Policy, not dollars, may delay Iowa Republican agreement on human services budgets

DES MOINES — A House panel has approved a 76-page health and human services budget that would spend nearly $2.05 billion from the state’s general fund and another $425 million from other funds on Iowa’s myriad health and social programs.

That’s an increase of nearly $60 million in general fund dollars from this fiscal year’s budget, according to the Legislative Services Agency, but $14.5 million less from the other funds.

The budget approved Thursday by the House Health and Human Services Appropriations Subcommittee is more than the Senate’s $2.03 billion budget that would increase spending by $36.9 million.

The dollar differences may be less of a barrier to agreement — as well as to adjournment that is scheduled for the end of the month — than policy language majority Republicans have included in their budgets.

House position

House Republicans sent a “clear message” that their requirement — that health insurers pay for telehealth mental health services at the same rate as in-person treatment — must be included in the budget.

Access to telehealth is seen as key to improving the availability of mental health services across Iowa, which ranks 44th in the nation for psychiatrists per capita.

That need and demand for telehealth services has been highlighted by the coronavirus pandemic, HHS Appropriations Chairman Joel Fry, R-Osceola, said.

In the quarter preceding the pandemic, there were 9,386 uses of telehealth among Iowa’s Medicaid population, which covers 25 percent of all Iowans.

That jumped almost 2,000 percent — to 185,205 — in the next quarter, with the largest increases in behavioral testing, alcohol and drug abuse treatment, vision and hearing testing and evaluation and management.

Senate position

The Senate plan has two policy changes not included in the House budget: a real-time verification system for public assistance programs under the management of the Department of Human Services; and $50 million to implement the repeal of the mental health property tax levy with the state taking over funding of those services.

The latter is a non-starter in the House, Speaker Pat Grassley, R-New Hartford, told reporters Thursday.

“In its current form with no guardrails, I don’t see any interest in the House to begin down that path,” he said. “We really have to look at services, the inequity that may exist with services across the state, some regions offering more than others.”

Senate Republicans are “open to changes,” Senate Majority Leader Jack Whitver, R-Ankeny, responded.

“Our goal is stable, reliable funding for mental health and property tax relief,” Whitver said in a written statement.

Dollar details

The House budget plan, approved on a party-line vote Thursday, would appropriate $45 million more for Medicaid, including a $20 million increase for nursing homes, $11 million for home- and community-based services, $7.1 million for home-based services for disabled Iowans, $3.9 million for psychiatric medical institutions for children and $1 million to reduce the children’s mental health waitlist, and $2 million for home health provider rates.

Subcommittee Democrats said they would have liked more time to look at the budget, but its last-minute delivery was consistent with Republicans’ lack of transparency.

In their weekly newsletters, House Democrats said Republicans have reached a stalemate and are “refusing to compromise with each other and shutting the public and other lawmakers out of the budget process.”

Comments: (319) 398-8375; james.lynch@thegazette.com