Proposed Medicaid cuts threaten Hope Haven, disabled Iowans

June 28--Hope Haven will celebrate its 60th anniversary with a party Thursday recognizing the work being done on behalf of children and adults with disabilities across southeast Iowa.

Celebration aside, Hope Haven and organizations like it currently face the threat of a significant financial squeeze if Medicaid cuts are enacted to the extent proposed in the U.S. Senate's health care legislation.

Medicaid is a federal program that provides insurance to low income and disabled Americans.

In Iowa, 17 percent of children and adults rely on Medicaid for at least a portion of their health care needs, according to Kaiser Family Foundation data.

Hope Haven executive director Bob Bartles estimated 80 percent of the 500 people served by the organization are reliant on Medicaid.

"I've never seen a more harmful piece of legislation (with one exception) in regard to how it impacts persons with disabilities," Bartles said of the Republican-backed health care bill unveiled in the Senate Thursday. "The exception is President Trump's proposed budget."

Shelly Chandler, Iowa Association of Community Providers executive director, called it "by far the biggest threat to Medicaid we have ever faced."

The Iowa Association of Community Providers issued a statement last week urging their members to contact Iowa Sens. Charles Grassley and Joni Erst to convey their opposition to the bill.

Nearly 100 percent of community mental health and disability services are funded by Medicaid, Chandler wrote. Hope Haven is one of 145 IACP member organizations in Iowa that would see their funding dramatically reduced if the proposed Medicaid cuts are enacted.

According to estimates released Monday from the Congressional Budget Office, 15 million Americans would lose Medicaid coverage over the next 10 years under the Senate bill.

For Iowans who access mental health services through organizations like Hope Haven, states could request waivers to opt out of requiring essential health benefits such as behavioral health treatment, prescription drugs and emergency services. If a state opted out of coverage for mental health care, the CBO predicated insurance plans offering mental health coverage could become "extremely expensive."

Currently, Iowa is one of 31 states that adopted former President Barack Obama's Medicaid Expansion program offered through the Affordable Care Act, according to Kaiser Family Foundation data.

"The new bill shifts hundreds of billions of dollars in costs to the states. At a time when Iowa faces over $100M shortfall in its current budget year, this is clearly not sustainable," Chandler wrote. "We URGE you to ensure that revisions are made to protect the 140,000 Iowans who will suffer if this draft moves forward in its current form."

Hope Haven provides residential opportunities for people with disabilities, in addition to employment, community living and crisis stabilization services, all of which would be affected by reductions to Medicaid.

"If Medicaid gets slashed, some funding responsibilities will almost certainly get shifted to the counties," Bartles said. "That puts county funding at risk as well, since there will be new demands placed on the finite amount of existing county funding."

Senate Majority Leader Mitch McConnell of Kentucky announced Tuesday a vote on the proposed Better Care Reconciliation Act will not take place until after lawmakers return to Congress after the fourth of July holiday.

Hope Haven and other health care providers in Iowa also have been dealing with the aftermath of the state's decision to privatize Medicaid in April 2016. Although service reimbursements from the insurance companies have improved since the Iowa Health Link program was implemented, Bartles and others continue to face uncertainty with the new program as the Department of Human Services struggles to reimburse the three managed-care companies for some of their financial losses acquired through the privatization process.

The Des Moines Register reported in March the state's agreements with the insurance companies would help them make up for an estimated $450 million in loses since they took over the Medicaid program, which includes financing from the state and federal governments.

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