Gov. Terry Branstad approved plans Friday to require increased accountability for Iowa’s newly privatized Medicaid health care program while taking final action on 30 bills and the state’s $7.35 billion general fund budget for the upcoming fiscal year.
The Republican governor vetoed portions of a broader health and human services budget bill. But he left intact all the oversight requirements placed on private companies contracted to manage Iowa’s $4.2 billion Medicaid health insurance program, which helps 560,000 low-income and disabled Iowans.
Branstad also rejected a study of charging user fees for state parks; agreed to exempt natural hair braiding from cosmetology licensing requirements; approved money to repair the Iowa Capitol’s golden dome; agreed to allow some psychologists to prescribe drugs; and expressed hope that Iowa’s drug courts will remain in operational despite status-quo budgets.
The Medicaid oversight language was one of the last measures passed by the Iowa Legislature before it adjourned last month, and it was unclear whether Branstad would approve it. The bill includes provisions requested by Republicans that require data reporting to ensure managed-care organizations are meeting outcomes standards. It also includes a request by Democrats for an additional long-term-care ombudsman who has expanded and strengthened oversight authority.
Branstad wrote that he appreciated that the Legislature agreed in a bipartisan manner that a modernized Medicaid program is needed to focus on health outcomes to improve the lives of the most vulnerable Iowans. Iowa will now have nearly 1,000 measurable results tracking the outcomes of Medicaid patients, he said.
“By signing into law every Medicaid modernization oversight item, Iowa’s Medicaid program will be one of the most transparent, outcome-focused and accountable programs in the country,” he added.
Iowa began a process to transition management of its Medicaid program to private companies in 2014.
Jason Clayworth/The Register
State Sen. Amanda Ragan, D-Mason City, chairwoman of a Senate budget subcommittee, said she was pleased Branstad approved the oversight provisions. But she and other Democrats still have serious concerns about having private companies assume management of Iowa’s Medicaid program. Democrats have expressed worries that Medicaid recipients will be shortchanged on health care by private firms seeking to boost profits. Branstad counters that the change will help curb taxpayers’ costs and improve health care outcomes.
State Rep. David Heaton, R-Mount Pleasant, chairman of a House budget subcommittee, said the oversight legislation does a good job of representing consumers, providers and the Legislature and will ensure a “super transparent” Medicaid program. However, he was disappointed Branstad vetoed provisions in the health and human services bill aimed at helping hospitals and physicians affected by the change to managed care. The governor’s vetoes will ensure certain cost-saving measures will proceed.
“We would have liked things to go the other way, but we know he has an item veto, and we know what he can do, and that is the way the process works,” Heaton said.
PREVIOUSLY: Medicaid shift brings lots of hassles, few catastrophes
Branstad also approved controversial provisions in the health and human services bill that would allow nursing homes and hospitals to collect an additional $206 million annually from the Medicaid program. Ragan said it’s important to note the plan must still be approved by the federal government.
The additional money would be obtained through a series of steps in which nursing homes would give their state license to a county hospital but the homes would maintain ownership and management structure. (Medicaid pays county hospitals and their affiliated nursing homes more than it does unaffiliated nursing homes.) Under Iowa’s new “supplemental payment program,” the hospitals and nursing homes would then split the Medicaid revenue.
The arrangement would not have any impact on the state budget, because the hospitals would reimburse the state for its share of the Medicaid expense. Medicaid is funded by both the state and federal governments, and under the new program, hospitals would keep the larger portion of Medicaid funding that comes from the federal government.
Sen. Robert Dvorsky, D-Coralville, chairman of the Iowa Senate Appropriations Committee, said it appeared that Branstad may have backed off on some possible budget vetoes this year. He said the governor’s vetoes last year, which included the rejection of $55.7 million in state spending for pre-kindergarten-through-12th grade schools, “really soured the atmosphere with the Legislature.” Another factor this year is that spending approved by the Legislature this year has resulted in “an extremely tight budget,” Dvorsky said.
Here is what happened on some other bills as Branstad wrapped up his work on the 2016 Legislature’s session:
Branstad approved legislation to establish regulatory standards for boarding schools, hoping to avert the types of serious problems reported at the now-closed Midwest Academy for troubled youth in southeast Iowa. State and federal authorities raided the academy in late January after two staff members reported alleged sexual abuse. Subsequent reporting by The Des Moines Register showed that law enforcement officers had received about 80 calls to the academy since January 2013, five of which included sexual abuse allegations. However, in the 13 years since Midwest Academy opened in Iowa, no state agency had inspected or monitored it, and state officials said they lacked regulatory authority over many aspects of the facility’s operations. The legislation establishes minimum health and safety standards and will require children’s residential facilities to either obtain a state license or certification.
Golden dome repairs
The governor approved a state infrastructure appropriations bill that includes $10 million to repair the crumbling golden dome at the Iowa Capitol. The work is expected to begin later this summer. The measure also requires repairs at the Iowa Law Enforcement Academy, which has been plagued by black mold, to be given priority for major maintenance funding.
Branstad approved provisions exempting natural hair braiding from cosmetology licensing requirements and vetoed requirements that people involved in natural hair braiding take an annual course and be inspected by the Iowa Department of Public Health. He said licensing and regulations should only be required when needed to protect public health and safety.
State park fees
The governor vetoed plans for a feasibility study of charging fees to use state parks. He noted that state parks charged fees in the 1980s and found that Iowans “greatly disliked them.”
Branstad signed a bill providing money for Iowa’s justice system, and he said he supports the mission of drug courts operated by Iowa’s community corrections programs. Given status-quo funding, he said he is challenging community corrections officials to find ways to maintain drug courts.
Psychologists prescribing drugs
Branstad approved legislation that will permit some psychologists to prescribe mood-altering medications if certain requirements are met. Psychologists say the change can help the state cope with a critical shortage of psychiatrists, which often leads people to wait months for appointments. But the legislation was strongly opposed by Iowa psychiatrists, who contended that psychologists don’t have extensive medical training in how the body functions.
The governor signed legislation that means crime victims, particularly victims of domestic violence, won’t have to worry about being kicked out of their rental properties if they call police. Officials from the American Civil Liberties Union of Iowa and the Iowa Coalition Against Domestic Violence contended that some municipal nuisance ordinances have made people think twice about calling 911 because they fear eviction or discrimination by a landlord.
Elite baseball tax break
Branstad approved a $2.5 million state tax break for an elite baseball tournament facility proposed in the Cedar Rapids area. The legislation is aimed at helping the development of the nonprofit Prospect Meadows ball fields on a 121-acre site just north of Marion as a place to hold regional baseball tournaments. The proposed complex would include eight large regulation baseball fields and eight smaller fields with 300-foot fences, plus one “miracle field” for people with disabilities and special needs. The legislation places $5 million cap on sales tax rebates for such projects and limits the awards to two projects.