The Fry Times

This week, the House and Senate released an agreement on the Health and Human Services Budget for FY 2024. Below is a list of highlights of the significant investments to advance access to mental health and support Iowa’s nursing homes. This budget appropriates $2.124 billion of state general fund (in total with federal money and other funds it is over $6 billion) towards Medicaid, child care, child welfare, public health and aging and veteran services.

1. Mental Health and Substance Abuse

– This budget provides $13 million in increased state funding towards mental health and substance abuse Medicaid rates. In total with federal funding, this is over $35 million increase to ensure that the state can recruit and retain mental health providers to care for Iowans in need. These increases came based on a Medicaid rate review that compared Iowa’s mental health rates to surrounding states and to Medicare.
– Provides funding and employees to specialize the Independence Mental Health Institute to behaviorally complex youth and the Cherokee MHI to acute and forensic adults.
– Increases funding towards Iowa’s Mental Health and Disability Services Regions based on the state completely taking over the funding of the MHDS Regions last year.

2. Nursing Homes

– Provides $15 million of state funding (meaning over $40 million of total funding) increase to Iowa’s nursing homes. Unfortunately, Iowa’s nursing homes have faced significant challenges with workforce, more complex patients, and closures in recent years. This funding, along with a provider tax increase, will ensure Iowa’s nursing homes are on a stable path going forward.
– This budget includes a $68 million increase to the Quality Assurance Assessment Fee. On April 1, the contribution rate increased and has brought in additional federal funding that goes directly to Iowa’s nursing homes ensuring quality care is provided to Iowa’s seniors.

3. Family Medicine OB Fellowships – Funds 4 annual family medicine obstetric fellowships every year. In order to participate, the family medicine doctor must sign an agreement with a teaching hospital to participate in the fellowship for one year, and then commit to remaining in Iowa and serving rural and underserved areas for 5 years after completing their fellowship.

4. Child Welfare

– Provides $1.3 million increase to Iowa’s child welfare workers. The state has had a difficult time recruiting individuals to these positions to help Iowa’s children in need.
– Increases the allowable expense for nonrecurring legal fees from $500 to $1000 per child for reasonable, necessary costs directly related to the legal adoption of a child eligible for Iowa’s adoption subsidy program.

5. Workforce for difficult to serve Iowans:

– This budget maintains the $14.6 million increase to home and community-based service providers and $7.4 million intellectual disability waiver waitlist buy down that began this year by committing $5.5 million to fund quarter 4 of FY2024.
– This budget maintains the $3.8 million appropriation provided last year to Qualified Residential Treatment programs by ensuring that a future shortfall does not occur to the child and family services section.

6. Health and Human Services Alignment – this bill continues the work done over the last 2 years regarding alignment of Iowa’s health and human services programs, including adding in aging, human rights, child advocacy board and volunteer programs.

7. Medicaid disenrollment – For the last two and a half years, the federal government has prevented states from disenrolling ineligible Medicaid members. This has results in an estimated 100,000 ineligible Iowans receiving free health insurance, without paying any premiums or copays, and the state paying a monthly capitation payment for every single ineligible member. This bill ensures that the state disenrolls these individuals as soon as possible this spring/summer.

8. Establishes a Public Assistance Modernization fund to enhance IT capabilities for Iowa’s welfare programs. This will streamline applications for Iowans as well as ensure that those on the programs are truly eligible for the entitlement program.

9. Providesa $500,000 increase to the more options for maternal support program that will focus on promoting healthy pregnancies and childbirth through nonprofits that provide pregnancy support services. This bill also allows the funds to carryforward to future fiscal years as DHHS goes through the RFP process.

10. Provides a $200,000 increase to the Veterans Home Ownership Assistance Program, allowing 40 more veterans to receive grants every year.