covid19.  

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It is really hard for anyone to predict what is next with things changing daily, but what we know is the Iowa Legislature does plan to come back to pass a budget for the next fiscal year (FY 2021).  As mentioned before, legislators did pass a continuing resolution that funds government through the end of August, should they be unable to reconvene session in time to adopt a budget before the new fiscal year starts on July 1.  We are told that is just a precaution; legislative leaders hope to get back before that to pass a budget and take action on any remaining priorities.

Good News (Short-Lived) on Budget
Just days before they suspended session, the Iowa Legislature had some good budget news.  The Revenue Estimating Conference (REC) met on Thursday, March 12th to look the current fiscal year (2020) and make predictions about the upcoming fiscal year 2021.  The state would end the year with an additional $76 million unspent (so over $400 million).  Revenues for the next year were still looking good, but were leveling off, so estimates were lowered slightly (but it's still an overall increase in money available for budgets).  

At the meeting, they did discuss at length the economy and how the COVID-19 issue could affect numbers.  They settled on their predictions, but said they may need to come back together this year for extra meetings, depending on what happens with Iowa’s economic picture over the months ahead.   It is safe to say that the economy is going to suffer from the business closures and people sheltering in place, so budgets may not look that rosy when legislators get back to town.  This may mean dipping into our reserves since this is likelly to be a temporary situation, or it could mean legislators will decide to pass a status quo budget (that is, the same spending as last year).  Or they could decide to cut back on funding.  

The continuation of the session is a big question mark.  When will they come back? And how will they continue? By rushing to assemble a budget and be done for the year within a week? Or pick up where they left off and work on some more big policy and tax reform bills in addition to the budget without a real emphasis on the calendar?  What happens to bills advocates have been working on so hard this year?

The answer is, no one knows.  We won’t have a clear picture of any of these questions until pthe second week of April at the earliest.  If the COVID-19 numbers are still climbing at that point, then the Legislature may have to delay coming back.  So the best advice is stay connected with your legislators, and ask them what is going on, and if there is still an opportunity for your priorites to be addressed.

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There is no playbook for how to advocate when there is a public health emergency; it's new territory for everyone. But that does not mean you should give up.  Now more than ever it's important for legislators and the three members of Congress that represent you in Washington DC to understand what you need.  We will continue to post action alerts on our website and through social media, so take part in these easy opportunities to advocate.  

Most legislators and all of Iowa's congressional delegation are still taking calls and answering emails, it just may take them a while.  Some tips:

• Use our grassroots action center to email your elected officials - it's easy and you don't need to look up emails.
• Call your state legislators at their home/business numbers; these are listed in our Legislative Guide.
• Remember you can find out who your legislators & congressional officials are here.

Advocacy at this time will be challenging, so be creative!  The goal right now is to keep your issue on your elected officials' radar. The only way to do that is to stay in touch while the session is suspended.  Legislators are talking to each other, developing plans, mapping out the path to end session.  So don't quit now!  Instead of emailing a written note, take out your smartphone and videotape your ask.  Maybe you want to show how important having your service provider still at work, and ask that legislators recognize their value with an increase in Medicaid reimbursements.  If you are out for a walk, video tape why it's so important to have access to the community, and encourage legislators to invest in public transit and trails. Whatever your issue, make it interesting with a short video and email it to your legislators.  If you don't know how to send it - just email it to us with your name and address, and we'll get it to them for you (infonetiowa@gmail.com).

Another reason to reach out is that legislators are working directly with the Governor's office to address concerns people have during this emergency.  Providers have asked their legislators to help with specific regulations, and the Governor has responded and fixed those issues.  Remember, your legislator is also your advocate!

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Iowa Medicaid communicates through "informational letters" to providers and members.  A recent letter announced that all Medicaid-covered services could be provided by telehealth including mental and behavioral health benefits without additional approval and at the same rates as if the service were delivered in person.  In addition, Iowa Medicaid will be eliminating all premium and cost sharing for Medicaid programs until the public health emergency is over.  In addition, Medicaid members will be allowed to fill up to 90 days of their prescriptions.  Medicaid typically only pays a month at a time, but will pay for the additional months as long as the original prescriber approves it.  That means fewer trips to the pharmacy (and fewer chances to catch the virus).  You can read all of the Medicaid Informational Letters here.  

The State of Iowa may follow what other states have done and request a special waiver from the federal government to change Medicaid program benefits and procedures.  For instance,  Florida became the first state to get this waiver approved. They asked to eliminate all prior authorizations requirements to remove barriers to needed services, streamline provider enrollment processes to ensure access to care, allow care to be provided in alternative settings in the event a facility is evacuated to an unlicensed facility, and get rid of hiring barriers so staff who become infected can be temporarily replaced. Washington was the second state approved; they asked to be given flexibility to enroll additional providers to make sure all Medicaid recipients have access, allow people to receive multiple services in a single day, administrative changes to expedite enrollment (including provisional enrollment), and other changes similar to what Florida requested.

Legislators are also in communication with Medicaid staff, and discussing items that should be included if the state decides to pursue a waiver.  This is another opportunity to make sure the Medicaid program is working efficiently for everyone.

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Congress has sent two COVID-19 bills to the President as of March 20, 2020; both have been signed into law.  The first bill (HR 6074), which makes $8.3 billion in all new funding for a robust response to the coronavirus, including support for state and local health agencies, vaccine and treatment development, and loans for affected small businesses to lessen the economic blow of this public health emergency. Additionally, the legislation provides the authority for broader use of and payment for telehealth services for Medicare beneficiaries during the public health emergency period, which took effect when the President issued a national emergency proclamation due to COVID-19 on March 13, 2020.  Iowa's share is yet to be determined, but we'll keep you posted.

The second bill (HR 6201) provided additional relief to states (called the Families First Coronavirus Relief Act).   This $104 billion bill guarantees free coronavirus testing, covers the costs of testing for uninsured individuals, provides paid family leave, and strengthens food security initiatives through additional investments in food assistance (WIC, food banks, SNAP, and seniors nutrition), makes sure that children who depend on free and reduced-priced meals have access to food during school and child care closures, and increases federal Medicaid match by 6.2% while the COVID-19 national emergency is in effect.  The Department of Human Services (DHS) is in the process of calculating the impact of the match change, but the state's legislative services staff estimates that Iowa will receive approximately $62 million in additional federal funds for each quarter the national emergency remains in effect. To qualify for the enhanced match rate, Iowa must maintain all standards in place at the beginning of the calendar year, not increase any copays or premiums, maintain enrollment (i.e. no dropping people's coverage unless they are no longer residents of the state), and cover COVID-19 testing and treatments without costs to members.

Additional COVID-19 response bills are moving fast and changing by the minute.  The National Association of Councils on Developmental Disabilities (NACDD) has been working with Congress to: 

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As mentioned earlier, the President signed the Families First Coronavirus Response Act into law this week.  That bill includes a historic provision that provides temporary paid leave for some families (in effect for the next 12 months), but there are still gaps that Congress could address in future bills.  Here's a quick review of what the bill does (does not) do:

• The new law grants two weeks of paid sick leave at 100% of the person’s normal salary, up to $511 per day. It would also provide up to 12 weeks of paid family and medical leave at 67% of the person’s normal pay, up to $200 per day.
   
• The two weeks of paid sick leave apply to anyone told to quarantine, showing symptoms, exposed to the virus, or trying to get a test or preventive care.    Part-time employees also get paid sick leave equivalent to the number of hours they typically work during a two-week period. So if a person usually works 15 hours a week, they are eligible for up to 30 hours of pay (but only if they work for a company required to provide coverage under the bill).

• Small and midsize companies (under 500 employees) are required to provide these benefits for workers impacted by the coronavirus, but the US Secretary of Labor can exempt businesses with fewer than 50 employees and health care providers like hospitals and nursing homes and other providers that receive Medicaid. Independent Contractors and people who are self-employed also get these benefits in the form of a tax credit.  
   
• All government employers are required to comply with these leave requirements, including union-negotiated contracts.
   
• Large companies are not mentioned in the bill; their employees are not covered by the legislation.  This may or may not impact many people in Iowa; the US Department of Labor estimates that 89% of the workers at these companies have access to some paid sick leave already, with an average of eight days offered (which is short of the 14-day quarantine prescribed for people who may have the coronavirus). 
   
• Employers who are health care providers or emergency responders can be excluded from the bill's coverage.
   
• The Center on Budget and Policy Priorities analyzed this bill and concluded that the paid sick leave would fully pay employees earning up to about $130,000 a year for the two-week leave period, and paid family and medical leave would fully compensate employees earning up to about $75,000 a year for the three-month period.

• The Center for American Progress estimates that about a third of those working for small businesses (12.6 million people) had no paid sick leave and 87% (30.5 million workers) had no paid family leave prior to the passage of this bill. 

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The Iowa DD Council wants to hear from you!  It's important that providers and other partners fill this survey out as well.  The DD Council wants to hear from all perspectives - individuals with disabilities, family members, advocates, partners, elected officials, providers, and funders.  So between telecommuting and binge watching your favorite Netflix shows, fill out this survey!  It closes at the end of the month, so take some time now by clicking on the image below!

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The Iowa DD Council is looking for people to serve on their Council.  The mission of the Iowa DD Council is to create change with and for persons with developmental disabilities so they can live, work, learn, and play in the community of their choosing.  The Council wants to assure that individuals with developmental disabilities and their families participate in the design of and have access to needed community services, individualized supports and other forms of assistance that promote self-determination, independence, productivity and integration and inclusion in all parts of community life. They achieve this through engaging in advocacy, capacity building and system change activities. You can find out more about the council here.

The Council meets six times a year (every other month).  While anyone can and should apply, there is a need for representation from a provider and a board or staff member from an MH/DS region.  If you are interested, contact Brooke Lovelace at  blovela@dhs.state.ia.us or 515-288-0442.

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COVID-19 is coming in the middle of the official census count, and in order to avoid having to send people out to survey households, the US Census Bureau is asking for people to answer questions online or by phone.  So watch your mail for your census letter and help those census workers out by answering immediately!

You may not realize how important the census is to your everyday lives.  The population counted in the census determines how much money our state receives for school lunches, roads, libraries, employment and training (like vocational rehabilitation), Medicare reimbursement rates, public health, food assistance, and much more. It is the basis for redrawing Congressional and legislative districts, and a complete count of all Iowans makes sure Iowans get back their fair share in federal funding.  You can watch some great videos on how the census impacts your community here.

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