INFONET 2021: Issue #8

• Health insurers will have to pay equally for telehealth-delivered mental health care, regardless of where the patient or the provider is located (telehealth payment parity). This was added to the tax plan that passed at the end of session (SF 619).  This has not yet been signed into law.

• Iowa's regional mental health and disability services (MHDS) system will be entirely financed by the state, with a two-year phase out of the property taxes that have paid for the majority of services since the mid 1990s.  Also a part of the tax bill (SF 619), the plan will provide regions with an incentive fund to address shortfalls but make no changes to the service expectations in place now.  Legislators believe this will help address the inequities in funds availble thorughout the state and free counties up to join regions that may make more sense after removing  financial barriers. 

• Additional layers of “public assistance oversight” that could have kicked people off food assistance, Medicaid, and family support did not pass!

• Iowans will be able to convert their special needs or supplemental needs trusts into an ABLE Account without risking their eligibility for Medicaid or Social Security under HF 835, which was signed into law on May 20.  ABLE Accounts are more flexible, have higher investment limits, and are protected against most Medicaid estate recovery.  You can learn more about them at iable.gov.

• Beginning November 1, courts will have to make sure a sign language interpreter is available at any legal proceeding involving a person who is deaf or hard of hearing. (HF 707, which has been signed)

• The Department of Human Services (DHS) is directed to make policy changes to ensure pediatric health services are covered by Medicaid when delivered by telehealth (including physical therapy, occupational therapy, applied behavior analysis, speech-language pathology). (HF 891, which has not yet been signed)

• Families receiving childcare assistance (including special needs childcare assistance) will have a ladder to step down as they earn more money, rather than a cliff they fall off (graduated eligibility), if HF 302 is signed into law. Also, more families will be able to receive the childcare tax credit if SF 619 is signed - the income threshold will double from $45,000 to $90,000.  Both are expected to be signed, as the Governor had recommended these and several other childcare changes in her Condition of the State speech in January. 

• Massive changes that could have ended professional licensing and oversight boards for many state-regulated professions (including health care professions) did not pass.

• Major election law changes as noted above that combined shorten and complicate early voting, especially for those that rely on the assistance of others to exercise this constitutional right. (SF 413, SF 568)

• The Governor did sign a bill that stops cities and counties from passing local laws that prevent landlords from discriminating against a tenant who uses federal housing choice vouchers to pay their rent.  Three communities - Marion, Iowa City, Des Moines - have passed these ordinances. They will stay in effect for two years (until January 1, 2023), but no new communities will be able to pass enforce similar laws.  Two out of every three people using these vouchers are either a person with a disabiity or an older person. (SF 252)

Bills that would have rolled back (or fixed) some of the changes made last year in the guardianship laws did not pass, but there are a few of these bills that will become "live rounds" in 2022.  Many other bills failed to make it through the entire legislative process this year and will also be eligible again for debate in 2022 , including bills that would have created a public portal to a direct caregiver database (HF 692), controlled the rising cost of prescription medication (HF 263, HF 526), required adult changing stations in almost all public places (HF 306), set up a program to help offset home modification costs (HF 506), developed milestones and school plans for deaf and hard of hearing children (HF 604), required AEA services to be provided to a child in school regardless of whether they attend a private or public school (SF 168), and required insurers to pay for treatment of PANS/PANDAs (SSB1200). You can see more about these and other bills in our Bill Tracker. 

At the beginning of the year, we said the Legislature really only has two things it must do this year - pass a budget and complete the redistricting process.  Budgeting is usually a really hard process and the Health/Human Services Budget is usually the bill that holds up the end of session.  Not so this year.  In fact, budgeting was relatively easy this year, thanks to extra federal funds helping pay for COVID-19 expenses and picking up a greater share of Medicaid expenses.  Legislators had more flexibility in spending this year, but budgets were held up while House and Senate leaders were gridlocked on a tax cut bill.  Since tax cuts mean less money coming into state bank accounts, legislators could not agree to budgets until the tax plan was hammer out. 

The second "must do" of 2021 is redistricting, and that has been delayed as the state waits for the federal Census data to be delivered. The Federal government hopes to get the census data to states in August, but it may be later in September.  Iowa's redistricting process is very structured, with non-partisan staff drawing the new maps and legislators voting on them. We'll talk about this more, but legislators will have to come back into session in August to pass a redistricting map before September 1, the deadline set by the Iowa Constitution. You can read more about this process here. 

Taxes: As mentioned, the biggest delay forcing the session overtime was the "Omnibus Tax Bill" (SF 619).  The House and Senate started the month of May off having more than 30 areas of disagreement in the tax bill; when the final deal was sealed, there were 28 sections, each section making a significant change in Iowa's tax laws.  The bill is considered the crown jewel of the session for many legislators, including some changes that have been more than thirty years in the making. It contains more than $400 million in tax relief, including the elimination of the property tax that pays for regional mental health and disability service (replacing it instead with an automatic state appropriation). The tax bill:

• Makes the income tax cuts made in 2018 effective in 2023 (the original law required Iowa's revenues to increase by 4% before "triggering" the tax cuts; this just eliminates the triggers and has them go into effect).
• Eliminates the inheritance tax.
• Creates a new fund to provide investments in manufacturing and adds more incentives for the redevelopement of environmentally contaminated sites (called "Brownfields" and "Grayfields").
• Increasing the volunteer emergency responder income tax credit from $100 to $250.
• Increases the number of people eligible for child care tax credits (those earning up to $90,000/year - up from $45,000).
• Exempts any COVID-19 grants or funds received by businesses or individuals from state income tax.
• Increases workforce housing tax credits (that incentivize developers to build housing in area where there are jobs but not enough houses to meed the demand).
• More than doubles the Housing Trust Fund - sending out $7 million for local affordable housing and homeless programs (up from $3 million).
• Phases out county MH/DS property tax levies over two years and instead funds with an automatic (standing) state appropriation. 

Budgets:  Even after the $400 million price tag for tax cuts, budgets still had a lot of room for increases, and that translates to some really good news for Iowans with disabilities and their support networks.  The FY 2022 budget spends $8.1185 billion in the upcoming year (FY 2022). This represents 97.7% of the money available to spend, an increase of $291 million over the current year (FY 2021).  Even after these increases and paying for the tax cuts, the state's two main "rainy day" funds are expected to be full. These reserve funds are like savings accounts and help the state through rough times, so having them full just one year since the pandemic began is really good news.

To the left, you will see a chart produced by House Republicans that shows how the budget breaks out by Appropriations subcommittee within the Legislature.  As you can see, spending on health and human services, education and school aid, and other automatic required spending make up 85% of the state's budget.  Here are some highlights - you can click on the links provided for a more robust description.

HEALTH & HUMAN SERVICES BUDGET (HF 891) 

• $11 million for HCBS waiver provider rate increases and an additional $7 million for habilitation services. 
• $3.9 million to increase Psychiatric Medical Institution for Children (PMIC) rates. That is a 28% increase!
• A little over $1 million to take more kids off the children’s mental health waiver waiting list.
• Adds $200,000 to fund two more (six total) rural psychiatrist residencies to address rural access issues.
• Increases funding for special foods for kids with metabolic disorders like PKU by $35,000 ($188,000 total)
• Shifts funding from Glenwood ($1.9 million cut) to Woodward ($1.3 million increase) to reflect a move of a cottage.
• Medicaid is increase by $44.2 million overall (no mention of how that translates into MCO contracts).

EDUCATION BUDGET (HF 868) 

• Additional $1 million for AEA school-based mental health services ($3 million total).
• Increases the Department for the Blind by $528,723, including funding to hire another Independent Living teacher).
• Adds $300,000 to Vocational Rehabilitation to draw down more federal funds for independent living.
• New appropriation for therapeutic classrooms authorized in 2021 to address classroom behavioral issues ($1.6 million).

ADMINISTRATION/REGULATION BUDGET (HF 867)

• $100 million to improve access to broadband (high speed) Internet. The discussion has been entirely around access, not affordability.  Federal COVID-19 relief funds can also be used for this purpose, should the Governor decided to do so.

JUDICIAL BRANCH, aka "the courts" (HF864) 

• Sets aside $700,000 to pay for increased ASL interpretation services, per HF 707.

We know this is all confusing, so if you have questions or want to know more, join us for our summer Capitol Chats - you can register for them here.

There are still a lot of people on the waiting lists for the Home and Community Based Services (HCBS) waivers, even after these increases.  You can see the current (as of May 5, 2021) list here.  This may be something advocates want to continue to address, as some people have been waiting for these services now since 2017.  

• There are a total of 26,151 Iowans served by the seven HCBS waivers, and another 15,956 on one of the waiver waiting lists.
• Health & Disability Waiver (5,966 waiting)
• Intellectual Disability Waiver (4,802 waiting)
• Brain Injury Waiver (2,201 waiting)
• Physical Disabiity Waiver (1,858 waiting)
• Children's Mental Health Waiver (1,129 waiting)
• Elderly Waiver (no waiting list)
• AIDS/HIV Waiver (no waiting list)  

Iowans are represented by two US Senators in Washington DC - Sen. Charles Grassley and Sen. Joni Ernst.  Iowa is divided up into four congressional districts, which are represented by Rep. Cindy Axne, Rep. Randy Feenstra, Rep. Ashley Hinson, and Rep. Marianette Miller-Meeks. They are facing a number of issues of interest to Iowans with disabilties as they serve out in our nation'a Capitol.  We have a couple that we wanted to let you know about.

SENIOR CARE (TICKET TO WORK).  US Senators Rob Portman (R-OH), Bob Casey (D-PA), Tim Scott (R-SC), and Catherine Cortez Masto (D-NV) introduced the bipartisan Supporting And Empowering the Nation to Improve Outcomes that Reaffirm Careers, Activities, and Recreation for the Elderly (SENIOR CARE) Act (S.1476). This bill would get rid of the Ticket To Work Program's Medicaid age restriction to allow individuals with disabilities who are over the age of 65 to continue to work and keep their Medicaid coverage. Senators Portman and Casey first introduced the SENIOR CARE Act in 2019. 

   Plain language:

• This bill would help older adults with disabilities to have Medicaid while still working.

   What it means to you:

• Under current law, when individuals with disabilities reach 65, they are often forced to make a choice between their job and their Medicaid benefits. Unfortunately, the advantages of meaningful employment are not enough to offset the increased healthcare costs that would result from a loss of Medicaid benefits. While many individuals find meaning in their work well into their later years, the current system discourages workers with disabilities from staying on the job they enjoy.

   Action steps:

• Contact Senators Charles Grassley & Joni Ernst to urge support by email here, or by calling the United States Capitol switchboard at (202) 224-3121.
   

CARE OPPORTUNITY ACT. Representatives Bobby Scott (VA-03), Susan Wild (PA-07), and Susie Lee (NV-03) introduced the Direct Creation, Advancement, and Retention of Employment (CARE) Opportunity Act (H.R. 2999). This bill would invest more than $1 billion over five years in training for direct care workers. 

   Plain language:

• This bill would help direct care workers get training.

   What this means to you:

• This bill can be a part of the conversation about the $400 billion investment in HCBS as proposed in the American Jobs Plan.

   Action steps:

• Learn more:

o   Fact sheet on the Direct CARE Opportunity Act.

o   Bill text of the Direct CARE Opportunity Act.

• Email or call the Capitol Switchboard at (202)224-3121 (voice) or (202)224-3091 (tty) and ask to be connected to your Senators and Representative. 

o   You can find your Members of Congress on www.congress.gov.

o   Leave a brief message sharing the Home and Community Based Services and Competitive Integrated Employment are important to you. Ask to be updated on how the Member plans to vote on the Direct CARE Opportunity Act.

We have had a great time sharing information and hearing from you during our Capitol Chats this year, and the events aren't over yet! Even after this legislative session ends, we want to continue the advocacy conversations.  Join us throughout the summer to learn more about what happened at the end of this session, how you can keep advocating for yourself and others, and additional ways to get involved in the community. 

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Friday, June 4th | 11 AM 
Friday, July 9th | 11 AM 

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Our bill tracker is updated and will be changed as the Governor takes action on the bills.  A reminder: 

• You can find the list of bills that passed and were sent to the Governor on the "Active" list.
• You can see the bills that didn't make it (but wil be eligible for debate again in the 2022 session) in the "Inactive" list.
• You can print a copy of the entire list or download it in an Excel spreadsheet and make it your own! 

We would love to hear how we can make this Bill Tracker more user friendly to you.  We will be making changes to it over the summer/fall, so let us know what you think by emailing us at infonetiowa@gmail.com.