2014 INFONET #6

Issue 6, 4/4/2014

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Every night of the legislative session, legislators "adjourn" for the day.  The Legislature is closing in on what is called "adjournment sine die" - literally adjourning "without day."  It is what the Legislature calls their final adjournment for the session - the end of session - adjourning without setting another date to meet again.   Whether legislators can finish up their work before the Easter holiday remains to be seen, but that is their goal.

With only a handful of policy issues left to sort out, legislators are making quick work of the state's budget.  All but two of the planned budgets for this year have now seen the light of day.  Yet to be seen are the "Standings Budget" and the mysterious "Debt Reduction Act" that will pay off about $100 million of the state's debt and spend another $100 million (or so) on pet projects that were left out of the normal budget process.  All of these projects are intended to fill one-time or short-term funding needs.

Typically the Health and Human Services Budget holds up the end of session with arguments over its nearly $2 billion price tag. Recently it has also become a magnet for hot button issues like abortion and medical marijuana,  This year House leaders have made sure that debates on bills stick to the topic at hand, rather than straying to other issues.  They have made sure amendments that are off-topic are not debated (they are ruled "not germane" - or literally "not relevant"). 

So this is our final issue of infoNET to be sent out while legislators are in session.  The next issue you will see will be after that final adjournment (adjournment sine die), when legislators leave the Capitol in Des Moines and hit the campaign trail.  After all, we're just 8 weeks away from the June  3 primary election!

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Governor Terry Branstad signed Senate File 2320, which makes sure Iowans with disabilities have options to self-direct their care.  Last year, the Iowa Legislature approved language that would have required providers of Consumer Directed Attendant Care (CDAC) services to be affiliated with an agency.  Under this change, CDAC providers would no longer be able to also serve as their clients' legal guardians. So many family members that provided CDAC services would have had to become employees of an agency and stop being their loved ones' legal guardians in order to continue to provide care.

This year, legislators reversed this decision, allowing a more orderly transition that gives Iowans with disaibilities more options in self-directing their care. Senate File 2320 allows any CDAC providers under contract as of June 30, 2016 to continue to provide services independently (not affiliated with an agency).  Beginning July 1, 2016, people with disabilities wanting to self-direct their care can hire an agency-affliated CDAC provider or hire an independent provider through the Medicaid Consumer Choices Option (CCO).  Providers may continue to be their clients' legal guardians, but they will need to include safeguards in their contract that spell out the payment rate, prohibit billings of more than 40 hours per week, and outline a contingency plan if they are not able to perform their duties because of illness or other unexpected event.  You can see the final bill here.

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The Legislature must pass eleven budget bills this year - and all but two are now in progress. Here is a quick run-down of where things are at, and some highlights of each budget:

  • Administration/Regulation Budget (Senate File 2342) has passed the Senate and is now being considered by the House.  This budget funds various state agencies, including funding for the Department of Inspections & Appeals (which inspects hospitals, nursing homes, care facilities), the Insurance Commissioner (which regulates health insurance and is helping roll-out the Affordable Care Act efforts), and the Secretary of State (which oversees voting and elections).

  • Agriculture/Natural Resources Budget (House File 2458) has passed the House and is now being considered by the Senate.  This bill funds things like water quality initaitives, state parks, and farm programs like the Easter Seals' Farmers with Disabilities Program ($130,000).

  • Economic Development Budget (House File 2460) has also passed the House and is now ready for Senate debate.  This bill provides money for workforce development, job training, economic development programs, and tourism.
  • Education Budget (Senate File 2347) isn't as far along in the process; it has not yet passed the Senate but is ready for debate.  This bill funds schools, Area Education Agencies (AEAs), community colleges, state universities, libraries, anti-bullying efforts, and Iowa's vocational rehabilitation services.  Included in this bill is a small increase for vocational rehabilitation ($320,000),  independent living services ($50,000), and Centers for Independent Living ($50,000).  The budget funds other programs at current levels, like the Entrepreneurs with Disabilities Program ($145,535).  Funding for the Department for the Blind, Iowa Braille and Sight Saving School, and Iowa School for the Deaf are also included in this budget.
  • Health/Human Services Budget (House File 2463) became publict this week and was voted out of the House Appropriations Committee within hours of its release.  This bill funds Medicaid, regional MH/DS services, and much more (see next article for details).

  • Infrastructure Budget (Senate File 2349) also made its first appearance this week, and was voted out of the Senate Appropriations Committee. It will have a new Senate File number soon (probably by the time many of you read this).  This budget spends gambling money from Iowa's casinos and lottery to pay for things like trails, state parks, public transportation, building construction and maintenance, environmental programs, airports, state government technology purchases, and other "infrastructure" types of projects. This year, the budget bill includes an additional $10 million for trails.

  • Judicial Branch Budget (House File 2449) provides money for Iowa's judicial branch (courts).  This bill is the farthest along in the process - it has passed both House and Senate, and is on its way to the Governor's office for final approval. The Governor can sign the bill, veto the bill, or veto parts of the bill he doesn't like (called a line-item veto).

  • Justice Systems Budget (House File 2450) has passed the House and is now being considered by the Senate.  This bill funds Iowa's prisons, community based corrections, victims services, Attorney General's Office, public defenders, law enforcement acadamy, fire fighters, state patrol, and other public safety programs.  This year, there is a new $25,000 appropriation for the Department of Public Safety to review and provide more public education on the Endangered Person Advisory Alert System that lets law enforcement and the public know when a person with a cognitive disorder has gone missing.  This could be a person with an intellectual disability, a person with a disease that affects their mental condition, or an older Iowan with Alzheimer's Disease.

  • Transportation Budget (Senate File 2130) is very near final passage in the House.  The bill funds Iowa's Department of Transportation and other transportation-related programs, mostly from the Road Use Tax Fund which is earmarked for road construction and bridge maintenance.

 That leaves only two budget bills yet to come out - the "Standings" bill that is always one of the last budgets to emerge and makes appropriations for programs that are required by law (like property tax credits) and the mysterious "Debt Reduction Act" that is new this year and will pay off $100 million in state debt and spend another $100 million (or so) on one-time or short-term projects. You can see details of all of the budget bills as they are amended and changed here (just make sure you select the documents with the most current date).

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The nearly $2 billion Health and Human Services Budget (House File 2463) passed out of the House Appropriations Committee this week, and is ready for debate by the full House.  House leaders say they would like to debate the bill on Tuesday, April 8. The bill will get a new House File number soon.  Here are a few highlights from the bill:

  • Adds $35 million to Medicaid (total $1.3 billion) to make up for the change in federal matching rates.  This additional funding is needed to replace lost federal dollars after hte Medicaid match rate was lowered.  An additional $13.4 million was added to Medicaid as well to pay for the increased demand for Medicaid mental health services.

  • Adds $4.8 million to take about 1,500 people off the HCBS waiver waiting lists.  There are currently 7,590 individuals waiting for Medicaid waiver services (2,793 waiting for Health and Disability Waiver services; 914 waiting for Brain Injury Waiver services; 2,239 waiting for services from the Physical Disability Waiver; and 1,644 children are waiting for services offered through the Children's Mental Health Waiver).

  • Increases funding for Regional Mental Health/Disability Services (MH/DS) by $735,435.  This is the "Equalization Formula" that gets money out to 54 counties to bring their levies up to the $47.28 per person spending limit.  This increase was needed to reflect increased population - the total funding for regions is $30,555,823.  The  bill also continues the "Equalization Formula" for another year, through June 30, 2016.  This funding was set to expire June 30, 2015 (but that doesn't give the Legislature time to come up with a new formula for funding before counties must begin the process to certify their budgets right after the first of the year).

  • Continues the Medicaid offset, which cuts funding to MH/DS regions who "save" money because of the Iowa Health and Wellness Plan, which made people earning up to 138% of the federal poverty level eligible for Medicaid or subsidized health insurance.  Counties would have to give back 80% of the savings that is calcuated using a formula that looks at the county-funded services people actually received prior to signing up for the Iowa Health and Wellness Plan. Since the county (because regions are not operational until July 1 of this year) had been paying for these services but is no longer paying for them to these individuals, they are considered a "savings" and the county would have to send back 80% of those savings.  Unfortunately, this formula can only work for one year, and it does not reflect unmet demands for services.  Savings is put into a strangely titled "property tax relief fund" which the Legislature can then decide how best to use (for property tax relief, for reinvestment in the system, for core or core plus services, for services to non-target populations (DD/BI). 

  • Eliminates county auditor approval of the Medicaid offset amount, and replaces it with the State Auditor review.  This is of concern to counties, as DHS is calculating the offset then the State Auditor is reviewing them for accuracy (and counties want to have some say in whether these figures are accurate).

  • Allows MH/DS regions to maintain a reasonable ending fund balance each year (no more than 25%) for cash flow purposes and can be used to expand core servcies and make progress on additional core plus services.

  • Clarifies that "activities leading to employment providing an appropriate match with an individual's abilities" is considered a core service under the "support for employment" category.  There continues to be a lot of concern that work services are not a core service, but legislators wanted to continue to keep this category flexible to support the work choices of all Iowans with disabilities.

  • Adds $1 million to the Autism Support Program that was created last year to provide Applied Behavioral Analysis and other treatment options to children with autism that do not qualify for Medicaid or private insurance autism coverage ($3 million total funding).

  • Adds $1 million to the medical residency training program ($3 million total) with preference to be given to new medical residencies and psychiatric residencies, and allocates an additional $100,000 to the University of Iowa to provide psychiatric training to its primary care physician residency program.
  • Adds new funding ($250,000) to establish a mental health advocate division in the Department of Inspections and Appeals (and includes language making mental health advocates state employees, transfrerring them from the courts which currently provide their supervision).  The Governor vetoed this change last year.

  • Allows community mental health centers to choose between cost-based reimbursement and an alternative reimbursement methodology developed by Magellan.   This change is cost-neutral overall, but some CMHCs will get a little more money, some a little less, and some will opt to stay the same.  This change is retroactive to July 1, 2013.

  • Decreases funding for the Community Circle of Care/System of Care pilots in Polk County by $116,075, Northeast Iowa by $250,000, and Linn and Cerro Gordo Counties by $50,000.  These coordinated networks of community-based services and supports are organized to meet the challenges of children and youth with serious behavioral or mental health needs and their families.

  • Increases funding for the state's Mental Health Institutes to meet current needs, and increases funding for the Glenwood and Woodward State Resource Centers to make up for lost federal funds.

  • Eliminates $25,000 funding for the Prevention of Disabilities conference that was held last year (but not planned again this year)

The following programs will be funded at current levels:

  • University of Iowa College of Dentistry program to provide dental care to underserved populations ($25,000)
  • Funding for Youth Suicide Prevention initiatives ($50,000)
  • Grants to assit with the costs of special foods for children with phenylketonuria (PKU) ($159,932)
  • Brain injury funding for resource facilitator services ($891,644)
  • Epilepsy support, education, and programming ($99,823)
  • Child health specialty clinics ($785,114) and their regional autism assistance program ($400,000)
  • Mental health professional recruitment and retention efforts at Cherokee MHI ($99,904) and University of Iowa ($110,656)
  • Funding for post-doctoral psychologist internships, including a new child psychologist in Cerro Gordo County ($50,000)
  • Continuation of direct care worker initiatives ($429,775), including outreach, education, and conference scholarships.
  • Autism spectrum disorder services at Four Oaks in Cedar Rapids ($25,000)

If you want to dig deeper into this budget, there are a number of resources that are very useful. 

Watch for breaking budget news at www.infonetiowa.org or on Facebook. We will let you know when the bill comes up for debate, how you can watch or listen to it on your computer or other mobile device whether live as it is happening, or later when you get home. 

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Only ten legislators have people running against them in the primary election on June 3, 2014.  Every day these legislators are in Des Moines at the Capitol is a day that their opponent has to knock on doors, make phone calls, raise money, and ask for votes.  While these ten legislators are very motivated to get home soon, that doesn't mean the other 140 legislators want to hang around the Capitol any longer than necessary.  They too want to get back home to talk to the people they represent, and help others running for office locally.

With the primary election only eight weeks away, now is the time to make sure you are registered to vote and make sure the information on your voter registration is accurate.  Here is some important information for those wanting to vote this year:

  • You must register if you want to vote.  You can check if you are registered to vote here, or you can call your county auditor. If you are already registered to vote, and your voter registration information is current, you do not need to re-register.

  • You have until 5 p.m. on Saturday, May 24 to register to vote. If your voter registration forms are received by this date, your name will appear on the lists that election workers have at the polls on Election Day.  You can find registration forms and more information here.

  • You can register to vote at the polls on Election Day (June 3).  However, you will be required to show a photo ID and proof of residence, or must have another voter from your precinct sign forms saying you are who you say you are in order to vote.  If you choose to register to vote after the May 24 deadline, you might want to read more about what you will need to do here.

  • You can also vote by mail, but you will need to request your absentee ballot by Friday, May 30. Your request for an absentee ballot must be received by your county auditor by 5 p.m. on May 30 and your absentee ballot will need to be returned by mail.  Absentee ballots must be received by your county auditor by the end of Election Day to guarantee it will be counted.  Absentee ballots received after Election Day will only be counted if they are postmarked before Election Day.  We have learned that many post offices do not post-mark these postage-paid absentee ballots, so to be safe, do not wait until the last minute to send in your absentee ballots.  To learn more about voting by mail, click here or contact your county auditor.  Once you send in your absentee ballot, you can track its progress here.

  • You can vote early in person at your county auditor's office.  To find out more about your early voting options, contact your county auditor (a list is available at http://sos.iowa.gov/elections/auditors/auditorslist.html).
  • You can always vote on Primary Election Day - polls are open from 7 am to 9 pm on Tuesday, June 3.  To find your polling location, click here.  Remember that the parties and candidates often offer rides to the polls for people that have transportation barriers.  Just contact a candidate that you support or your county Republican or Democratic Party to see if this is an option in your area.

  • Want to know who is on your Primary Election ballot? Remember that voters must be registered voters of either the Democratic or Republican Party to participate in the primary election. Voters can change their party affiliation anytime before Election Day or at their polling place on Election Day.  You can change your party affiliation back the next day if you want.  Click here to find out who is running in the Primary Eleciton.

  • Need more information? Contact ID Action to know more about your rights or help find answers to your voting questions - call us at 866-432-2846, visit us at www.idaction.org, or send us an email at http://www.idaction.org/contact_us/.

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You can check out disability-related bills (including budget bills) that are still under consideration in the infoNET Bill Tracker.   We update the status of these bills daily - sometimes more frequently - so check back often.  As things move quickly in these final days of session, we will do our best to update descriptions of bills as they change and are amended.

Bills that are not longer eligible for debate have been moved to the "inactive" list.  Bills that have been signed by the Governor remain in our "active" list, but work on them has been done and they are now (or will be soon) law.

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PUBLIC FORUMS - Don't Miss Out on This Advocacy Opportunity!

Most legislators hold public forums and town hall meetings when they are back in their districts on Fridays and Saturdays. These are ways they keep in touch with their constituents.  Some of them (like Council Bluffs) are so well-attended, they have been moved to larger venues.  Others are small, with only a handful attending.  But they are all excellent opportunities for you to meet your legislators, learn from them, and educate them on your priorities.  Try one out - a full schedlue is available here.

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