Medicaid: A promise to keep

A number of years ago the state of Iowa made a commitment to reshape the manner in which support services are delivered to people with mental health or developmental disability related service needs. Effective July 1, 2014, the state of Iowa reshaped mental health and developmental disability (MH/DD) service delivery from a county-managed system to a regional service delivery model grouping Iowa's 99 counties into 15 regions. Ideally, this restructuring would result in more uniform service access and delivery across the state.

While the regional system still is a work in progress, there was another key component of the system redesign that involved the state of Iowa assuming fiscal responsibility for the non-federal share of Medicaid funded services. The idea was that the state could collect needed revenues and administer Iowa Medicaid, leaving regions to focus primarily on service delivery and funding for services not covered under the Medicaid umbrella. Assurances were made by state leaders that those who rely on Medicaid would not see their services reduced or eliminated due to this initiative but, rather, service access would improve under the new system.

Medicaid funding is based on the economic well-being of each state. The Federal Medical Assistance Percentage (FMAP) increases or decreases in accordance with the current state fiscal environment. The good news is that Iowa fared better than many other states during the recent recession. The bad news is that Iowa's share of federal funds (FMAP) has decreased each of the last several years, creating a significant funding gap for Medicaid services.

In short, having fared better than most states during the recent recession has resulted in the federal government funding a smaller percentage of Iowa Medicaid expenses each of the past several years. Since Fiscal Year 2012, Iowa's Federal Medical Assistance Percentage has decreased over 7 percent, resulting in the shifting of responsibility to pay for millions in Medicaid expenses from the federal government to the state of Iowa. In Fiscal Year 2016 alone, further reductions in federal funding are projected to result in a $56.1 million Medicaid shortfall in Iowa.

My employer, Discovery Living, Inc., is a local, non-profit provider of community-based residential supports to over 150 people with intellectual disabilities in the greater Cedar Rapids area. Medicaid is the primary source of funding for virtually every person we support. On a state level, Medicaid is expected to be accessed by over 800,000 Iowans in Fiscal Year 2016.

Clearly, a program the size and scope of Medicaid needs to be carefully monitored to ensure that Medicaid funds are utilized for their intended purposes. It is also important to remember that reductions in federal funding, which state leaders anticipated, should not be used as an excuse to compromise services for those who need them.

As the state budget is prepared, I hope our political leaders remember the commitment they made to their fellow Iowans and fully fund Medicaid.

' Robert Hebl is the executive director at Discovery living, Inc. Coments: bhebl@discoveryliving.org