February News 2013 (Issue #2)

Issue 2, 2/8/2013

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MH/DS Redesign Round 2

When legislators redesigned the Mental Health and Disability Services (MH/DS) system last year, they knew they left alot undone.  They set up a Transition Fund to help counties maintain services while the system is redesigned, but they didn't fund it.  They created a new equalization formula to get money to the counties that don't raise enough money locally, but they didn't fund it.  They required counties to regionalize, but they won't know what the regions will look like for two more months.

Over the last two weeks, several bills were introduced to start checking off that "to-do" list:

  • HF 98 fixes a problem that 45 counties were faced with after the Legislature adopted the new "Per Capita Equalization Formula" last session.  Beginning July 1, 2014, counties are allowed to spend $47.28 per person living in their county on non-Medicaid mental health and disability services.  Counties raising less than this amount from their local property taxes will receive state dollars to make up the difference.  Counties raising more than $47.28/person must lower their property taxes and won't get any state money.  Not all of the 45 counties in this position will need extra money, but some will.  This bill allows those counties to continue to collect more than $47.28/person if they need it (but they still won't receive state dollars).  Two Clinton County legislators sponsored this bill, Rep. Mary Wolfe (a Democrat) and Rep. Steve Olson (a Republican).  The bill is now in the House Ways & Means Committee.
  • HF 97 would require the newly formed MH/DS regions to pay for services delivered to children, as long as their diagnosis is covered under the regional management plan and a qualified professional associated with the child's school makes that diagnosis.  Because the state is currently required to pay for services to children, and the regions are required to pay for services to adults, this would be a new requirement that would require additional dollars over and above what the Legislature has discussed to date.   There are a few counties that provide outpatient, school-based services to children, but continuation of this is unknown under redesign as children are not a part of the "targeted population."   Rep. Pat Murphy, a Democrat from Dubuque, sponsored this bill.  It is currently in the House Human Resources Committee, assigned to a subcommittee of Rep. Linda Miller (Chair), Rep. Lisa Heddens, and Rep. Kevin Koester.
  • HF 117 distributes the full $20 million in transition funds as recommended by two MH/DS Redesign interim work groups (Transition Committee and Fiscal Viability Committee) and the MH/DS Commission. This funds all 32 counties that applied for transition funds, as well as others that are experiencing short-term funding problems.  The bill also requires counties to establish a payment plan to pay their Medicaid bills over a defined period of time (no deadline set).  This bill is an alternative to HF 160 below, and is sponsored by 30 House Democrats (lead sponsor is Rep. Lisa Heddens of Ames).  It is currently in the House Human Resources Committee, assigned to a subcommittee of Rep. Greg Forristall (Chair), Rep. Dave Heaton, and Rep. Mark Smith.
  • HF 160 distributes $11.6 million in transition funs to 26 counties, and requires all counties (whether receiving money from the transition fund or not) to pay their Medicaid bills by the end of next year.  Read more about this bill, which will be debated by the full House next week, in the next article.

  • HF 161 makes the new regional MH/DS system responsible for paying for non-Medicaid services to both adults and children.  There is no additional funding in this bill to help regions pay for these additional services.  Rep. Mark Smith of Marshalltown sponsored the bill, which s currently in the House Human Resources Committee and assigned to a subcommittee of Rep. Linda Miller (Chair)Rep. Lisa Heddens, and Rep. Kevin Koester.


If you see something that you like in these bills (or something you don't like) - contact your legislators.  If you want to do more, contact the members of the subcommittee and committee.  Click here to use our Grassroots Action Center to email your legislator.

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Transition Fund Debate Begins

You have probably heard alot recently about the "transition" from the old (county-based) to the new (regional) mental health and disability services system. We are currently halfway through the "transition year" - the year when counties have only their local property tax dollars to pay for non-Medicaid services and the several months of Medicaid bills that were received after July 1, 2012. 

For some counties, the transition year isn't a problem. They will have plenty of money to get through this year, and will start off on good footing next year.  Others have just enough to get through this year, but won't have any money in the bank at the end of the year.  Still others say they can't make it through this year without cuts to services.  So the Legislature created a Transition Fund to help those counties that need assistance to make it through the transition.  The trouble is, people have different thoughts on "need." 

Some counties say they need enough to get through the first quarter of the year, until property taxes are paid in October.  Legislators say that counties can just move money around and borrow from other funds until their property taxes come in.  Either way, the Transition Fund was created to help 1) stabilize county services at current levels; and 2) start counties off on the right foot toward regionalizing.

While there has been a lot of talk about it, the Transition Fund debate has begun, and it got heated at the Capitol this week as legislators disagreed about the amount of money needed to help counties maintain services as the state begins to regionalize its non-Medicaid mental health and disability services system.  

Last year, legislators reserved $20 million in federal funds for the Transition Fund, but didn't appropriate it because they wanted to see how much money was really needed by counties. DHS made three recommendations, but none used all of the $20 million.  Here are the amounts that the various groups recommended for the Transition Fund:

Transition Committee                 $20 million 32 counties
Fiscal Viability Committee $20 million 32 counties
MH/DS Commission $20 million 32 counties
DHS (Option 1) $11.6 million 26 counties
DHS (Option 2) & Governor $3.8 million 11 counties
DHS (Option 3) $1.5 million 3 counties

The House Appropriations Committee took up (and eventually passed) House FIle 160, which would distribute $11.6 million to the following 26 counties to help maintain services as the system is redesigned:

  • Adair ($140,478)
  • Adams ($150,742)
  • Calhoun ($27,386)
  • Clarke ($22,347)
  • Delaware ($89,618)
  • Dickinson ($56,565)
  • Guthrie ($122,708)
  • Jackson ($508,580)
  • Linn ($2.2 million)
  • Lyon ($158,780)
  • Madison ($311,109)
  • Marion ($366,429)
  • Monona ($136,657)
  • Osceola ($247,991)
  • Plymouth ($217,140)
  • Poweshiek ($12,667)
  • Sac ($372,522)
  • Scott ($2.4 million)
  • Sioux ($1,817)
  • Story ($752,700)
  • Taylor ($318,252)
  • Union ($597,792)
  • Warren ($1.4 million)
  • Wayne ($53,237)
The six counties that do not receive funding in HF 160 are Clay, Clinton, Des Moines, Muscatine, Polk, and Ringgold.  During the debate, it became very clear that there was a difference of opinion about why the transition fund was created, how much was to be put in the fund, and who should get it. 
“Some counties will have to make changes because they do more….some counties will have to cut back on services in order to get equalization for all,” said Rep. Dave Heaton of Mt. Pleasant.  "Some counties are already doing too much."   Many advocates expressed concern last year when the redesign bill passed that "equalization" would mean bringing all counties down to a common level (rather than raising them up to an equal level).  
Rep. Lisa Heddens of Story County, who is a parent of a child with an intellectual disability, offered an amendment to increase transition funding to $20 million.  It failed on a party-line vote (Republicans voting against, Democrats voting for). 
"This is a very personal issue for me as well…I feel for these families. I hear their stories.  They cry to me and they tell me what they are going to lose.  Who are we focusing on?" said Rep. Heddens. "This bill is well-intentioned, but I don't think it goes as far as it needs to. I have concerns with the dollars identified and I do believe there will be cuts in services. I would hate to start a regional syste already in a deficit situation.”

Rep. Tyler Olson of Cedar Rapids also defended the $20 million amendment.  "Most importantly, this (amendment) makes sure that hundreds and thousands of Iowans continue to receive the mental health services they need. There were a number of counties that applied for funds that were left out of this bill, and (the amendment) goes a long way to make sure the people in those counties continue to receive the services they need.  I look at this amendment as the ability to continue services…without it we will see counties cutting services." 

Even with the additional dollars, the 26 counties receiving transition funds will still have no money left in the bank at the end of the year.  So they and many other counties may have trouble getting bills paid and services delivered between July 1, 2013 (when the new fiscal year starts) and October 1, 2013 (when property taxes start coming in).  Legislators acknowledged this was a problem during debate, but said counties could borrow from other funds (as long as they pay it back before the end of the year).
The bill also requires counties receiving transition funds to repay all of their Medicaid bills before June 30, 2013.  All other counties are required to repay their Medicaid bills by June 30, 2014.  However, transition funds cannot be used to pay for Medicaid bills, so counties will have to find "other money" to pay for them.  And counties not receiving transition funds have no idea where they will get the money (because funding for the "equalization formula" has not yet been appropriated).

Legislators expect to debate House File 160 sometime early next week.  When the bill comes up for discussion, we will put a note on our Facebook page, so make sure you have "liked" us and you'll get a notice.  You can also listen and watch live debate from your computers at www.legis.iowa.gov.

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Voter ID & Sex Offender Bills Back For More Debate

The Iowa Legislature tabled discussion on two contraversial issues last year, but they are back again this year.

  • Voters would be required to show a valid driver's license or state-issued ID in order to vote if the Legislature passes SSB 1012, HSB 23, or SF 85.  Voter rights advocates say minorities and individuals with disabilities are less likely to have drivers licenses and IDs, adding barriers to voting.  Secretary of State Matt Schultz says showing an ID makes sure non-citizens are not voting.  The Democratic-controlled Senate has refused to take up these bills in the past, so don't look for much action this year.

  • A bill being discussed in the Iowa House of Representatives would require nursing homes, residential care facilities, and assisted living programs to check the sex offender registry before admitting a person to their facility, and to notify residents, their families, and local law enforcement when they accept someone who is required to register as a sex offender.  Iowa has more than 5,000 registered sex offenders, and about half of them are lifetime registrants (their names never come off the sex offender registry).  What to do with aging sex offenders is a big issue, and one that Rep. Joel Fry, Rep. Bruce Hunter, and Rep. Mark Lofgren are trying to tackle with HF 53.  Despite dozens of meetings last year, legislators were unable to come to agreement on what to do with these individuals, and how to guarantee the safety of other residents and employees of the facilities.  HF 53 passed out of subcommittee this week, and is set to go before the full House Human Resources Committee in the next week or two.  The bill also creates two work groups - one to study the workforce needs; and another to find a place for sex offenders not accepted in private facilities.


If you see something that you like in these bills (or something you don't like) - contact your legislators.  If you want to do more, contact the members of the committee.  Click here to use our Grassroots Action Center to email your legislator.

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50+ Groups Urge Legislative Action on Medicaid Expansion

More than 50 organizations came together last week to urge the Iowa Legislature to take action and expand the state's Medicaid program as allowed under the Affordable Care Act.  Federal health care reform gives states the option to cover more people using their Medicaid programs.  Iowans earning up to 138% of the federal poverty level would be able to receive Medicaid services.  Right now, you must have a disability, be elderly, or have a child in the home and earn less than 133% of the federal poverty level in order to qualify for Medicaid services.  As an incentive to help states expand their Medicaid programs, the federal government will pay 100% of the costs for three years, then slowly lower the match rate until the federal government pays 90% and the state pays 10%.  (Current Medicaid match in Iowa is roughly 40% state, 60% federal).

Governor Terry Branstad has said he will not consider a Medicaid expansion, because the federal government is not a dependable partner financially, and because Medicaid has done little to improve the health status of Iowans (so he would like to see signficant changes in how Medicaid delivers services, so that it focuses on outcomes as well as access).  

The following groups have come out in support of a Medicaid expansion:

American Cancer Society Cancer Action Network
AFSCME Iowa Council 61
Alzheimer's Association of Greater Iowa
American Heart Association
AMOS (A Mid-Iowa Organizing Strategy)
Brain Injury Alliance of Iowa
CHAIN (Community HVI/Hepatitis Advocates of Iowa Network) Community Health Charities Iowa
Communications Workers of America Iowa State Council Easter Seals Iowa
Epilepsy Foundation of Iowa
Every Child Counts (Child and Family Policy Center Initiative) HCI Care Services (formerly Hospice of Central Iowa)
Family Planning Council of Iowa
Hospice & Palliative Care Association of Iowa
Iowa Alliance for Retired Americans
Iowa Alliance in Home Care
Iowa Annual Conference of the United Methodist Church
Iowa Association of Area Agencies on Aging
Iowa Care Givers Association
Iowa Catholic Conference
Iowa Citizen Action Network (ICAN)
Iowa Community Action Association
Iowa Developmental Disabilities Council
Iowa Federation of Labor, AFL-CIO
Iowa Hospital Association
Iowa Human Needs Advocates
Iowa Medical Society
Iowa Mental Health Planning Council
Iowa Nurses Association
Iowa Occupational Therapy Association
Iowa Olmstead Consumer Task Force
Iowa Public Health Association
Iowa Primary Care Association
Iowa Psychological Association
Iowa Statewide Independent Living Council
League of Women Voters of Iowa
Leukemia and Lymphoma Society, Iowa Chapter
Mercy Health Network
NAMI (National Alliance on Mental Illness) Greater Des Moines National Association of Social Workers, Iowa Chapter
National Multiple Sclerosis Society, Upper Midwest Chapter Polk County
Planned Parenthood of the Heartland
Progressive Action for the Common Good
Progress Iowa
Results (The Power to End Poverty)
South Central Iowa Federation of Labor, AFL-CIO
Visiting Nurse Services of Iowa 

Two bills have been introduced to expand Medicaid - House File 83 and Senate File 71.  The first subcommittee meeting on Senate File 71 will be on Monday, February 11 at 10 a.m. in Room 22 at the State Capitol.  Sen. Pam Jochum is chairing the subcommittee, which also includes Sen. Jack Hatch of Des Moines and Sen. Nancy Boettger of Harlan.


Learn more about Medicaid Expansion in ID Action's upcoming "Perspectives in Policy."  Let your legislators know what you think about expanding Medicaid using our Grassroots Action Center.


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RSVP Now for Advocating Change Day 2013

The Iowa Developmental Disabilities Council, ID Action and Polk County Health Services invite you to participate in Advocating for Change Day 2013.

Advocating for Change Day is a day specifically for Iowans affected by disability to become skilled at communicating with their legislators and other elected state officials.  As a participant you will have the opportunity to learn how to develop and deliver an effective message, visit with available legislators and other elected officials and lobbyists, and watch the legislative process from the galleries (when the Senate and/or House are in session).  The event is free, and a free lunch will be available for all registered participants.

Fill out the online form to get registered for the event. Register to attend by March 13, 2013  to guarantee your free lunch. You can register up to 30 people per form. If you need to register more please contact ID Action atcontactus@idaction.org or 866-432-2846.

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Grassroots Advocacy Center Makes Advocacy Easy

infoNET has added a new tool to your advocacy toolbox - the Grassroots Advocacy Center.  You do not need to know the names of your legislators, the Governor, or the people that represent you in the US Congress.  If you know your address, our Grassroots Advocacy Center will match you to your elected officials, and automatically find their emails for you. All you need to do is write your message and hit "send."  It's just that easy.  So try it out - click here to get started.

If you need more help in crafting your message, make sure you check our new infoNET website for more information (www.infonetiowa.org) and ID Action's new Advocacy University website (www.advocacyuniversity.org).  You will find lots of useful information and videos other advocates have made to help you get started.

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All Advocacy is Local: Go to a Public Forum

Local advocacy is the best advocacy. Your legislators come home to their legislative districts on Fridays-Sundays during the legislative district, and many hold open public forums during that time. They call them by many names - public forums, town hall meetings, listening posts, Eggs & Issues, Pizza & Politics, legislative breakfasts, legislative forums.   But they all give legislators a chance to talk to the people they represent, answer their questions, and hear their concerns.  They are great and highly effective ways to advocate.

To find a forum near you, click here.  
For tips on going to a forum, click here.

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Bills of Interest

You can find bills of interest to Iowans affected by disability here.  We update our bill list daily, adding new bills and changing them as they move through the process.  Check back often as this changes daily.

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