‘Something’s got to give’ on Iowa’s proposed health and human services budget

CEDAR RAPIDS - After accomplishing the heavy lifting required to redesign Iowa's mental health services delivery system and create the Iowa Health and Wellness Plan during recent sessions, human services issues might not be front and center during the 2015 legislative session.

They won't be absent, however, because there are a number of tweaks and fixes required of those recent initiatives, according to Senate Human Services Committee Chairwoman Liz Mathis, D-Robins.

And then there is the budget.

The stage was set in December, when Department of Human Services Director Chuck Palmer presented a request for a 7 percent spending increase that would push state general fund spending for the department's programs and services above $1.9 billion.

The state 'can't handle that,” Gov. Terry Branstad responded. The request will have to be 'pared back ... in a thoughtful way.”

Adding to the budget pressure is the fact that federal matching funds will decline by tens of millions of dollars because the state has recovered from the recession better than other parts of the country.

'It's going to be a pretty tough year,” Mathis said. 'Something's got to give.”

On the positive side, Palmer said there have been savings generated by the state's mental health and disability redesign that shifted to a regional service delivery network and reduced costs associated with integrated health homes. Iowa hospitals saw charity care costs decrease by more than $32 million during the first six months of 2014.

The Iowa Health and Wellness Plan, the differential response approach to child welfare and the Mental Health and Disability Redesign - all approved by lawmakers in recent years - will change the way services are delivered to Iowans for years, according to DHS spokeswoman Amy Lorentzen McCoy.

Lawmakers want to know how costs can be contained and programs adjusted so services can be delivered effectively and efficiently to nearly 1 million Iowans - many of them children or elderly - who receive services through the department.

Lawmakers want to know they are getting the outcomes they sought when they approved changes, before they commit more resources to 'core-plus” services, House Human Services Committee chairwoman Linda Miller, R-Bettendorf, said.

'We're somewhat impatient to see those trends start to happen” she said, adding that the challenge for lawmakers will be balancing 'how much to spend to get the outcomes you want against there is no more money.”

So far, she's hearing a lot of ideas, 'but none with a lot of traction yet.”

'We have made a commitment to make this work,” Miller said. 'The Legislature has a moral obligation to follow-up. We're not sure what it will take.”

The budget won't be the only item on the human services agenda. Miller and Mathis have questions about how the state will provide services to juvenile female offenders a year after Branstad closed the Iowa Juvenile Home.

Although Mathis said that the teenage girls who were moved from the Toledo campus to other facilities 'have done very well,” Miller isn't sure anyone is 'truly satisfied that we've reached the best outcome.” The Iowa Juvenile Home 'was not the best fit,” she added.

'So if they can be taken care of in other ways, it's a gain,” Mathis said

Other issues that will draw lawmakers' attention will be grandparent rights, elder abuse issues and providing services to the 50 percent of Iowa seniors who are living at home, sex offenders in long-term care, services to Iowans with Alzheimer's and dementia, and how to attract health care workers to rural Iowa, according to Miller and Mathis. Miller also is concerned about fraud and abuse in human services - 'getting t he right service to the right person.”

'We always say we have no fraud and abuse, but Vermont looked at electronic benefit cards and discovered a third were being fulfilled in Florida,” she said. 'We can't just say we don't have fraud and abuse. We have to prove it.”

Mathis would like to continue the wellne ss initiative to address smoking, obesity and other preventable health problems. She wants to see more education than regulations, but says there is a role for legislators.

'Someone has to drive it, keep it on the front burner,” she said.