2015 ISSUE #11
Issue 11, 12/11/2015
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Articles in This Issue:
- Budget Biggest Issue in 2016 Session
- Session Begins on January 11, 2016
- Meet Iowa's Newest Legislators
- Governor Announces Medicaid Safe Harbor
- State's Managed Care Readiness at Second Oversight Committee
- MCOs Say Thousands of Contracts Signed
- Health Policy Oversight Committee Next Steps
- Advocacy Corner: Send Your Legislator a Holiday Card
- 2016 Guide to the Iowa Legislature Available Online
Budget Biggest Issue in 2016 Session
Iowa's 150 legislators will face many tough issues when they come back to the State Capitol for the start of the 2016 legislative session on January 11. Tax cuts, tax increases, gun rights, gun control, Medicaid managed care, water quality, and worker's issues will all be discussed, but no issue will be tougher than tackling the state's budget. Here's why:
- The education community want at least 4% more than last year for local schools. Every 1% increase costs $41 million. That means 4% will cost the state $164 million.
- Property tax cuts for business owners passed two years ago cost the state about $161 million this year, and will increase again next year. These funds reimburse local governments for the lost tax dollars.
- The state's Mental Health and Disability Services Regions will need money this year to preserve the non-Medicaid services they provide to Iowans with mental illness and intellectual disabilities (and to a lesser extent, developmental disabilities). Regions received $30 million two years ago, and one region (Polk County) received $2 million this year. Regions will need more money, but the exact amount is not yet known (it will be at least $8 million).
- The state's Revenue Estimating Conference released new numbers on December 10, saying the state will only collect a little over $7 billion this year, and about $7.2 billion next year. Iowa can only spend 99% of its revenues (the rest is saved in a reserve fund for emergencies, a 'rainy day' fund).
- Rep. Pat Grassley, the new House Appropriations Committee Chair, said the latest revenue estimates mean lawmakers will only have about $153 million in new money to spend this year. But he adds that the Legislative Services Agency projects built-in increases in the state budget of $200.7 million, including spending increases for Medicaid, teacher leadership programs, property tax relief and other expenses. That built-in budget increase does not include increased school funding.
For those that do not want to do the math, the state budget will increase by $200.7 million this year if the Legislature does nothing but stick to the current budget. But they are only allowed to spend $153 million. That means legislators will be $47 million short if they just want to live up to current commitments. So what will they cut? Will they raise taxes to make up the difference, or dip into their rainy day fund? Does this year qualify as a "rainy day?" Tough decisions will be made this year, so if you want to keep something funded this year, start asking now!
Session Begins on January 11, 2016
The Iowa Legislature will come back into session on Monday, January 11, 2016 for a "short" 100-day legislative session. Below are a few dates you might want to note - you can view the full session timetable here.
January 11, 2016: Session Starts
January 26, 2016: Last day for legislators to ask staff to write bills.
February 19, 2016: First funnel deadline, when all House bills need to be voted out of House committees, and Senate
bills to be voted out of Senate committees; bills that don't are dead)*
March 11, 2016: Second funnel deadline, when all House bills need to be voted out of Senate committee, and all
Senate bills out of House committee; any bills left in committee are dead)*
April 19, 2016: Last day of session (day when legislative expenses run out, they can go longer)
*Note that these "funnel" deadlines do not apply to bills that involve taxes (Ways & Means Committee), spending (Appropriations Committee), and government oversight (Government Oversight Committee).
Meet Iowa's Newest Legislators
Northwest Iowa has a new state legislator representing them at the State Capitol in Des Moines this year. Chuck Soderberg, who represented Plymouth and part of Woodbury County since 2005, decided to leave office in September after becoming the Executive Director of the Iowa Association of Rural Electric Cooperatives. In a November 3rd special election, voters in the area picked Dr. Charles Hotz as their new State Representative.
Dr. Charles Holz is from Le Mars and was a veteranarian for 38 years before retiring. He served on the Le Mars school board for 18 years, including two years spent as the board president. He is a long-time member of the Le Mars Rotary Club, and is an elder and trustee at Presbyterian United Church of Christ. He and his wife Patricia have three grown sons.
"I appreciate the opportunity to serve the people of Northwest Iowa," Holz said after being elected. "I've been here almost 40 years. They're good honest people, and I want to do my best to represent them at the state level." He added that he does not have a specific agenda if elected but added: "I think the financial aspect of the state is going to be a real challenge. I hope I see at least a steady to a slight increase in revenues, but I'm not sure that's going to happen."
Rep. Holz will receive committee assignments soon, but he will not take over as Chair of the House Appropriations Committee, a position held by Soderberg. That powerful position went to Rep. Pat Grassley.
For people living in this district, it's a great time to reach out to Rep. Holz and introduce yourself and let him know what YOUR priorities are for the state. Remember, your legislators are sent to Des Moines to represent you, and the only way they can do that is if you want them to do. You can reach Rep. Holz at: 712-540-1954 or firstname.lastname@example.org. Once session begins in January, you can send him emails at email@example.com.
Tom Moore, a retired teacher and coach from Griswold, became the newest member of the Iowa House of Representatives on December 8. Moore will represent House District 21 in the Iowa House of Representatives, a district that includes all of Adams and Union counties, most of Cass county, and the eastern part of Pottawattamie county. He replaces longtime Rep. Jack Drake, who died of natural causes two months ago.
Tom Moore is a 33-year education veteran, having served 26 years as a teacher and coach in the Griswold School DIstrict, and 7 years in the Grinnelll school district. He was a high school wrestling official for 38 years and a softball umpire for 26 years. Moore is currently a Griswold School Board member, but he will need to resign from that position in order to become a State Reprsentative. "I think it's important that I represent the people of District 21," said Moore prior to the election, "and that's my main concern. I guess my overall theme in this election is 'people over politics.'"
Moore said he will make education a priority, and has said he understands the pressures small school districts face in terms of budgets and regulations. Moore believes smaller districts must consider consolidation because of dollars and cents. However, Moore says the state must address funding issues in terms of special education. "If you talk to schools all around the area," Moore said, "their special education budgets run in the red, year after year after year. And the only way we can do that is by getting more dollars from the state, or by increasing taxes. We're either taxing them here, or the state is taxing them there. I think we need to make if fair for everybody."
When asked recently about Medicaid managed care, Moore said he would consider privatizing Medicaid in Iowa. "I think we've got to do something," he said, "because of the abuses in the Medicare and Medicaid systems. And I think we've got to do something to look at that program, and maintain its health in my generation, your generation, and generations to come. It's an important issue. I think I need to look at that more, to decide exactly where I am on privatization.
For people living in this district, it's a great time to reach out to Rep. Holz and introduce yourself and let him know what YOUR priorities are for the state. Remember, your legislators are sent to Des Moines to represent you, and the only way they can do that is if you want them to do. You can reach Rep. Moore at: 712/789-9954 or firstname.lastname@example.org. Once session begins in January, you can send him emails at email@example.com.
Former Representatives Drake and Soderberg were both Republicans, and Republicans won both special elections. That means there will be no change in the Republican-Democrat balance in the House. Republicans will continue to control the House of Representatives with 57 seats; Democrats have 43 seats.
Governor Announces Medicaid Safe Harbor
Iowans that receive Medicaid services have been calling on the Governor to slow down the transition to Medicaid managed care, and give them time to pick a managed care organization (MCO) that best fits their needs. Medicaid providers have asked for more time to review contracts, and many have said they still don't know what they will be paid (and don't want to sign a contract until they know). The Governor has repeatedly said he will not slow it down, and our state's budget depends on it.
On December 7, the Governor announced a compromise. Under his new plan, Medicaid members will be able to continue to see their current providers until April 1, 2016, and those providers will continue to be paid 100% of current rates even if they do not have signed contracts with a managed care company. Before this was announced, providers faced a 10% cut in reimbursements if they did not sign up with a managed care plan by January 1, 2016.
The Governor said this "safe harbor" will give people more time to make decisions and will give providers more time to sign contracts without compromising the state's budget. "The extension announced today is intended to give patients peace of mind that they can continue seeing their providers," said the Governor. "The measure also gives providers additional time within the safe harbor to contract with a partner plan."
MEDICAID MANAGED CARE TIMELINE (SAFE HARBOR):
Late November/Early December: Medicaid members get their enrollment packets & are assigned an MCO.
December 17, 2015: Medicaid members have until this date to switch to another MCO.
January 1, 2016: Four MCOs take over management of the state's Medicaid system. Network open (can see any Medicaid provider whether or not they have a contract with your assigned MCO, providers get 100% of current rate).
March 17, 2016: Final day that Medicaid members can switch MCOs for any reason. After this time, you must show a valid reason to switch (i.e. your provider dropped out, you have a new service need not available in network).
March 31, 2016: Final day for providers to be paid fully without contracts.
April 1, 2016: MCO networks close; MCOs only required to pay 90% of the Medicaid fee for service to providers that have not signed contracts with them.
State's Managed Care Readiness at Second Oversight Committee
During the 2015 legislative session, legislators knew there would be issues that needed to be addressed as the state moved its Medicaid system into managed care. That's why they created the Legislative Health Policy Oversight Committee - so key legislators could get updates on the transition, look at data once managed care begins, get public input and hear concerns, and make recommendations that will improve the Medicaid managed care system.
Ten legislators serve on this group - evenly split between House/Senate, and Republican/Democrat. So any decisions made by this committee must be supported by both parties, and acceptable to both the House and Senate. The co-chairs of the Health & Human Services Budget Subcommittee are also the co-chairs of this committee (Rep. Dave Heaton of Mt. Pleasant and Sen. Amanda Ragan of Mason City). You can see who serves on this committee here.
The committee met for the first time in early November, before many managed care organizations (MCOs) had contracts with providers and before rates were available. At that meeting, there were definitely more questions than answers, and some legislators were frustrated that the state was not further along. Some on the committee called for a vote to slow the process down and delay the January 1 start date. That vote failed (5-5). Other committee members said the state needs to keep moving in order to meet its goals, and argued that managed care will eventually not only save the state money, but provide people with more flexible options. It was clear members of the public attending the meeting were frustrated too. Dozens asked to stop or slow the start of managed care, and more than 40 people submitted public comment. You can read a staff summary of this meeting here.
The committee met again on Monday, December 7, and devoted even more time (nearly two hours) to public comment. More than 200 people came to the Capitol for the meeting, most had to sit in the hall and watch the meeting on TVs. While many of these advocates took the opportunity to speak to members of the committee, others said they were there for emotional support. To date, the committee has accepted more than 159 written comments, and heard testimony from many more. The same themes came up once again during these comments:
- Slow this down so we can do it right.
- People still do not have the information they need to make an informed decision in choosing an MCO.
- There is a lack of coordination and a breakdown in communication.
- Information that is provided is often conflicting, leaving people confused and frustrated and fearful.
- Providers aren't signing up, contracts are complicated, and rates are not available to all.
- Difficult to look up providers that have signed onto an MCO, particularly if you don't have the Internet.
- Concern providers haven't been trained on new administrative practices but must be in compliance on January 1.
- People don't see the benefit to managed care because of the confusion and chaos and lack of communication, and they are afraid that what is working for them will be taken away.
Legislators sat through nearly two hours of emotional testimony, as families pleaded for their children and people needing services expressed their frustration with the communications. Public demonstrations are not allowed in legislative committee rooms, but those in the hallway were not shy with their applause as they watched the live-streamed meeting. Several people receiving services from managed care companies in other states came to talk about the benefits they see in managed care.
We do not have the space to list all comments, but here are a few examples of what was said:
- People keep saying that we fear change; it’s not change we fear, it’s the failure to answer our questions, to get basic answers about the care my daughter will receive, and where she’ll get that care. My daughter still has not received her enrollment packet, yet she must make a decision by December 17. This is a fast track to disaster.
- As a WellCare member from out of state, managed care was life-changing. My advice to you: It has been a positive experience…don’t give up and find what works for you.
- Let’s delay this process, take a little more time on implementation, and do it right by Iowans. People are caught in a communication loop with no resolution – people call Medicaid through the Help Line; they are told to call the MCOs; they call the MCOs and are told to call each of their providers to see which networks they plan to participate in; they call their providers who say they are still working through that process. It’s an unending loop, with no answers.
- I am a parent of three kids that receive Medicaid services. We received their enrollment packages on November 27, and all three kids were assigned to different MCOs. This is just not something that should be done quickly and without proper preparation.
- My son receives services through the HCBS waiver. Medicaid is a one-stop shop for the most needy Iowans – this should not be rushed.
- As a parent of a son with cerebral palsy, there are two things I want to say: 1) we do not have a list of providers that have signed contracts with MCOs, so we do not know where to go and how far we will have to travel for medical care; and 2) information has been hard to find and impossible to grasp, and most times we have gotten conflicting information from Medicaid and MCOs.
- I am the parent of a daughter with mental illness and other disabilities; she is successfully and happily employed as cashier at local grocery store on a part-time basis. She is a loyal and dependable worker, but makes minimum wage and has no benefits, so depends upon Medicaid to help pay for the services she needs. Her hope and mine is that she can find a full-time position with benefits that allow her to be self-sufficient and independent.
- There are no primary care physicians signed up with MCOs as of today in Dubuque County, and none of the MCOs have contracted with psychiatrists anywhere in the state.
- Our son spent 4 months in NICU after he was born, and at the age of four has already had 11 surgeries. They have had great difficulty with this transition, and the lack of information about their child’s care is causing huge strain on the family. I keep asking myself, Will my son survive this change to managed care? And I ask you - are you willing to risk my son’s life? Because that is what you are asking us to do, risk his life. This is not right, taking the most fragile population and risking their lives. The right decision is to slow down.
After a long day of status updates and testimony, the committee again took a vote on whether to slow down managed care, but it failed 5-5 (Republicans against, Democrats for). Republicans said the motion was outside the charge of the committee. Rep. Joel Fry reminded his colleagues that they had not passed legislation that started us down the path to managed care. "This was the Governor's call," said Rep. Fry. He said that the committee’s charge was not to recommend legislation or weigh in on managed care, but to provide a venue for people to have their issues addressed.
- Watch as much (or little) of the five-hour December 7 meeting on YouTube here. For those of you nervous about telling your story, there are some great examples on this video stream!
- You can read all of the comments submitted so far to the committee here. Again, if you want to write your legislator and want some examples, this is the place to find them. But remember not to copy - your story is best told by you.
- If you want to submit comments, its not too late! You can send your comments to firstname.lastname@example.org. Put "Health Policy Oversight Committee - Public Comment" in the subject line of your email. You can also mail your comments to Health Policy Oversight Committee, c/o Patty Funaro, State Capitol, Des Moines, Iowa 50309.
- Finally, you can send the members of the Health Policy Oversight Committee your comments directly using our online Grassroots Action Center here.
MCOs Say Thousands of Contracts Signed
Managed care organizations (MCOs) and state Medicaid staff presented to the Legislative Health Policy Oversight Committee on December 7. Here is what they talked about:
Mikki Stier, the state's Medicaid director, discussed problems with the state's Medicaid help line, and tech proglems that caused some family members to be split up among MCOs.
- Auto-Assignment Glitches: Over 100,000 Iowans were assigned to each MCO. These assignments were to consider existing provider relationships in that assignment, and keep famillies in the same MCO. As sometimes happens with techonology, there was a glitch that caused at least two families to be split up. According to Stier, the problem was not wide-spread and the situation has been fixed.
- Call Center Wait Times: Iowans concerned about the change to managed care, or having questions about how the transition will impact them, were told to call the Medicaid Help Line. Many people have complained that they were put on hold for hours, their calls were dropped, and questions went unanswered. Stier reported that they had investigated these complaints and found that their vendor had never increased call capacity and had not added more lines as requested. Those changes have now been made, and they have hired 24 more staff to take these calls. Stier added that they are now actively monitoring the lines to make sure calls are answered quickly.
The managed care organizations (MCOs) also updated committee members on their progress to date in signing up providers, and hiring staff. Currently, there are 29,961 Medicaid providers in the state.*
- Amerigroup reports that they have more than 8,000 providers signed up, including 11 hospitals. They have hired about 80% of their staff.
- AmeriHealth Caritas has signed contracts with 2 major hospitals, and is very close to having contracts signed with 2 more. They are just under 100% "critical position" staffing.
- United Healthcare reports that it has hired 85% of its staff and has signed contracts with 4 large health systems (University of Iowa, UnityPoint, Genesis, Covenant). They also report having signed contracts with 50% of Medicaid’s current fee for service providers, 90% of the long-term HCBS providers signed up, and 80% of the Behavioral Health providers. United Healthcare has been an insurance provider in Iowa for some time, so it has many existing relationships with providers (although these providers must sign separate agreements for the Medicaid population).
- WellCare has signed a contract with one hospital system, with two others very close to being signed. They now have 5,300 providers under contract and are at 76% staff capacity.
Medicaid staff and MCO representatives fielded many questions from legislators. Some wanted to know impacts on their providers, others wanted to know details about rates, but most wanted to know where the breakdown in communications was occuring, and how it can be fixed. To sum it up - most legislators just wanted to know what to tell their constituents. The biggest question was about providers - and how Iowans were to find out which providers had signed up with each MCO. The MCOs responded that people should call them directly, and that the information is updated daily on their websites. You can find links to these websites here.
Rep. John Forbes, a pharmacist by trade, expressed disappointment in the numbers of providers signed to date. "I'm disappointed with the numbers you are giving me - 8,000 out of 29,000 providers under contract? We are just 25 days away from the live date." Rep. Lisa Heddens, who has a son that receives Medicaid services, expressed similar disappointment, saying the numbers presented were only 17-26% of the current Mediciad provider network. That's one in four Medicaid providers - with less than a month to go before the system switches to managed care, and just days before people must choose an MCO (by December 17).
Legislators were pleased to find out all four MCOs planned to adopt the current Integrated Health Home model that has been operating in the state under the Magellan behavioral health managed care plan. Providers who participated in this program were concerned that they would have to replace the current model that has been working for Iowans with mental illness with potentially four new models.
Medicaid staff reminded legislators that contracts are being signed every day, and that the numbers are continuing to grow dramatically each day. After the meeting, Medicaid sent out this update on signed MCO provider contracts (click here).
*You may have heard that there are about 40,000 Medicaid providers in the state. That is true - there are about 40,000 individual providers of Medicaid services. However, many of them work for large health systems or work at the same clinic. Iowa Medicaid tracks provider contracts by tax ID number, so those that bill together are counted as one contract (because they contract together). By that standard, there are 29,961 Medicaid providers. This is the number that Medicaid is using to track contracting.
Health Policy Oversight Committee Next Steps
While the Health Policy Oversight Committee only met twice this year, it's importance will continue to grow as the managed care system rolls out. That is because the legislation that created it also required the Department of Human Services and the 11-member Executive Board of the Medical Assistance Advisory Council (MAAC for short) to begin hosting monthly meetings around the state starting March 2016 to continue to receive public comment on Medicaid managed care. These meetings are intended to continue to give the public a voice in the evolving system.
The full MAAC includes representatives of 56 provider, consumer, and advocate organizations - just about anyone in the state that has a stake in Medicaid is on the full council. You can see the full membership here. You can see who serves on the MAAC Executive Committee are:
- Gerd Clabaugh, Director - Iowa Department of Public Health (Chair)
- Dan Royer, Iowa Hospital Association
- Cindy Baddeloo, Iowa Health Care Association /Iowa Center for Assisted Living
- Dennis Tibben, Iowa Medical Society
- Shelly Chandler, Iowa Association of Community Providers
- Jess Purcell Smith, Iowa Pharmacy Association
- Anthony Carroll, AARP
- Kristie Oliver, Coalition for Family and Children’s Services in Iowa
- Jim Cushing, Iowa Association for Area Agencies on Aging
- Nancy Hale, NAMI Iowa
- Paula Connolly, Public Member (ASK Resources)
The Department of Human Services and the MAAC Executive Committee are to report on their findings, and develop recommendations for consideration by the Health Policy Oversight Committee. The Committee will then make a decision on whether legislative changes are needed to protect access to the services 560,000 Iowans need to live healthy, independent lives in their communities. These reports are to come to the Health Policy Oversight Committee four times a year (quarterly).
Advocacy Corner: Send Your Legislator a Holiday Card
Talking to your elected officials can be intimidating to even the most experienced advocates. But not all advocacy has to be serious business. Have some fun with it. One way you can jump start your communications with your legislators and other elected officials is to send them a holiday card. It could be as simple as:
Wishing you and your family a wonderful holiday. Thank you so much for your service to this state, and to me, your constituent. I know that you spend a lot of time away from your family to represent your district, and I want you to know that I appreciate it. Please add me to any email lists you have so that I can keep up to date on your work, and let me know if I can help you with anything. I am very interested in (insert your issues), and will happily give you my thoughts on it when I see you in the district! Thanks again, (add your name, contact information, phone, email, etc).
You can find your legislator's home address here.
2016 Guide to the Iowa Legislature Available Online
This is the last issue of INFONET for 2015. Normally we produce 12 issues in a year, but this year we are using our final issue to print a correction to the 2015-2016 Guide to the Iowa Legislature, which needed signficant updates after two special elections were held in November and December to replace Rep. Chuck Soderberg, who resigned from office to take a new job, and Rep. Jack Drake, who died of natural causes earlier this fall.
We have made updates to the 2016 Guide to the Iowa Legislature, and it is now available online here. While we have removed the former two legislators from committees, the new committee assignments have not yet been made. Those changes will be made as soon as they are available (likely not until early January). Please go ahead and make these changes in your Guide.
The Guide will not be reprinted, but we will mail out corrections when finalized and post the final version when completed. You can see the changes made to date here.