State Capitol Report

January 20, 2024

Legislature Back in Session

The Iowa Legislature is back at it in Des Moines. Before we recap what has happened in the first two weeks of this legislative session, we wanted to review a few details:

• This is a 100-day session. April 16 will be the final day legislators receive a per diem to offset their costs of serving, and they will no longer have a clerk after that date to help them answer emails and perform administrative functions. So while they can go longer than the 100th day, there is incentive to get done on time.

• Friday (January 19) was the final day for legislators to request individually-sponsored bills. Committee chairs can still request study bills, but legislators who wanted to sponsor a bill under their name had to have their requests in by January 19. In the first two weeks, legislators introduced 352 new bills.

• There are two "funnel" deadlines that are one month apart. The first deadline (February 16) is when bills need to be voted out of their originating committee. The second is March 15, when bills need to be out of the opposite chamber's committee. So House bills out of Senate committees, and Senate bills out of House committees. These deadlines do not apply to budget, tax, and government oversight bills.

• The public can watch subcommittees and committees online. The House uses a Webex platform, and the Senate uses Zoom. The Senate also allows remote testimony via zoom in subcommittees, which is a great option for mental health professionals that want to weigh in with their expertise but can't afford to take the day off to drive to Des Moines for a 10-minute meeting. However, note that you must sign into a zoom account to participate (it can be a free account - it's to avoid horrible zoom bomb attacks). You can find schedules and links to meetings here.

Governor's Policy Priorities

Governor Kim Reynolds gave her annual Condition of the State speech on Tuesday, January 9. Tax cuts, setting up families for success, and government efficiency remain themes for the Governor in 2024.

• Accelerate income tax cuts enacted in 2022 by moving the current 3.9% income flat tax rate to 3.65% in 2024 and 3.5% in 2025. According to the Governor's budget documents, this would "save Iowans" $3.8 billion over the next five years.

• Cut the number of state boards and commissions in half, as recommended by the Boards & Commissions Review Committee. No bill on this yet, but IPA is concerned about the proposed merging of the boards of psychology, social work, and behavioral health.

• Create a new Thrive Iowa effort to connect Iowans in need to non-profit and private resources, using a system of navigators. The focus is on helping Iowans achieve long-term independence by connecting them with non-government resources. 

• Give new moms earning up to 215% of the federal poverty level Medicaid coverage for 12 months after birth. Currently Medicaid only continues for 30 days if they earn less than 380% of the federal poverty level. Iowa is one of three states that have not yet done this (Idaho, Iowa, Arkansas). Rep. Ann Meyer has introduced a bill (HSB 500) to extend coverage for 12 months without changing the income eligibility. IPA supports HSB 500. 

• Change in how mental health, disability, substance use, and other addiction treatment is delivered. You can read this plan and look at proposed maps here.

• The 13 existing MH/DS regions would be eliminated and replaced with 7 Behavioral Health Districts that coordinate mental health services, substance use and gambling treatment, and tobacco (anti-smoking) partnerships.  A lead agency would coordinate these services, through a contract with Iowa HHS. Each district would have an advisory council (not governing board) that includes equal membership of elected officials, persons with lived experience, and providers.

• Regional disability services would be moved to the Aging & Disability network, which would be built out to include more Aging and Disability Resource Centers (ADRCs) that have expertise in disability services. Currently the state’s only ADRCs are housed in Area Agencies on Aging, which never received funding to expand beyond aging programs. The plans for this part of the system have not yet been released but are on the same schedule (implementation 7/1/2025).

• Overhaul the state’s Area Education Agencies (AEAs), which provide special education and other services to Iowa schools. Governor Reynolds says that Iowa’s students with disabilities are performing below the national average, even though spending for special education is $5,331 more per student than the national average. 

• There are currently nine AEAs that offer special education, media services, and professional development for teachers. Under the Governor’s plan, AEAs would no longer provide media service and professional development. They would only be allowed to provide special education services, which would reduce property tax funding by $69.7 million.  

• The state would receive $20.1 million in current AEA funding to support the new Special Education Division in the Iowa Department of Education. Funds currently dedicated to AEAs for professional development ($2.1 million) and mental health training ($3.38 million) would be used to help the Department support local schools in these areas.

• AEAs would no longer be governed by local boards (but would still have local advisory boards). Oversight of AEAs would come from the Department of Education (which will hire 139 employees charged with improving and overseeing the new special education system). 

• School districts would no longer have to pass their special education funds on to their local AEA. They will keep funding for special education and will individually decide how to use these funds. They can continue to contract with their local AEA or another AEA. They can also decide to contract directly with professionals or provide the service on their own. 

• The Governor received significant backlash from legislators, AEAs, school districts, and parents on this proposal. She issued a press release this week saying she is going to work with legislators to address some of the issues brought up. She followed that with an Open Letter to Iowans on Improving Special Education. The Governor's original proposal is House Study Bill 542 & Senate Study Bill 3073. We have not yet seen the amendment.

Legislative leaders laid out their priorities during the first week of the 2024 legislative session. Common themes from Republican leaders include:

• Lowering taxes for Iowans.
• Making government work better for Iowans.
• Moving Iowa up in education rankings.
• Helping universities fill state workforce gaps.
• Fixing the backlog in nursing home inspections.

Democrats, who are in the minority in both the House and Senate, had a different set of priorities for the year:

• Protecting public education.
• Defending reproductive rights.
• Legalizing marijuana for adult use.
• Lowering costs for Iowa families.

Governor's Budget Priorities

The Iowa Legislature has one thing it absolutely must do each year – pass a budget. This session, legislators will be deciding how much to spend during the fiscal year 2025 (which begins on July 1, 2024). Governor Kim Reynolds outlined her top budget priorities during her session-opening speech:

• $96.1 million to increase teacher salaries, $62.3 million to increase local school aid, and $51.3 million increase for private school tuition (called “educational savings accounts”).

• $20.1 million for the new Special Education Division within the Iowa Department of Education. This is not new money; it is taken from the AEAs.

• $75 million more for Medicaid, including $34.9 million for MCOs, $5 million to improve case management, $16.5 million to replace federal funds used to increase Home & Community Based Service (HCBS) provider rates, $14.6 million to increase access to HCBS providers, and $3.9 million for various provider rate increases. These rate increases are for home health providers ($3 million), physical therapists ($418,121), community mental health centers ($276,947), medical supply providers ($144,014), occupational therapists ($64,692), physician assistants ($29,691), and certified nurse midwives ($3,122). Note that the MCO funding is not new or an increase - last year the Legislature allowed a tax on MCOs to increase federal match, and this is returning the "taxed" amount to keep the MCOs whole. This is similar to what is done with hospitals and nursing homes.

• Increasing MH/DS regions by $6.7 million (for a total of $134.4 million). This raises the per capita rate from $40 in 2024 to $42 in 2025. These amounts will need to be adjusted in the 2025 session as the state implements the new Behavioral Health District plan over the next year.

• $69.5 million in new funding from the state’s infrastructure account to expand the Medical Examiner’s office ($36.3 million), fix tunnels at Woodward State Resource Center ($21.7 million), and renovate the Lucas State Office Building to house the newly combined HHS ($10 million).

• No increases or changes in the workforce incentive programs or loan repayments. IPA has requested increasing funding for the psychologist internship & recruitment program but this was not included in the Governor's budget.

You can view the non-partisan fiscal staff reviews of the Governor's budget here. Below you can see how the HHS budget has remained fairly stagnant over the past few years (but this does not include the additional federal funds in the system during the pandemic) and how education and the HHS budget make up most of the state's budget (and how they are at risk if tax cuts significantly lower revenues available to spend).

Bill Watch

The IPA Bill Tracker is the best way to keep tabs on newly introduced bills and the progress being made on other bills. Here are some bills to watch from the first two weeks, and updates on bills that are on the move.

• HF 2054 by J. Shipley: Allows therapeutic classroom funds to be used for vitamins D and K2, macronutrients, minimally processed foods, remediating negative impact of digital screens and devices, etc.

• HF 2063 by Isenhart: Requires mental heath professionals on site at all schools. Good thought, but we all know there are not enough licensed mental health professionals to do this.

HF 2064 by Fry: Requires health care providers disclose a minor's electronic protected health records to a parent or guardian.

• HF 2065 by Sherman: Establishes thresholds to meet for a person to receive worker's compensation for "injury of a purely mental nature."

• HSB 500: Expands postpartum Medicaid coverage to 12 months. IPA supports

• HSB 501: Limits Medicaid claims reviews to 24 months (no recoupments after that, and one-year recoupment window still stands if you have documentation that eligibility was confirmed at time of service). IPA support this, and HHS says it is working toward this goal. A subcommittee unanimously passed this out and I expect it'll come out of committee as well.

• HSB 511 & SSB 3011: Allows defense counsel access to psychological testing materials (tests & scoring keys) and raw data. IPA opposes this, and we are facing subcommittees that may be inclined to support. See call to action below on this.

• HSB 523 & SSB 3023: Increases penalties for assault on law enforcement & health care workers (from class D to class C felony). Includes spitting on/at as assault.

• SF 2037 by Salmon : This poorly written bill prohibits cities and counties from regulating services provided under behavioral health, social work and psychology licensing laws, and goes on to say they can't stop non-licensed clergy and others from providing services under those laws, which is a breach of state regulatory law. This is being done to allow conversion therapy. IPA is opposed, but the bill came out of a local government subcommittee.

• SF 2049 by Salmon: Round two of the anti-DEI legislation that states that contractors, teachers, and administrators can't provide training, tests, screening, or curriculum that racially scapegoats or stereotypes or in any way makes white people feel guilty (sorry that was Amy's interpretation). Already snippy after two weeks…and just seeing who's reading this.

• SF 2055 by Salmon: Prohibits any cross-gender bathroom use, anywhere. Traditionally the majority party has not liked bills telling what private businesses can and cannot do on their own premises, so I would expect this is going nowhere.

• SSB3001: Requires insurance coverage of biomarker testing. Several mental health advocates expressed support for this as some testing has helped find the right mix of medication for individuals with schizophrenia and other mental health conditions.

• SSB3006: Allows health care workers and providers to refuse to provide care on moral grounds ("right of conscience protections").

There are a couple of themes also going on in two areas:

• Food Insecurity: There are a number of bills to address the Governor's decision to not apply for Summer EBT funding as well as addressing the larger issue of food insecurity.

HF 2022 by Latham, Ingels, Young: $1 million increase for Double Up Food Bucks.

HF 2042 by Isenhart: Total $5.7 million increase for Double Up & Summer EBT.

SF 2039 by Trone Garriott & Ds: Requires state to apply for Summer EBT.

SF 2060 by Weiner & Ds: Makes school lunches & breakfasts free for all kids.

SF 2069 by Trone Garriott & Ds: Modernizes all nutrition programs.

• Anti-Immunization: There just is not the appetite to keep going after vaccines, but that won't stop the bills from being introduced.

HF 2041 by J. Shipley & SF 2058 by Guth: Requires signed informed consent to upload vaccine information to the IA Health Information Network or vaccine registry.

HF 2044 by J. Shipley & SF 2064 by Guth: Minor cannot give consent for a vaccine.

HF 2055 by J. Shipley: Eliminates all vaccine requirements for school & childcare.

HF 2071 by J. Shipley: Bars enforcement of vaccine laws if vaccine does not meet certain FDA standards (or has emergency status).

SF 2003 by Green: Requires information about vaccine exemptions be sent to parents and posted on school websites.

The House and Senate unanimously adopted resolutions this week supporting the use of the term "brain health" to reduce stigma around mental illness - SR 102 & HR 102. A reminder that resolutions express the sentiment of the Legislature; they have no binding legal authority.

Your Bill Tracker

Click above to see status of important bills, or create your own report with our custom download.

Town Halls & Public Forums

Find a local event with your state or federal elected officials here. Three weeks are shown at a time on this website.