Amid Healthcare Successes, Iowa Official Sees "Storm Clouds" in 2015

Iowa quietly and successfully implemented a unique form of Medicaid expansion and revamped mental health services in 2014. But will budget problems unravel all the good news next year?

Iowa healthcare officials have touted many healthcare success this year. The state negotiated its own version of Medicaid expansion with CMS in late 2013, and the progressive groups this week published letters in state newspapers saying it’s working.

Known as the Iowa Health and Wellness Plan, the expansion reached 113,000 residents, including 26,000 who had their first dental checkup, according to Iowa Director of Human Services Charles Palmer, who spoke at an appearance this week. The Iowa rollout went more smoothly that some, which Mr Palmer attributed to coordination with county-level administrators.

But reports of residents who need waivers for some services, and Palmer’s own warning of “storm clouds” before a legislative panel this week have raised concerns that the good times won’t last. Gov. Terry Branstad, a Republican fresh off re-election to his fifth term, made it clear he would not accept the initial Department of Human Services request for a 7% budget increase for the coming year. A reduction in federal funds appears forthcoming because Iowa is bouncing back faster than other parts of the country, according to published reports.

One item in Gov. Branstad’s sights is consolidating the state’s 4 mental health institutions, which he said this week are costly, outdated and inefficient. The average price tag is $260,000 per bed, but cost varies widely by site. Resistance to closing any facility has been firm, due to local concerns about job losses and family desires to keep loved ones within a short drive.

Concerns about the cost of institutional care are hardly unique to Iowa; the state has received high marks elsewhere for its 2014 redesign of mental health services, which pooled county resources on a regional basis.

Gov. Branstad’s singular brand of Medicaid expansion, and its smooth, peaceful implementation were seen as potential models for future expansion in Republican states, given the outcome of the midterm elections. Will the good news continue?

“The glass is clearly more than half full,” Mr Palmer said at an appearance Monday.

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