March News 2013 (Issue #4)
Issue 4, 3/8/2013
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Articles in This Issue:
- Session Hits Halfway Point
- Budget Targets Announced
- Mental Health & Disability Services Redesign Update
- Governor Proposes Medicaid Expansion Alternative
- It's Here - Sequestration
- Funnel Highlights
- RSVP Now for Advocating Change Day 2013
- Grassroots Advocacy Center Makes Advocacy Easy
- All Advocacy is Local: Go to a Public Forum
- Bills of Interest
Session Hits Halfway Point
As we prepare to "spring ahead" and set our clocks for daylight savings time this weekend, the Iowa Legislature is also preparing to move ahead. Friday (March 8) was the first legislative deadline, called a funnel. To survive, bills had to be voted out of committee before the Friday deadline. Bills left behind in committee are dead for the rest of the year. Of course, there are always exceptions. Bills that spend money, deal with taxes, or are sponsored by the Government Oversight Committee or legislative leaders are "funnel-proof" and can be debated at any time.
Saturday (March 9) isn't only the day we move our clocks ahead, it's also the 55th day of the 110-day legislative session. While the session is now halfway through, the Governor has only received and signed three bills into law (two bills changing Iowa law to match new federal laws, and one bill addressing pipeline safety violations). If you think things will pick-up now that we're in the downhill side of session, think again!
This year, the close 53-47 Republican margin in the House and the closer 26-24 Democrat margin in the Senate are creating some problems with floor work, particularly in the Senate. Senator Tom Courtney of Burlington had emergency surgery two weeks ago, and has been out on medical leave. He is expected back at the Capitol sometime next week, but probably on a very limited basis. The Senate needs 26 votes to pass a bill, so one person's absence can really slow down the workings of the Iowa Legislature.
The Administrative Rules Review Committee waived its in-person voting rules on Friday, allowing Sen. Courtney to vote from his hospital bed via telephone. The Committee was voting on the Secretary of State's new rules that take suspected non-citizens off voter roles, rules which Senator Courtney has strongly opposed. While committees can waive their in-person voting rules, Senate rules require legislators be present for any vote taken on the floor.
The Senate can certainly take action on legislation that has bipartisan agreement. However, any bills that are controversial - budgets, education reform, tax reform, Medicaid expansion to name a few - will have to wait until Senator Courtney's return and will need to be scheduled on the days he'll be available to vote. We all wish him a speedy recovery.
The Legislature will also begin to switch focus toward the second legislative funnel deadline on Friday, April 5. For a bill to survive the second funnel, it must be approved by either the House or Senate and then approved by a committee in the opposite chamber. Legislators spend the majority of the four weeks between the funnels on the floor, debating bills. You can listen and watch live debate from your computers - just click here.
Budget Targets Announced
State government budgeting is a session-long process. It starts with the Governor presenting his budget requests. Then each of the seven budget subcommittees meets twice (sometimes three times) a week to learn more about each item in their budget. Subcommittees hear testimony from experts and interest groups on various issues. But they cannot really take action until their leaders tell them how much money they will have to spend on their area of the budget.
Last week, the House and Senate both introduced their "budget targets"- the amount of money each budget subcommittee will have to spend on programs and services in their area. But don't expect there to be too much detail in these targets - how the money is divided up is a decision of the budget subcommittee.
House Republicans want to increase spending by 3%; the Governor asked for a 4% increase, and Senate Democrats want 11% more for next year.
The House Appropriations Committee plans to move out their versions of the eight main budget bills this week - Administration/Regulation, Agriculture/Natural Resources, Economic Development, Education, Health/Human Services, Judiciary, Justice Systems, and Transportation. Two other budget bills come out much later in session - Standings (required spending set in law) and Infrastructure (gambling dollars for special projects). While the House plans to get their bills out onto the calendar soon, don't expect them to be in a rush to do anything with them. The Senate plans to do the same with their versions of the budgets.
The budget negotiation process is long, so legislators are just getting their initial bills in position so the talks can begin. Agreement is easy in some areas, while others (like Health/Human Services) always seem to be among the last bills passed in the session.
- The Governor's budget does not expand Medicaid as allowed in the Affordable Care Act ("ObamaCare") and does not include money for non-Medicaid services delivered by the new regional mental health and disability services (MH/DS) system.
- House Republicans do not include a Medicaid expansion (they were waiting to hear more about the Governor's alternative plan) but does include $29.8 million to pay for non-Medicaid MH/DS services. This $29.8 million was promised to counties last year when the MH/DS redesign passed. It funds the "Per Capita Equalization Fund" that ensures each county/region has $47.28 per person to spend on services to people living in their area.
- The budget proposed by Senate Democrats expands Medicaid to cover 150,000 low income Iowans and includes $29.8 million for the regional MH/DS system. The Senate plan does not address how that $29.8 million will be distributed - some say they are not thrilled with the "$47.28 per capita distribution formula" established in the MH/DS Redesign passed last year. In addition, their funds for MH/DS services come from the budget surplus, which could be a challenge for funding in later years.
Mental Health & Disability Services Redesign Update
The Legislature is making quite a bit of progress on many of the unresolved issues around the redesign of the state's mental health and disability services (MH/DS) system. Here's a quick review.
Money to help counties get through the rest of this year (Transition Fund). The Senate Appropriations Committee will take up House File 160 on Monday (March 11) at 2:30 p.m. This is the bill that allocates $11.6 million to 26 of the 32 counties that applied for Transition Funds to help them make it through the current fiscal year without cutting services or starting waiting lists. These "transition funds" were meant to stabilize the system as the state moved from a county based system to a regional one. Last year the state took all money that had been going to counties, but also assumed the responsibility of paying for the non-federal share of all Medicaid services. This "Medicaid Lift" helped some counties, but without state funds, other counties found themselves in trouble. Six counties that had applied for transition funds will not get money from this bill because they will end their year with some money left in the bank (although they will argue they need this cash balance to pay bill while waiting for property taxes to come in three months later). The 26 counties that would receive funds from this bill will also be at "zero" at the end of the year, so they too will have the same "cash flow" problem. If the Senate does not amend the bill, it will go straight to the Governor for signature. Senators are considering an amendment that would change the source of the funds, so counties would not run into trouble spending the money.
Money to help those other six counties (Transition Plus). Rep. Megan Hess of Cherokee has introduced a bill (House File 399) that allocates $750,000 to pay off a portion of the Medicaid bills in the counties that didn’t receive transition funds. Five of the six counties that applied for transition funds and were not included in the transition fund recommendations have outstanding Medicaid bills. This doesn't cover all of the obligations out there, but does help with some. The bill is in the House Appropriations Committee, where it is not subject to funnel deadlines. Rep. Dave Heaton of Mount Pleasant is assigned as the subcommittee chair, along with Rep. Dean Fisher of Garwin and Rep. Lisa Heddens of Ames.
Money for next year (Per Capita Equalization). The legislators serving on the Fiscal Viability Committee made several recommendations for changes in the redesign law, including passage of the $29.8 million needed to equalize funding for regionally delivered, county funded non-Medicaid core services. This $29.8 million equalization fund makes sure that every county has $47.28 per person living in their area to spend on mental health and disability services. The money goes out to counties that raise less than $47.28 per person living in their county; counties raising more than that amount locally must cut their property taxes and will not receive money from the state. Senate Study Bill 1199 passed out of committee this week, and will head to the Senate Appropriations Committee once it gets a new number. The bill as amended does a number of things:
- Appropriates the $47.28 equalization funds ($29.8 million) promised last year to help pay for core regional services to people not eligible for Medicaid or for core services not covered by Medicaid.
- Allows county mental health programs to pay for services to people in community-based corrections if funds are appropriated.
- Directs the MH/DS Commission to make recommendations on ways to better coordinate substance use disorder and mental health funding.
- Establishes a children’s cabinet to address the mental health needs of children (systems of care approach) and creates a Center for Child Health Innovation and Excellence to provide a policy forum for efforts to improve overall child health (subject to funding).
- Grandfathers in non-target eligibility groups currently served (regions are only required to pay for the "targeted populations" of individuals with intellectual disabilities and mental illness, even though many counties serve people with other developmental disabilities, people with brain injuries, and children with mental illnesses; this allows counties to continue to maintain this level of service).
While SSB 1199 passed out of committee, there is more work to be done. Some Senate Democrats don't like the "per capita equalization formula" that is currently in law, and would like to distribute the $29.8 million in a different (yet to be announced) way. House Republicans say it's the law, and they plan to live up to their promise to fund the current distribution. Counties say they've already set their budgets based on the $47.28, and they don't want to change course now. Seems nothing is ever simple when it comes to MH/DS services reform.
Governor Proposes Medicaid Expansion Alternative
Medicaid Expansion got a new number (Senate File 296) when it came out of committee this week (beating the funnel). The bill expands Medicaid to individuals earning up to 138% of the federal poverty level regardless of whether they have children (that's $25,571 for a family of three). It also sets up a new model of care, where services are integrated and the focus is on making sure the person stays healthy and gets the services they need, when they need them. Providers are then rewarded for improving the health of their patients. The state's limited benefit IowaCare plan would expire on December 31, with the expansion taking its place on January 1, 2014. The federal government has already appropriated the funds needed to pay for 100% of this expansion, which will eventually phase down to 90% federal share in 2020 and thereafter.
Republicans have been uncommitted as they waited to hear what alternative the Governor might propose. Many share the Governor's concerns that just expanding Medicaid doesn't mean Iowans will get healthier. They would like to include some element of personal responsibility (co-payments and deductibles), and wants to make sure the program improves health not just pays for the "cadillac of services."
The Governor proposed his Medicaid expansion alternative this week - called the Healthy Iowa Plan. it would replace the current IowaCare waiver, but still requires federal approval and an additional federal appropriation (while the Medicaid expansion is paid for already, this waiver would be a traditional split with the federal government picking up only 58% of the cost). The Governor would continue to limit benefits, and would require copays and deductibles that would be waived if a person agrees to certain prevention measures (like an annual health assessment). The cost to the state is $160 million - and the cost to the federal government is $227 million. Again, the federal government would have to approve the waiver, and then appropriate the new money requested (which opponents of his plan say adds to the national deficit).
The Governor's plan is paid for with $160 million from several new and existing appropriations:
- $42 million Broadlawns Polk County property tax levy
- $43 million county mental health property tax levies
- $12 million state appropriation now going to the University of Iowa Hospitals & Clinics
- $24 million new general fund appropriations
- $34 million in Medicaid "savings" reinvested in the program
- $7 million in participant premiums reinvested in the program
The Governor plans to use one-third of the existing $125 million of MH/DS levies, but the mental health benefits in the plan would likely be limited. Counties were quick to point out that they need every bit of their levies to pay for the existing demand for services, and are in the middle of a major redesign of service delivery. In addition, many county levies pay for services delivered to people earning from 150%-200% of the federal poverty level (whereas the Governor's plan only goes up to 100% of the federal poverty level). On the other side, Medicaid expansion is estimated to result in $40-60 million in savings to counties/regions when some of those receiving non-Medicaid services become eligible for Medicaid services.
We don't know if the program would be capped (that is, would only be available until funds ran out). So the Legislature is faced with the following choice:
- Expand Medicaid to those earning up to 138% of the federal poverty level, which covers as many as 150,000 Iowans at no cost to the state (and limited costs after the first three years). This option would include mental health and substance use treatment funding, and is already paid for by the federal government.
- Request the federal government approve the Healthy Iowa Plan waiver proposed by the Governor, which covers half the people (89,000) at a state cost of $160 million. The plan includes a limited benefit package that may include some mental health services, and takes $43 million away from the ongoing redesign of the mental health and disability services system. The plan would be subject to federal approval, and would require an additional federal appropriation of $227 million (adding to the federal deficit).
You can see a side-by-side comparison of the two plans here. You can find more resources on this issue here. Look soon for the ID Action network's next issue of Perspectives in Policy, which will include a more detailed analysis of the state's options in Medicaid expansion.
It's Here - Sequestration
You've heard a lot about it - the "sequester" - those automatic federal budget cuts that went into effect last week because Congress failed to work out an agreement to reduce federal spending and balance the federal budget. Iowa's top budget official David Roederer held a press conference on Thursday to outline the impact the "sequestration cuts" will have on Iowa. Roederer said education reading programs, public health, and workforce development will be hit the hardest by the $46.5 million cut in federal funding.
David Roederer, director of the state Department of Management, said initial reviews indicate 236 positions that are funded with federal money could be affected by employee furloughs or permanent layoffs if no changes are made by Congress. He said the cuts affect only about 0.4% of all state spending, which is more than $12 billion when federal funding and state spending are combined. He did not include impacts on state universities, which he did not expect would feel much of an impact.
“We believe we’ll be able to handle things without a whole lot of problems,” Roederer told reporters this week, but said that the problems could get worse. “This isn’t going to be short term,” he said. “This is not a good way to run anything, let alone a federal government.”
The breakdown of current year funding reductions included $14.1 million for education, $8.75 million for public defense, $4.32 million for human rights and $4.25 million for vocational rehabilitation. Click here for a spreadsheet showing all of the cuts.
Clean-up after a funnel deadline is like clean-up after a funnel cloud - there is a lot of scattered debries and it takes some time to pick through all the pieces to find out what can be saved. We hope to have our online Bill Tracker caught up and current by the end of next week, so please be patient with us as we work to make sure our list is accurate and complete.
We have a new feature in our Bill Tracker this year - at any time you can go back and look at the "dead bills" that didn't make it through the funnel deadline. Simply select "inactive" and you'll get a list of those bills that didn't make the cut this year. Click here to go to our Bill Tracker.
We know you may be getting tired of all the MH/DS Redesign coverage. While redesign definitely has the most potential to impact the lives of Iowans with disabilities, we did want to highlight a few other bills that may be of interest:
- Anti-Bullying (HSB 196) – Recent bullying incidents have caused lawmakers to close gaps in Iowa's anti-bullying laws. This bill does that by adding harrassment by electronic means (social networking, internet sites, emails) to the definition of bullying, and including all school property in anti-bullying zones (so that bullying that goes on at football games, in school buses and in school parking lots can be addressed). Right now, the only bullying teachers can address are inside school buildings. The bill also requires school districts to report bullying and any training offered to students and staff annually. The bill survived the funnel and will be managed by Rep. Josh Byrnes of Osage. It will be ready for floor debate as soon as it is redrafted as a committee bill (so it'll get a new House File number soon).
- Consumer Choice in Residential Programs (HSB 119 & SF 351) – Right now, up to five people with intellecual disabilities can live together in a residential program paid for by the Medicaid ID waiver. However, some people with intellectual disabilities want the option of living with people whose services are paid for by other Medicaid waivers. This bill gives them that choice by waiving that limitation - but the five-person cap remains in place. HSB 119 will get a new House File (HF) number before it can be debated. Rep. Rob Bacon of Maxwell and Sen. Joe Bolkcom of Iowa City will lead the debate on the bills (they are called "floor managers").
- Voter ID (HSB 23)- Iowa's Secretary of State campaigned on the need to prevent voter fraud by requiring Iowans to show government-issued photo IDs in order to vote. This bill requires such ID, and requires the Iowa Department of Transportation to issue free voter ID cards to those without driver's licenses. The bill will get a new HF number before being debated. The Iowa Senate says the bill is "dead on arrival" if it comes over, so prospects aren't good. Rep. Dawn Pettengill of Mt. Auburn is the bill's floor manager.
- Fuel Pump Accessibility (SF 235) - The House version of this bill died in the funnel, and the Senate version was amended significantly before passing out of the Senate Agriculture Committee this week, keeping it alive for at least another four weeks. The bill had required a large call button be installed near one pump at the gas station, which could be reached from inside a person's vehicle, and can be pushed with a closed hand. That language was removed after legislators expressed concern about the estimated $500 cost of adding the buttons (even though small businesses would be able to offset those costs with a tax credit). The amended bill calls for a sign to be posted on or near the accessible pump, listing the hours an employee is available for assistance and giving them the option of calling the site or honking their horn (an option that some advocates say is unacceptable because it calls attention to the person with a disability, and could make them feel vulnerable). The amended bill also requires the International Symbol of Access sign (blue sign with picture of white wheelchair) to be posted on the roadway sign listing the accessible pump's site name and gas prices. Finally, the amendment added a $250 fine for sites without an accessible pump, or not following sign requirements. The addition of this fine likely makes the bill funnel-proof, as it will need to go through the Senate Ways & Means Committee before it can be debated by the full Senate. If that happens, it can be debated at any time during the session. As in the previous version of the bill, the Iowa Department of Agriculture, as part of their annual inspection of gas pumps. will check to make sure at least one pump at each site is accessible per the ADA regulations, and that the appropriate sign requirements are met. Sen. Tod Bowman of Maquoketa will manage the bill when it comes to the floor for debate (and it will be getting a new SF number).
- Accessible Parking Passes (HF 493) - This bill, being managed by Rep. Bobby Kaufmann of Wilton, increases the penalties for a person who fails to return an accessible parking permit, and subsequently misuses it.
- Brain Injury Funding for Veterans (HF 348) - This bill allows money in the Veterans Trust Fund to be used for screening and treating veterans with military service-connected traumatic brain injuries. Rep. Dwayne Alons of Hull, the bill's sponsor and floor manager, is a veteran.
- Sex Offenders in Nursing Homes (HF 53) - The bipartisan sponsors of this bill (Rep. Joel Fry of Osceola and Rep. Bruce Hunter of Des Moines) continue to work out the details of this bill, which they started working on three years ago. The bill made it out of committee before the funnel deadline, and will get a new number, but both legislators say it still needs work and they welcome input. The bill addresses the placement of elderly sex offenders in nursing facilities. Before admitting a sex offender, a facility must access and search the sex offender registry to determine if the potential resident is a sex offender. The facility has to develop and implement a written safety plan for the sex offender. The plan has to include consideration for the safety of other residents. The facility can get a civil penalty for non-compliance. The facility can also discharge the sex offender based only on their status as a sex offender, and DHS is to find a placement option for them.
- Mental Health Advocates (SSB 1192) - This bill moves the responsibility for hiring and overseeing mental health advocates from counties to the Department of Inspections and Appeals (a move which makes them state employees). The bill also requires a person who is being involuntarily committed for substance use or mental illness be informed of their right to have a pre-application screening to determine the need for the commitment. The bill makes many other administrative changes, but also requires DHS to develop a bed tracking system so that courts and law enforcement officers can have acccess to real-time data on the availability of hospitalization beds (and not have to spend all their time calling around for placements). The bill is safe from the funnel, will get a new SF number, and is being managed by Sen. Rob Hogg of Cedar Rapids. It is likely the bill will continue to be worked on, as the House killed their version of the bill this week.
On a final note - the bill that created a career path for Direct Care Professionals, including training requirements and licensure, died in the funnel. Senate File 232 didn't get assigned a subcommittee until seven working days before the funnel making it difficult for a complex bill like this to emerge from committee. It is unlikely to get up enough steam to pass this year, but look for renewed advocacy to move the bill next year.
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 email@example.com or 866-432-2846.
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.
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.