2012 Issue #9 September 14, A publication of the Governor s DD Council & ID Action CONTINUED ON PAGE 2

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1 2012 Issue #9 September 14, 2012 A publication of the Governor s DD Council & ID Action Advocate s Guide Now Available! Nothing is ever simple when it comes to Iowa s mental health and disability system. That s why we ve created a new Advocate s Guide to MH/DS Redesign and are hosting community discussions! PAGE 2 Survey Says Thanks to all of our readers for their excellent suggestions and comments on infonet. Every year we ask our readers how we are doing and what they would like to see changed or added to infonet s news coverage and website. Here is what you told us! You like infonet and say it helps you be better advocates. Nearly everyone said they were satisfied with the publication (99%) and the website (98%). You share infonet with others regularly - 7 out of every 10 readers forwards infonet on to friends, family, and others. Our readers don t just read about the issues they take action! Only 9% of you said you didn t take some type of action in the last year. Nearly 75% of you voted, and 69% contacted their elected officials to talk about issues important to them. Our readers spent the most time on two issues this year improving community supports and services (71%) and mental health/disability services redesign (64%). In this Issue PAGE 2 PAGE 4 PAGE 6 PAGE 6 Congress & Federal Budget DHS Council Passes Budget Request Update on MH/DS Transition Fund Rules Advocate s Guide to MH/DS Redesign & Community Conversations Town hall meetings are a great places to meet your elected officials. Find one near you at: CONTINUED ON PAGE 2 ADVOCACY REMINDER: Pre-register to vote before October 27, 2012 You can vote by mail starting September 22, 2012

2 Congress & the Federal Budget What it means to you and what you can do! It is no secret that the US Senate (controlled by Democrats) and the US House of Representatives (controlled by Republicans) are having trouble agreeing on federal spending for things like defense, disaster relief, farm subsidies, tax cuts, Medicaid/Medicare, Social Security, and education. The one thing Congress could agree on is that they need to find a way to cut spending in order to balance the budget. Right now, Congress is spending more money than it has in the bank. They keep borrowing money, but do not have a plan to pay it back. So they passed a bill last year requiring that they find a way to cut spending, or the budget would be cut automatically. The problem was, they could not agree on HOW to cut spending. Because of the bill they passed last year, Congress must find a way to cut $1.2 trillion in spending by the end of 2012, or programs will be automatically cut through a process called sequestration. Normally we would never use such an insider term, but it is important because you may hear about it in the news this year. Sequestration is a fancy word for an automatic budget cut. If Congress doesn t meet its deadline, the cuts start automatically to almost every program that gets federal dollars. So Congress has two choices this year: 1. Pass a bill that cuts spending the way they want this could be done with across-the-board cuts to all programs, by making bigger cuts to fewer programs, by increasing taxes, or any combination that adds up to $1.2 trillion. 2. Do nothing and cuts begin automatically Jan. 1, Congress will probably not pass anything before the November 6 election; they want to see who gets elected. But that doesn t give agencies and the people that depend on government programs much time to prepare. That s why you may start hearing about this in the news or from advocacy organizations. The $1.2 trillion in cuts has to happen over ten years, so the first year of cuts is $110 billion. Here is how the Office of Management and Budget plans to proceed if sequestration happens: Medicare payments to providers will be reduced by 2% ($11 billion in 2013), so Medicare providers will be reimbursed at 98 cents on the dollar. That may make it more difficult to find Medicare providers or access more costly specialty care. CONTINUED ON PAGE 3 Survey Says (continued) Eight out of every ten readers say their advocacy efforts were successful. Funding for services is the biggest issue for our readers in % are concerned about MH/DS redesign funding and 71% are concerned about Medicaid funding. Almost 2/3 of our readers say MH/DS core services remains an issue for them in Half of our readers say regionalization of the mental health and disability services system is an issue they will be watching. Our readers made some suggestions for improving infonet - publish more often and cover federal issues were the most common. While we cannot publish more often because of budget issues, we continue to expand our use of social media like Facebook and add more content to the website between issues. We will be looking at how we might provide additional Federal coverage read the article on this page for a start! Thanks to all of you that took the time to respond to our survey it really does matter! And congratulations to the winner of two free tickets to the Journey/Pat Benetar/Loverboy show at the Iowa State Fair Rhonda Meyer! 2

3 Congress & the Federal Budget (continued) Mandatory (required) programs will be cut by $5.2 billion, the biggest of which supports farm prices. Others include student loans, vocational rehabilitation, and the Social Services Block Grant. Some programs are exempt and cannot be cut, including Social Security, Medicaid, the Children s Health Insurance Program, SNAP (formerly known as the Food Stamp Program), child nutrition, Supplemental Security Income (SSI), refundable tax credits such as the Child Tax Credit and the Earned Income Tax Credit, veterans compensation and other benefits, and federal retirement. Other non-required programs are cut by $38.5 billion. Veteran s funding and Pell Grants cannot be cut, and cuts to community and migrant health centers are limited to 2%. Programs that will be cut pay for air traffic controllers, national parks, food and drug inspections, and science and technology research (to name a few). Defense spending will be cut by $54.7 billion, including the costs of wars and national security. The President has the ability to stop cuts that affect military personnel, but he would have to make it up in other areas of defense spending. It is hard to say how you personally might be affected if these automatic cuts go through. Here are a few of note: Funding for Aging & Disability Resource Centers (ADRC) will be cut by 8% ($1.4 billion). ADRCs are one-stop shops that provide information and assistance to people who need public or private resources. (Source: Office of Management and Budget) Funding for the Individuals with Disabilities Education Act (IDEA) will be cut by $1.2 billion. Almost $1 out of every $3 cut in education spending will come from programs for children with disabilities. An estimated 15,000 special education teachers could lose their jobs and fewer skilled support staff would be available to assist children with special needs. (Source: Center on Budget & Policy Priorities) Funding for federal housing programs would be cut by $94 billion which means more than 140,000 households that currently include an elderly person or person with a disability would receive lower levels of supportive services. Cuts in other areas would result in 1,000 fewer fair housing complaints investigated, fewer families accessing services, and longer waits to get rid of lead in homes where children live (a preventable cause of intellectual disabilities). (Source: Congressional Budget Office) Funding for the Social Services Block Grant to states could mean big cuts to social services programs. As you ll read later, funds for redesign may be in jeapordy if the DHS budget is adopted as proposed (using SSBG funds to pay for redesign). TAKE ACTION! All five of Iowa s US Representatives are on the ballot this year and all have people running against them. They are elected by you to represent you in Washington D.C. To do this, they have to know what you want them to do. So tell them! Remember, the squeaky wheel gets the grease. Find out who represents you in Congress (look on last page). Find out who else is running for that office. Find out when they will be in your area - then show up! Introduce yourself, and ask them what they will do about the federal budget. Let them know what your priorities are when it comes to federal programs and spending. Want tax cuts tell them! Want to make sure certain programs are not cut tell them! VOTE on November 6 for the person who best represents your point of view! Need more help? Find more info at 3

4 DHS Council Passes New Two-Year Budget This is the first step in the Iowa budgeting process. The Iowa Legislature passes budgets that tell government agencies how to spend money. But that is one of the last steps in a very long process. STEP 1 STATE AGENCY PRIORITES State agencies decide what they need, and how they want to spend money. They send these budget requests to the Governor. Budget requests must be sent by October. STEP 2 GOVERNOR S PRIORITIES The Governor looks at the agency requests, decides how much he wants to spend overall, and makes changes to agency requests to reflect his priorities. STEP 3 GOVERNOR S REQUEST The Governor gives the Legislature his budget request. This must be done by the end of January, but the Governor usually gives it to legislators right after his Condition of the State speech on the second day of session (January 15, 2013). STEP 4 LEGISLATURE S PRIORITIES Legislative budget subcommittees work together to develop a budget that reflects their priorities. A budget must be passed by the end of the legislative session (which is scheduled to end May 3, 2012). STEP 5 GOVERNOR S APPROVAL The Governor signs budget bills into law. He may also veto the entire bill, or just parts he doesn t like. The Legislature can add the vetoed items back but they almost never do. If the Governor vetoes the whole bill, the process starts over with Step 4. Budgets must be signed by June 30 of each year, or government shuts down. The Council on Human Services, which oversees the work of the Department of Human Services (DHS), finished its budget request (step 1) for the next two fiscal years, which begin July 1, 2013 (fiscal year 2014) and July 1, 2014 (fiscal year 2015). The entire budget request is online at: Partners/Reports/BudgetReports/Budgets.html. Here are a few items of note: 950,000 Iowans benefit from the programs and services provided by the Department of Human Services. 4 4 cents out of every Medicaid dollar is used to provide services to a person with a disability. 82 cents out of every dollar is spent on health care for low-income famiiles. Medicaid is the second largest healthcare payor in Iowa. Children account for 70% of the growth in Medicaid. DHS is requesting $138 million more in the next fiscal year ($1.8 billion total). In the second year, DHS is requesting $114 million more ($1.9 billion total). Despite these large increases, the budget is status quo. Almost half of the increases cover the $52 million shortfall (because the legislature didn t fully fund Medicaid and the MH/DS Redesign this year). The rest pays for changes in the federal Medicaid match (the federal government changed its match requirements, so states have to put up more money to get federal funding). The budget request does not include funding for the Medicaid expansion allowed in the Affordable Care Act (aka ObamaCare ). States may expand Medicaid to cover anyone earning less than 133% of the federal poverty level, not just those that are elderly, have a disability, or have children. The state pays for 90% of these costs in the first few years, but our Governor has said he does not want to do this expansion because the state will have to find a way to continue to pay for it in years to come. This will be a decision discussed by the Legislature in 2013 and if they want to do it, they will have to find more money. CONTINUED ON PAGE 5

5 DHS Budget (continued) The Affordable Care Act did require states to make some changes, which will cost the state $100,000 in the first year and $1.5 million in the second year. Those costs are included in the budget request, and are mainly a result of an increase in reimbursement to primary care physicians.] The new MH/DS Regional Services Fund is set up. DHS did not make a recommendation to fund the Property Tax Equalization Fund that the Legislature has promised to address in the 2013 session. But because legal settlement ends on June 30, 2013, DHS took the $13 million that had been going to pay for state cases and added them to the new MH/DS Regional Services Fund for distribution to counties/regions. There are two issues that arise with this recommendation: there is no recommendation on how this $13 million would be distributed (that is a legislative decision) and DHS uses Social Services Block Grant (SSBG) funds to pay for this. Using SSBG funds to pay for this could cause big problems for two reasons: SSBG is subject to automatic budget cuts called sequestration and others in Congress want to get rid of all SSBG funding. The total MH/DS budget for counties in the first year (FY 2014) is $13.4 million (SSBG funds): $11.4 million pays for services previously provided through the state payment program and $2 million for growth in those services. DHS will keep $1.1 million to cover any final state cases claims. The total MH/DS budget for counties/regions in the second year (FY 2015) is $37.3 million: $12.5 milion for services previously paid for by the state cases program, $4 million for growth in those services, and $20.8 million to fund new additional core services (comprehensive crisis services and precommitment screenings). It should be noted that the two new core services chosen to be the first funded are focused on persons with mental illness (which DHS estimates will make up 73% of the people served by the new system). There is no recommendation to fund the MH/DS Transition Fund, which was created to help counties get through this year. The Governor will need to make this request, since it pays for services in this current fiscal year (the DHS budget only covers the next two fiscal years, not extra funds needed for this year). It s never too early to start advocating on the budget! Each step in the budget process shows the priorities of the person or people creating it the state agency, Governor, and Legislature. You may ask yourself: What about MY priorities? At each step, you have the ability to make a difference. Go to our website for more help ( Step 1: State Agency Priorities Tell the agency s director and board members about your budget priorities. You can do this by calling, in-person meetings, s, letters, or testifying during the public comment period of meetings. Step 2: Governor s Priorities Contact the Governor s office and tell them why your budget priorities are important. Make the case by telling a personal story. Now is the time to take this step! Step 3: Governor/Legislature Immediately after the Governor presents his budget to the Legislature, contact your legislators and let them know what you like, and what is missing. Continue to make your case with a story. Step 4: Legislative Priorities Go to local forums, contact your legislators throughout session, and enlist others remind legislators of your priorities. Budgets are the last thing done in the session, so keep up the pressure. Step 5: Governor s Action You should contact the Governor s office to support items in the budget you like, or ask him to veto things you don t like. 5

6 UPDATE: MH/DS Transition Fund Rules Rules go into effect despite continued concerns from advocates. Advocates for mental health and disability services continue to express concerns about the rules drafted to create the Mental Health & Disability Services (MH/DS) Transition Fund. The transition fund will help counties get through this year, since they lost the state funds they had been getting for local services. Because of changes made by the 2012 Redesign, counties have only their local property taxes to pay for services, and that isn t enough money to avoid cuts in some counties. In the last month, the MH/DS Commission, the MH/DS Transition Committee, and the Legislature s Administrative Rules Review Committee have all adopted the transition fund rules. However, because they were developed as emergency rules, these groups were not allowed to make changes. Failure to adopt them would mean funds not getting to counties to provide services in a timely manner (once the Legislature appropriates these funds since the fund is empty right now). Advocates continue to express concern about three things: 1. The Transition Fund provides onetime assistance to support county services to targeted populations. Targeted populations are people with intellectual disabilities or mental illness. This leaves people with developmental disabilities living in the 20 counties that pay for their services wondering what will happen to them. 2. The Transition Fund prioritizes who will get the money first. Those earning between % of the federal poverty level may lose their services if legislators do not put in enough money to cover the need. 3. Counties must have sustainability plan that shows how they plan to maintain services without transition funds in the next two years. Many counties wonder how they will do that since they do not know what the Legislature will do, how much they will be allowed to get from property taxes, and the regions they will join. Continue to talk to your legislators, candidates, supervisors, transition committee members, and others about your concerns. Representing you in Congress: Sen. Charles Grassley Sen. Tom Harkin [US Representative] Representing State Capitol: [Representative]- [IA House Home Phone] [Senator] - [IA Senate Home Phone] Your New 2012 Districts are: Congressional: #[Congress2012] State House: #[IAHOUSE2012] State Senate: #[IASENATE2012] The Advocate s Guide to Mental Health & Disability Redesign is now available! This is a great tool for advocates of all experience levels. ID Action will also be hosting Community Conversations to talk about redesign. Contact us for more information at or infonetiowa@gmail.com. A publication of ID Action & Iowa s DD Council PO Box Des Moines, Iowa NON-PROFIT ORG. U.S. POSTAGE PAID DES MOINES, IA PERMIT NO [First Name] [Last Name] OR CURRENT RESIDENT [Address 1] [Address 2] [City], [State/Province] [Zip/Postal Code]-[Zip+4]