Medicaid Rates & Gender Affirming Care in Committees
The Iowa Department of Health and Human Services (HHS) presented its "Improving Medicaid Program for Members" report last week during a House-only Health & Human Services Budget Subcommittee meeting. A large part of the review outlined how the state needs to develop a better, more cohesive, more transparent home and community based services system (as an alternative to higher-cost facility-based institutional options). The report did also highlight Medicaid rate structures and found:
- Need to set a regular, fact-based review process for rates.
- The two areas "most ripe" for increases are physician and behavioral health rates.
- Residential substance use disorder treatment should be covered, increased.
- You can see the benchmarking of rates here.
HHS also announced it would be maximizing state Medicaid dollars by adding a new intergovernmental transfer that allows them to tax MCOs as they do private insurers, then giving those funds back through contracts (which are then matched by federal funds). It basically allows the state to draw down more federal dollars without adding any additional taxpayer funds. That bill (HSB 177, SSB 1167) passed out of the House HHS Committee and is scheduled to come out of the Senate HHS Committee this week.
Switching committees, the House Government Oversight Committee heard from two health professionals about gender-affirming care (Dr. Katie Imborek, co-director of the UI LGBTQ+ clinic, and Dr. Dave Williams, chief medical officer of UnityPoint). They provided members of the committee, plus a packed room that included other legislators, with the steps that transgender youth and their parents must go through before receiving treatment.
As Dr. Imborek said, "It is a long, arduous and methodical process by which our providers, in collaboration with mental health providers, like psychiatrists, psychologists or counselors...provide parents and their children information about risks, benefits and alternatives, so parents have the freedom and liberty to make the decision that is best for their minor child."
Right before the committee, Speaker of the House Pat Grassley acknowledged he is considering allowing legislation this year to ban such care to transgender youth. Five other states have already passed legislation (Alabama, Arkansas, Florida, South Dakota, Utah). It's clear that legislators are going to advance something out of the 19+ bills already introduced, a record number according to One Iowa.
So far the only bill that has passed committee and through the funnel is HF 180, prohibits schools from accommodating a student's gender identity and bars teachers from withholding information about a student's expression of gender from parents (or encouraging parents to accept it). IPA is registered opposed.
The following bills have either not been assigned a subcommittee or the subcommittee has said they will not meet, and won't have the time to make it through the Friday funnel:
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HF 190 & HF 325 remove gender identity from civil rights protections.
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HF 290 requires government documents reflect gender on birth certificate.
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HF 229 & SSB 1164 enacts the "religious freedom restoration act."
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HF 401 eliminates required diversity and bias prevention in law enforcement training.
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SF 129 includes inaccurate "findings" about gender dysphoria and bans treatment.
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SF 335 requires K-12 students to use bathroom coinciding with biological sex.
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SF 348 makes it illegal for a parent to bring their children to a drag show.
The following bills may still be considered, but will have to make it out of committee this week:
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HF 367 protects schools from lawsuits for employee, contractor, and volunteer failure to use preferred name and gender pronouns. (no recommendation from sub)
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SF 159 bans gender and sexual orientation school instruction in K-8, changes human growth and development curriculum from grades 1-12 to 9-12, and other "transparency" and "parents rights" reforms. (passed subcommittee)
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SF 212 looks like a non-discrimination bill that bars discrimination against foster and adoptive parents based on religious beliefs, but it actually allows discrimination by permitting foster care and adoption providers to refuse to place a child in the care of someone whose lifestyles are in discordance with the provider's religious or moral beliefs. (passed subcommittee - and likely to be brought up in committee this week)
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HSB 112 requires schools post curricula on website for parent review, and a process for parents to report violations. (passed subcommittee)
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