Updates

Posted: February 16, 2009

I wanted to update the membership with respect to IAHC’s advocacy efforts regarding the new Medicaid home health fee schedule.  Let me emphasize that our advocacy efforts have never been so important at a time when the state’s financial condition has rarely been worse.  In fact, Iowa DHS has proposed a 4% reduction in Medicaid provider payments in order to meet Governor Culver's FY09 1.5% budget cut order if additional funds are not identified.

As previously reported, IAHC is advocating that the new fee schedule be funded at a level equal to the federal Medicare LUPA (i.e. low utilization “per visit”) level.  This amount would increase payments for most Iowa home care providers over current levels and is easily justified when compared with alternative Medicaid fee schedule rate rationale such as “break-even” and “Medicare Episodic Equivalent” (see “Medicaid Fee Schedule Rate Analysis Comparison).  However, this fee schedule funding basis still represents a need for an additional $9M in appropriations from the Iowa legislature over last year’s amount (see “Medicaid Fee Schedule Analysis – LUPA Basis Detail).  Note: Since Medicaid is jointly federal-state funded only approximately $3M is required from state funds.

The IAHC Advocacy committee, individual members and our lobbyists have consistently shared our fee schedule funding request and associated rationale with various legislators over the past several weeks and months.  Starting with the “Ask Me About Home Care” legislator home care visit campaign to the IAHC “Day on the Hill” event held last Tuesday.  “Thank you” to all IAHC members who participated in this important advocacy event!

The response from lawmakers has been consistent.  We hear your message and understand the need but the state’s financial situation is dire.  Help from the federal government in the form of stimulus assistance is essential for state legislators to consider our request.

As you know, both the U.S. Senate and House passed stimulus legislation last week that the President is expected to sign tomorrow.  Attached is a report from the Center on Budget and Policy Priorities describing what Congress approved for Medicaid in the federal stimulus legislation. In particular, it includes a state-by-state breakdown of Medicaid dollars expected over the next three years. 

Iowa Highlights:

·         Iowa will receive an estimated total of $550 million over three fiscal years -- FY09, FY10, FY11

-          FY09 -- $150 million

-          FY10 -- $260 million

-          FY11 -- $160 million

·         Increased funding is based on an increase in the state's FMAP rate of 6.2% over nine quarters -- October 1, 2008 - December 31, 2010.  This means the federal share for Medicaid will increase by a minimum of 6.2% over this time period.

·         If the state's economic condition worsens as measured by an increase in the unemployment rate, a state can become eligible for more Medicaid relief.

·         A state must ensure that their Medicaid eligibility criteria and enrollment/renewal procedures are no more restrictive than those in place on July 1, 2008 in order to qualify for the increase in federal Medicaid dollars.

 It is expected that the federal action will impact the 4% reduction in Medicaid provider payments proposed by DHS to meet Governor Culver's FY09 1.5% budget cut.  We further hope that this federal action will improve our case for increased budget appropriations.  We will monitor this in the coming days in update you as we know more. 

As far as FY10, with approval of the federal stimulus bill, Iowa legislators will assess and begin to assemble their budget.  Budget targets for each subcommittee, in particular the Health and Human Services Appropriations Subcommittee, could be out as early as this week.

I would like to end this update with a renewed request to all IAHC members to convey our advocacy message to your local legislators.  You can get legislator contact information at www.IowaHomeCare.org under the “Legislative Action Network” link.  You can get the advocacy information referenced in this article at www.IowaHomeCare.org/DayOnTheHill.