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Capitol Corner
 email Edition
for week ending
May 9, 2015

News from the State Capitol
Rep. Sandy Salmon

We enjoy hosting visitors from District 63
and from around Iowa:

Bridal Shower at the George Wythe House in Cedar Falls

Gathering at the George Wythe House, new home of Blake Conover’s Vision Media are longtime friends Angie Sorrell and Diane Prescott of Waverly, Lauri Conover of Cedar Falls, myself, and Cynthia Kressin of Janesville!
Medicaid Modernization

In January, Governor Branstad proposed a “Medicaid Modernization”, also known as “managed care”, plan to have private companies bid to manage portions of the Medicaid program.  This includes the Iowa Medicaid program, the Iowa Health and Wellness Plan and Healthy and Healthy and Well Kids in Iowa (HAWK-I) programs.  Eligibility and covered services will not change for members.  The Department of Human Services released a formal request to begin this process in March.  According to this proposal, between two and four managed care companies will get contracts to oversee Medicaid patients’ care. These companies must have a demonstrated capacity to coordinate care and provide quality outcomes for these populations.
The purpose of this “Medicaid Modernization” is to improve coordination, quality of care, and access to care for Medicaid patients while promoting accountability for health outcomes. Another purpose is to create more predictability and sustainability in the Medicaid budget for Iowa taxpayers.
This is not the first time that Iowa Medicaid has utilized managed care companies to coordinate care for a portion of the Medicaid program.  Iowa has used such companies to oversee parts of its Medicaid program, including care for people with serious mental illnesses and people with behavioral health issues. This is now spreading the managed care model to other parts of the Medicaid system. 

Jill Watson Visits the Capitol

HSAP teacher Jill Watson currently from Fairfield and formerly from Waterloo visits with me about funding for the HSAP program in the K-12 schools.

For example, in the current system, there is no financial incentive to prevent institutionalization.  The new system with unite health care delivery under one system.  The state will work with the federal government to obtain the authority to implement this new system.  
Thirty-nine states and Washington, D.C. use managed care. They have seen that it helps make sure members get effective health care with better outcomes.  At the national level, about 70 percent of people that receive Medicaid are under a managed care plan.
The Iowa Medicaid program has grown over 70 percent since 2003.  This is unsustainable for the state of Iowa. The transition is projected to save Iowa taxpayers $51 million in the first six months of the program.  The Iowa Medicaid program has 564,000 members and spends $4 billion of state and federal taxpayer money annually.
In 1965, Congress created two health care programs for different groups of Americans.  Medicare was created to provide a standard health plan for Americans over the age of 65.  It is run by the federal government - states have no role in its administration.
Congress also created the Medicaid program which is entirely different. This program provides health care services to those disabled Iowans with lower incomes.  Health services are provided to lower-income seniors, low income children and pregnant women, and those physically and intellectually disabled Iowans.  
Fifty two percent of the beds in our nursing facilities are occupied by those on Medicaid.  The state provides $20 million to $25 million dollars monthly to provide for their care.  Medicaid is also different from Medicare in the fact that the funding of the program comes from both the state and federal governments.  States pay up to fifty percent of the costs, based on a very complicated formula that differs from year to year and depends on how well each state’s economy does.

Spring Senior Recital

Esther Heise of Denver captivated a crowd of family and friends with beautiful and well-executed selections on the piano and violin for her senior recital. She graduates this spring and will go on to Wartburg College continuing her instruction in violin under Professor Daniel Kaplunas and in piano under Professor Suzanne Torkelson, both of Wartburg College. 

Sixteen years ago, in 1999, there were just under 200,000 Iowans enrolled in Medicaid. The budget spent $445.2 million on Medicaid, about 9% of the entire state budget that year.
Medicaid’s role in Iowa’s health care has grown significantly since then. Through this February, the number of people on Medicaid has doubled, rising to almost 404,000 Iowans.  This does not include the 57,000 kids currently covered by HAWK-I nor the 124,000 enrolled in the Iowa Health & Wellness program.  Currently, Medicaid consumes double the amount of the budget than it did 16 years ago, at 18%.
Last December, the non-partisan Legislative Services Agency reported that state revenue had annually grown by 4.1 percent.  State spending on our schools has risen by 4.2 percent.  Spending on the rest of state government, besides Medicaid, had grown by 1.9 percent.  Medicaid’s annual growth over this time period is 11.7 percent. 
Medicaid’s rate of growth is important to note, because the program plays a bigger role in the state budget each year.  The Legislative Services Agency has reported that, if no changes were made to the program this year, the state would need an additional $206 million to maintain the program at its current levels.  The Revenue Estimating Conference determined that the state’s new ongoing funding next year will only be $181 million more than what we are spending this year.

Eastern Iowa Leadership Summit

Jennifer Stevenson of Cedar Falls hosted a leadership seminar in eastern Iowa.  Speakers included David E. Carter of John Maxwell's Leadership Team, fellow Team member Jennifer Laughlin Stevenson from Cedar Falls, and Ryan and Rick Giarusso also of Cedar Falls. 
Further, Medicaid total expenditures are projected to grow by 24 percent in the next three years.  Medicaid is growing at about three times the rate of the rest of state government. 
In addition the better your state’s economy does the less money the federal government gives the state for Medicaid and the more money the state must come up with on its own to fund this program. This has been the case the last couple years for Iowa.
So the bottom line is we have to look for ways to slow down the growth in Medicaid costs.
Medicaid has a real impact on what can be spent in other parts of Iowa’s budget. You might ask where any potential savings from managed care for Medicaid would go.  There is a simple answer - schools.  As I mentioned earlier, if there were no changes made to Medicaid this year, all of the additional revenue would be consumed by Medicaid. There would be no money available for anything else in state government, including aid to our schools.
Iowans want to keep the education of our children as this state’s top priority.  In order for that to be more than words, we have to work together to control the growth in Medicaid.  We will not be the first state to use managed care to slow down Medicaid growth.  It is a reform that we must be willing to try, if we are to keep schools the top priority of our budget. 

Running an Amendment  

I offered an amendment voted by the House to be added onto the Education Appropriations bill. This amendment, intended to address the Common Core system of federal control, would prohibit the state from entering into an agreement with any entity that would share student data with the federal government.

Feel free to contact me with ideas, thoughts, and concerns. My phone is 319-987-3021 or you can email me at I want to hear what you are thinking and will listen to your input. Together we will work to make a difference for the future of Iowa. Thank you very much for the honor of representing you! 
For more details on the session you may click below for past Newsletters from the House Republicans:

4-16-2015 House Republican Newsletter
4-23-2015 House Republican Newsletter
4-30-2015 House Republican Newsletter
5-7-2015 House Republican Newsletter

*Some pictures may appear distorted depending on which email service you use.  I apologize for any inconvenience!*
Sandy Salmon
State Representative
Iowa House District 63

     9711 Streeter Rd .
     Janesville, IA  50647


Rep. Sandy Salmon is honored to serve her community in the Iowa House.  Please feel free to contact Sandy if you have questions or comments.