2015 INFONET #2

Issue 2, 2/6/2015

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As we finish up the first four weeks of session, the Legislature is focusing most of its attention on school funding.  Education is our state's biggest expense - 55% of the state's budget goes to education.  This year the Governor recommended increasing school aid by only 1.25%. That increase may seem small, but the money needed to make it happen is not ($150 million). 

The House passed this bill (House File 80) last week, and the Senate has plans to debate it next week. The Senate plans to amend the increase to 4%, but schools want 6%.  Given the tough budget year ahead, and a possible $206 million shortfall in Medicaid, legislators will need to strike a compromise or risk having no money to spend on other state programs and services.  As you can see, the job of a legislator is not easy, and balancing priorities like this can be very difficult.

Legislators are also looking ahead, realizing they are halfway to the first legislative deadline.  You may have heard us talk about "funnels" before.  The Legislature has two deadlines called "funnels."  The term gives you a good visual - bills are dumped into the top of a funnel, and must make it out of the narrow bottom before the deadline.  In the Iowa Legislature, bills must be voted out of committee before Friday, March 6 to stay alive.  Bills that fail to make it out of committee by this first funnel deadline will be set aside for the year, but may be taken up again next year.

That means you - the advocate - should look at the bills introduced so far this year (click here to view our Bill Tracker). If you see something you like (or don't like) - let your legislators know!  Ask them to help you.  Even if they are not on the committees discussing the issues you care about, you can always ask them to talk to their friends that are on those committees.  Your legislator is also your advocate - but they can't help you if they don't hear from you!

  • You can use our simple Grassroots Action Center to send your legislator an email.  You do not need an email address to do this (although you may get a faster response if you give them one). 

  • You can also say hello to your legislators at a town hall meeting or public forum near you.  These meetings are usually held on Fridays and Saturdays.  If you dont' see your legislator on our list, call or email them and ask them when they plan to hold a forum.  If you hear of forums not on our list, email us at infonet@idaction.org and we'll get them added to the list!

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As always, legislators that work on health and human services issues face many challenges. There is never enough money to pay for the ever-growing demands for services.  The money that is appropriated is never enough to pay the providers of those services adequately.  And the state is always so busy paying for the services it does fund, that it can never seem to reserve enough money to pay for new and innovative services.  It's a very tough job to work in this area, and you can be sure the legislators that volunteer for these committees do so because they want to help people live happy, healthy, independent lives.

This year, legislators are dealing with the Governor's proposal to close the doors at two of Iowa's mental health institutes (MHIs for short).  Both are located in Southern Iowa communities - Clarinda and Mt. Pleasant.  The Department of Human Services is calling these closures an "Institutional Realignment" because some beds will be added to the remaining two MHIs (Independence and Cherokee) and others will be sent to community-based residential programs if appropriate. 

Here are a few facts about the two MHIs that will be closed (they are currently no longer accepting new patients):

  • Mt. Pleasant has 9 beds, which are nearly always full (89%).  The cost of those beds is the lowest of all MHIs, at $714/day.  Mt. Pleasant also operates a specialized substance abuse unit with 50 beds and a dual diagnosis unit with 19 beds, which will also be closed. About 65% of those beds are filled on any given day. Mt. Pleasant currently does not have a psychiatrist on staff and recruitment has been difficult, which is one reason cited for closing this facility. 

  • Clarinda has 15 beds, but only 40% (6 beds) are being used regularly. These beds cost a little over $850/day.  Clarinda also has a special 20-bed unit for older Iowans with special mental health needs (called a "psychogeriatric unit").  Nearly all of these beds (90%) are filled on a daily basis.  The psychiatrist on staff at this MHI is retiring this year, and challeges in recruiting a replacement is another reason for the closure.

The Health/Human Services Budget Subcommittee discussed the plans to close these facilities at a recent meeting.  You can see the Department of Human Services' presentation on the MHI Closures here.

Managed care for Medicaid continues to be the elephant in the budget subcommittee room.  The Department of Human Services says they are working on a plan to be released in March, but will not discuss details of that plan.  Legislators from both House and Senate, Democrat and Republican, are clearly frustrated by the lack of information available to them.  Legislators also do not feel they will have much say in the design of the final plan, but hope that once an RFP is released and the state begins the process of asking for federal approval, their concerns and suggestions will be heard.  The only thing we know for sure is that the Federal government requires a public comment period when states make bold moves like this, and takes those comments very serously when deciding whether to approve changes to the state's Medicaid plans.  With 70% of the nation's Medicaid population in some type of managed care system, the Federal government will not stop the state from pursuing managed care, but may require certain things of those plans.  That's why public input will be very important.  So stay tuned for breaking news on this (www.infonetiowa.org or follow us on Facebook).

We do not have much new to report on the managed care front.  Given the "silence" on this issue from the department and Governor, the Health and Human Services Budget Subcommittee has invited national experts from the National Conference on State Legislatures (NCSL) to present on February 19.  Legislators hope to learn from the experiences other states have had with managed care, and find out more about best practices.  Our last issue of INFONET included a similar list of best practices put together by the National Council on Disabilities. You can find these, and other resources on managed care, in our Policy Tools section of the website.  We have recently added information from NCSL and other resources to help you understand the opportunities managed care could bring, and the potential impacts if not done carefully.

Finally, we are on the watch for legislation that is going to be filed to implement the ABLE Act.  In December, President Obama signed the Achieving a Better Life Experience (ABLE) Act, which when fully implemented will allow people with disabilities to open tax-free savings accounts where they can save up to $100,000 without risking eligibility for Social Security and other government programs. What’s more, individuals can keep their Medicaid coverage no matter how much money is in the account.  These savings accounts are modeled after 529 college savings plans, so interest earned on these accounts is not taxable.  Money saved can be used to pay for education, health care, transportation, housing and other living expenses.

States need to set up their own ABLE Account plans, but they cannot do that until Federal rules are written (which probably won't be done until September).  After Federal guidelines are complete, states will be able to design their own plans.  So even if legislation is passed this session requiring our State Treasurer to get started, you probably won't be able to start saving until later this year.  Watch Facebook and our Breaking News for updates on this.  You can read more about the ABLE Act here (including a video on the "10 Things You Need to Know about the ABLE Act").

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Legislators this week also began discussions about the growing waiting lists for Medicaid Home and Community Based Services (HCBS) waivers.  Iowa currently has seven HCBS waivers; only two of those waivers do not have waiting lists at this time.  Number of people served and waiting list size as of 1/23/15 is listed in () below.

  1. AIDS/HIV Waiver (30 served; none waiting)
  2. Brain Injury Waiver (1,209 served; 1,199 waiting)
  3. Children's Mental Health Waiver (731 served; 1,950 waiting)
  4. Elderly Waiver (8,615 served; none waiting)
  5. Health/Disability Waiver (2,063 served; 3,480 waiting)
  6. Intellectual Disability Waiver (12,672 served; 369 waiting)
  7. Physical Disability Waiver (724 served; 2,648 waiting)

Each waiver has its own menu of service options.  Individuals who receive waivers also receive Medicaid services. Most individuals on waiver waiting list also receive traditional Medicaid services, although this is not true for children whose parents have incomes higher than traditional income eligibility limits. You can see the Department of Human Services' presentation on waivers here.

The Department of Human Services is planning to begin several "cost containment" strategies to help stretch their Medicaid dollars.  A few of these impact HCBS waiver servcies, and will save the state about $6 million.

  1. Change the reimbursement rates for transportation to Federal IRS rate ($.575/mile) but cap the one-way reimbursement for each trip at $9.79.  The $9.79 cap is based on the current statewide average.  These savings are estimated at $1.1 million.  Several legislators expressed concern that this would more negatively impact rural Iowans, who must travel further to grocery stores, etc.  This cap will not impact transportation for non-emergency medical transportation or medically necessary trips.

  2. Put a cap on the cost of ID Waiver services.  If the Legislature approves this change, the ID waiver will pay for services up to $346.39/day (based on the daily ICF/ID per diem rate). This change will save the state about $1 million.

  3. Carefully review individual requests for exceptions to policy and make sure those exeptions to policy comply with the capped costs for services noted above. The state anticipates they will save about $1 million because of this change.

  4. Utilize the Supports Intensity Scale (SIS) to determine payment amounts for the services provided to adults served in the ID Waiver. The Supports Intensity Scale will base services on a person's level of need; the more you need, the more services will be available.  The state will use a tiered payment system, with the top tier of support (most services needed) limited to the ICF/ID payment rate noted above.  There will be a process developed to address needs of people beyond the capped limit.  Estimated savings is $2.5 to $3 million.

While these discussions have been happening in the Health/Human Services Budget Subcommittee meetings, a three-member subcommittee in the House has been reviewing another bill introduced by the Department of Human Services.  House Study Bill 82 requires the Department of Human Services to develop a process to prioritize people waiting for HCBS waiver services.  The bill does not outline the process to be taken, or the criteria to be considered.  Right now, services are available on a first-come, first-serve basis, and cannot be awarded based on level of need. 

The members of the subcommittee - Rep. Joel Fry of Osceola, Rep. Sandy Salmon of Janesville, and Rep. Lisa Heddens of Ames asked that advocates provide them with criteria they would like considered.  They plan to have an amendment that will require DHS to work with stakeholders in the development of the criteria and process before doing rules, and they may list some of the criteria to be considered.  If you have thoughts on this, let them know!

  • Rep. Joel Fry - joel.fry@legis.iowa.gov or call 515.281.3221
  • Rep. Lisa Heddens - lisa.heddens@legis.iowa.gov or call 515.281.3221
  • Rep. Sandy Salmon - sandy.salmon@legis.iowa.gov or call 515.281.3221
  • You can email your legislator using our Grassroots Action Center here.

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Never a dull moment in Iowa politics, particularly as the Presidential primary season inches closer.  People who want to run for President in 2016 have started making their way to the Iowa Capitol to meet with legislators -  former Texas Governor Rick Perry was seen there recently.  It may seem early, but Iowa's first-in-the-nation Presidential caucuses will be held sometime in January/February 2016.  Just around the corner.

In the meantime, Iowans in House District 23 in southwestern Iowa will go back to the polls next week.  Voters in this district have not been represented in the Iowa House of Representatives since session began. Their State Representative won the special election for the Senate seat in that area (which was vacated by now US Senator Joni Ernst).  David Sieck, a farmer from Glenwood, is the Republican candidate and Steve Adams of Red Oak, an economic development specialist with Iowa State University, is the Democratic candidate. After this special election is done, we can finally print our 2015-2016 Guide to the Iowa Legislature!  Expect it in your mailboxes by the end of the month!  In the meantime you can see a draft version of it online at www.infonetiowa.org.

Finally, legislators continue to discuss ways to make voting more accessible for Iowa's citizens (including voters with disabilities).  Iowa is already a leader in this area, allowing voters to register to vote on Election Day, allowing in-home absentee voting for any reason, providing numerous opportunities to vote early at community locations and county auditors' offices, and not requiring photo IDs when going to the polls to register.  While there continue to be a few legislators trying to eliminate some of these options, there are some that are working on ways to improve our already strong electoral system.

The ACLU, League of Women Voters of Iowa, and Brennan Center for Justice at New York University have been working with the Iowa State Association of Counties and county auditors to give Iowans the option to register to vote online.  Right now Iowans can register to vote when applying for a driver's license or non-operator's ID, at their county auditor's office, or by mailing in a voter registration postcard.  But they cannot go online and register to vote.

A bill has been introduced to do this - Senate Study Bill 1152.  The three-member subcommittee assigned to this bill will meet on February 11 at 11:30 am to discuss the bill and make recommendations to pass, amend, or set aside for the year.  The subcommittee members include Sen. Jeff Danielson of Cedar Falls, Sen.Tom Courtney of Burlington, and Sen. Jason Schultz of Schleswig.  One issue that will likely come up is voter ID.  Some legislators will want to require a driver's license number to register online, but current Iowa law gives Iowns the option of listing a driver's license/non-operator ID number, or the last four digits of their social security number.  The bill above is consistent with current law, allowing either to be used to confirm the person's identity.

There are a number of other election-related bills being considered this year, including:

  • Getting rid of "straight party voting" which allows voters to make one mark for all Democrats or all Republicans (HF 4)

  • Allowing people who want to vote by mail in every election to have their ballot mailed to them automatically; currently they have to request a ballot for each election (HF 48)

  • Requiring run-offs if no one in a primary gets enough votes - so voters select candidate in run-off election, not party officials in a closed meeting (SF 10)

  • Eliminating Iowa's same-day (Election Day) voter registration and in-person early voting options (HF 138)

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CAPITOL DAY GRANTS AVAILABLE.  Coming to the Capitol to see your legislators can be fun, educational, and very productive! ID Action is again offering to help local groups visit the Capitol and meet with their legislators during the 2015 legislative session. For more information call 866-432-2846 or go here.

ADVOCATING FOR CHANGE DAY.  Mark your calendars - the much-anticipated Advocating Change Day 2015 will be held on Wednesday, April 22, 2015.  Space is limited to this free event, and registration is now open. You can register online here, or by calling 866-432-2846.

NOMINATE YOUR ADVOCATE OF THE YEAR.  Each year, ID Action recognizes one outstanding ID Action advocate who works to improve the lives of Iowans with disabilities. ID Action is now accepting nominations for the 2014 Advocate of the Year award.  To nominate a deserving individual, please send us a letter that includes the nominee's name, address, phone number and how they are making a difference in their community, or at the state or federal levels. Please include your name and contact information for any follow-up questions. You can email nominations to contactus@idaction.org, or mail them to: ID Action, P.O. Box 737, Des Moines, IA 50303.   The deadline for nominations is March 12, 2015, and the winner will be announced at the 2015 Advocating for Change Day rally on April 22, 2015.

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Most legislators hold public forums and town hall meetings when they are back in their districts on Fridays and Saturdays. These are excellent opportunities for you to meet your legislators, learn from them, and educate them on your priorities. Click here to find a forum near you.

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Legislators read hundreds of bills each year, but only about 12% end up becoming law.  Even fewer of those have an impact on the lives of people with disabilities, their family members, their communities, and their service providers. 

  • Keep track of bills that may impact the lives of individuals with disabilities in our Bill Tracker.   We update this list daily, sometimes several times a day. 

  • You can look at all the bills introduced to date here.

  • You can look at the bills assigned to each committee here (just select the committee of interest, then click on the "Bills in Committee" link at the bottom right side of the page).

Here is a list of bills of interest introduced in the last two weeks:

  • HF113 - Electronic Applications for Absentee Ballots - Allows registered voters to apply for an absentee ballot electronically, either by emailing the county commissioner or online through the county commissioner’s website. The electronic application is to include all the same information as the paper application, but instead of a signature, must include a driver license number, non-operator ID number, or the last four digits of the social security number. (Status: House State Government Committee)

  • HF91 – Mental Health Advocates - Changes how mental health advocates are appointed for people who are involuntarily hospitalized. Under the bill, mental health advocates would be county employees, and the county would both pay for and supervise the mental health advocate. Only one county currently is allowed this arrangement – Polk County. (Status: House Human Resources Committee)

  • HSB65 - Food Assistance Eligibility - Requires the Department of Human Services to revise is elibility categories for the food assistance program and replace them with “income eligiblity” which starts at 130% of the federal poverty level. Requires an asset test for eligibility that is consistent with the federal Supplemental Nutrition Assistance Program (SNAP) requirements. (Status: House Human Resources Committee)

  • HSB82 – Medicaid HCBS Waivers – Requires DHS to develop a prioritization policy for openings when there is a waiting list for Medicaid home and community-based service waivers. Proposed by the Department on Human Services (Status: House Human Resources Committee)

  • SF106 – HCBS Elderly Waiver Reimbursement - Increases the reimbursement rate by 3% for providers of services under the Medicaid home and community-based services waiver for the elderly. Effectuve 7/1/15. (Status: Senate Human Resources Committee)

  • SF92 – Disability Caregiver/Income Tax Deduction - Says that individuals who work for a non-profit, tax-exempt organization and provide services to people with a physical or mental impairment will not have to pay individual income taxes. Effective January 1, 2016. (Status: Senate Ways & Means Committee)

  • SSB1094 – Physical Therapist Insurance Coverage - Requires insurance coverage for services provided by physical therapists, occupational therapists or speech pathologists. Applies to individual and group policies after July 1, 2015. (Status: Senate Human Resources Committee)

  • SSB1098 – MH Professional Loans - Creates a school loan forgiveness program for mental heath professionals who practice in underserved areas (five years of loan repayments allowed). (Status: Senate Education Committee)

  • SSB1113 – Court Interpreters - States that people who are limited English proficient (LEP), including those who are deaf, deaf-blind, or hard-of-hearing, are entitled to an interpreter in certain legal proceedings and court-related programs. The cost of the interpreter cannot be charged to the LEP person. The bill describes the options of who will pay the cost of the interpreter in different circumstances. (Status: Senate Judiciary Committee )

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