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Legislative Information
For information regarding some important issues at the federal level, please scroll down this page to "Full Range of Service Options at Risk".
State of Iowa Information:
May 2013 Update:
On a slim 51-49 vote, the House approved an alternative health care plan offered by the Governor last week instead of Medicaid expansion. The close vote signaled deep concerns about the Governor’s plan.
The Senate has offered a plan for Medicaid expansion and provides affordable health care to 150,000 Iowans who don’t currently have insurance through their employer. It would only be available to Iowans with annual incomes below 138% of the federal poverty level ($15,856 for a single person or $32,488 for a family of four).
The federal government would pay the full cost of the first three years and then pay at least 90% of all costs after that. The bill also includes an automatic opt-out of the expansion plan if the federal government does not keep its promise on funding.
The Governor’s plan would only cover 89,000 Iowans and it would cost Iowa taxpayers $163 million annually while also requiring more federal dollars compared to just expanding Medicaid. The Governor’s alternative also requires federal approval, which is uncertain at this time.
Last month, the Iowa House hosted a special public hearing on the issue and 87% supported Medicaid expansion compared to just 13% for the Governor’s plan. Testimony in support of Medicaid expansion included citizens of all ages, AARP, doctors, hospitals, and several other health care providers.
Lawmakers must take action this year because the current health care plan for low income working adults, called IowaCare, is set to expire in October. If no action is taken, 70,000 Iowans would lose their health care. The bill is now likely headed to a bi-partisan conference committee to reach an agreement. Any compromise plan approved by the Legislature must also win federal approval.
MH/DS Redesign
When the legislative session began, legislators were asked to act quickly to pass a bill providing transition funds for this year.
The House and Senate passed a bill to give counties $11.6 million in Transition Funds for this year, including $2.4 million for Scott County. The Governor signed the bill. These funds will help Scott County through the remainder of this fiscal year.
State legislators from Scott County are: Rep. Jim Lykam, Rep. Linda Miller, Rep. Steve Olson, Senator Joe Seng, Senator Roby Smith, Rep. Phyllis Thede, and Rep. Cindy Winckler. Their contact information can be found at this link: click here.
To contact the Governor, call 515-281-5211, write him at Office of the Governor, 1007 E. Grand Ave., Des Moines, IA 50319 or go to https://governor.iowa.gov.
The following link is a great newsletter that will provide much information about what is happening in Des Moines during this legislative session: click here.
MH/DS Reform Passes with Mixed Reviews
On the final day of the 2012 session, legislators passed the mental health and disability services system reform bill.
WHAT CHANGES IN THE NEW SYSTEM?
- Core services are defined. Core services must be available in all regions starting July 1, 2013 (but only as funding allows). Medicaid must also make sure that waiver programs pay for all of the core services (but it is also limited to available funding).
- "Core Plus" services are also defined. Again, these would be added as funding allows.
- Core services will be available only to people with an intellectual disability (ID) or mental illness (MI). Regions must be able to pay for all of the core services for people with MI and ID before they can begin serving people with brain injuries and other developmental disabilities (DD). Regions can continue to provide services to these people who are currently receiving services (but they do not have to if funding is tight, and no one new will be added until everything else is fully funded). Currently 20 counties provide services to people that have DD (other than intellectual disability).
- Regions may choose to provide services to people earning between 150-200% of the federal poverty level. Again, this is only if funding is available and regions can require this group to pay for a part of their services. Almost all counties currently provide services to this population.
- Defines "conflict free case management" so people can pick their case managers. Case managers must offer choices beyond what they provide and must honor these choices.
- Legal settlement ends on July 1, 2013. The county where a person lives will be responsible for managing and paying for the person's services. People may continue to go outside their county or region for services, but the county where a person lives must pay for those services.
- The State will now pay for all Medicaid services. DHS will manage and pay for all MH and DS paid for by Medicaid starting July 1, 2012. The Legislature gave DHS $40 million to take over payment for these services.
- Counties must form regions to fund and deliver all non-Medicaid services. Regions must be at least three counties, but no longer must have a minimum population. County property taxes would continue to fund non-Medicaid services. Regions must:
- Show they can provide all core services.
- Have at least one community mental health center or federally qualified health center in the region.
- Have access to inpatient hospital beds within the region or close to the region.
- DHS may grant waivers from the three-county region requirement. Counties would be allowed to operate as a single-county or two-county region if they can show they are capable of meeting all requirements on their own.
- A timeline for counties joining regions is in place.
- Regions will decide how they operate. Regions can decide how they manage their funds (joint regional account or separate county accounts). They will decide how they will work with service providers to make sure core services are available. They will make decisions about how they will track their performance and share information. The State will hold regions accountable for results; each region will have to sign a contract with DHS that outlines those expectations.
- A regional governing board will make decisions about the system, but only county supervisors are allowed to vote. Legislators wanted to make sure that the people making decisions about funding for regional services would have to answer to voters. For that reason, legislators were very specific about who could be on these decision-making boards, and who could vote.
- Regions must have a regional governing board made up of at least one county supervisor from each county in the region, one service provider, and one person who uses services or a family member.
- Regions must have advisory committees to get input from service providers and people using the services (or their familoy members).
- A regional administrator will be hired by the governing board to manage services in the region. Iowa law currently requires counties to hire a person to be a "Central Point of Coordination" (CPC) to manage county-funded MH/DS services. In the new system, there will be a regional administrator who manages a network of "coordinators of disability services" located throughout the region.
- As many as 50 sub-acute beds may be opened to address the needs of persons with serious and persistent mental illness.
- Work groups will continue planning for change. Work groups and committees will address financing the new system, transition from the current system to the new system, workforce shortage issues, outcomes and performance measures for the new system, regulation of sub-acute services, options to provide services to persons with other developmental disabilities and expanding services available to children with disabilities.
- DHS received $500,000 to provide technical assistance to counties as they organize into regions.
HOW ARE WE GOING TO PAY FOR SERVICES?
- The State will keep all money currently going to counties for MH/DS services ($170 million). The only state funds counties will receive are for state cases (which will go away when legal settlement ends July 1, 2013).
- The State got an extra $40 million to cover the shortfall. Medicaid will get the $170 million that had been going to counties, but that was about $40 million short of what they needed. However, counties say that the state will really need closer to $50 million to pick up the costs of all current Medicaid services. If the state doesn't have enough money to take over all services, some people may be put on waiting lists or the Legislature will have to give Medicaid more money when they come back in 2013.
- The county property tax for mental health and disability services is restored. Last year, the Iowa Legislature decided to eliminate this local property tax beginning July 1, 2013. If the state did not restore this property tax, counties would have no way to pay for non-Medicaid services and services for people who are not eligible for Medicaid. Currently, property taxes generate $125 million for local services, but they would bring in less than that under the new system.
- Beginning July 1, 2013, the state will "equalize" property taxes and counties will be allowed to spend $47.28 per sperson living in the county (per capita). Right now, counties are allowed to raise a total of $125 million from propety taxes - that's about $47.28 per person.
- Disputed bills that go back to July 1, 1997 will be written off by the state. These are bills that counties have said are not their responsibility and have refused to pay. This doesn't help counties pay for services, but it does address a source of confusion when looking at county financial information. There is an estimated $12 million in disputed bills statewide. Only bills disputed before July 2, 2011 will be written off. Bills disputed after that time will go through a new dispute resolution process that both DHS and counties support.
- Counties that received "risk pool" funds this year would be allowed to keep them for another year. Only four counties got these funds to avoid waiting list or service cuts, and some couldn't spend it all because of the timing of the awards. Counties needed to spend the money by November, or give it back to the state. This gives them until June 30, 2013 to spend it.
BUT HOW DO WE FUND THE SYSTEM THIS YEAR?
As you may have noticed, there is a timing issue with the change to the new system.
- Medicaid keeps the $170 million that had been used to support county-funded services starting July 1, 2012. Counties used these funds to pay for both Medicaid and non-Medicaid services.
- But county property taxes are not "equalized" until July 1, 2013. The Iowa State Association of Counties told legislators that counties need about $145 million to maintain non-Medicaid services and services to people not eligible for Medicaid next year. But they only have $125 million in local property taxes to pay for it. That leaves counties $20 million short in the fiscl year that starts on July 1, 2012.
Legislators did the following to address transition issues:
- Legislators set up a Transition Fund to help counties get through this transition year--but they didn't put any money into it!
- DHS will appoint a Transition Committee of stakeholders to make recommendations on the transition from the current system to the new regional one.
- A legislative interim committee will meet over the next two years to look at the financing of the new system.
To read the complete article click here.
To contact the Governor, call 515-281-5211, write him at Office of the Governor, 1007 E. Grand Ave., Des Moines, IA 50319 or go to https://governor.iowa.gov.
State legislators from Scott County are: Rep. Jim Lykam, Rep. Linda Miller, Rep. Steve Olson, Senator Joe Seng, Senator Roby Smith, Rep. Phyllis Thede, and Rep. Cindy Winckler. Their contact information can be found at this link: click here.
Full Range of Service Options at Risk
On May 3, 2012 the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register a proposed rule that would greatly effect the way services are delivered to people with disabilities. If the proposed language is adopted, settings like the HDC workshop and other services would be eliminated or severely restricted. Individuals would have fewer choices in their service options.
The time for comments to be accepted has passed; however, this is an important issue that will be hotly debated in the weeks and months to come. Click here for a sample letter that you can use to contact legislators.
At the end of August, the National Council on Disability published their final report calling for the phase-out of subminimum wages for people with disabilities. In essence, that move would close sheltered workshops and put thousands of people with disabilities out of work. ACCSES, The Voice of Disability Service Providers, has written a letter to President Obama in response to the final report. You can read the letter here.
Stay tuned to this website to remain informed.
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