Iowa’s Medicaid program has once again been a leading story in the news last week. I have been one of the legislators communicating with the Governor’s office and the Department of Human Services (DHS) since last fall as they negotiated with the federal government a mutually beneficial solution to the problem facing the state. The federal government has threatened a $65 million cut to Iowa in federal intergovernmental transfer dollars currently being utilized to help fund the Medicaid program.

Iowa receives approximately $2 from the federal government for every $1 of state funds. With this arrangement, Iowans and Iowa health care providers receive $2.17 billion in federal and state health care dollars. In January, I reported that the Bush administration plans to cut the federal deficit and pay for the war by cutting back on the federal share to Medicaid.

Iowa, and most other states, have transferred federal health care dollars between accounts in order to leverage additional federal Medicaid dollars. These are called Intergovernmental Transfers (IGT). Most of the IGT are unknown to Iowans other than those who administer hospitals or nursing homes. The $65 million of health related IGT have been leveraged into nearly $100 million worth of medical services for Iowans.

The federal government intends to end four IGT to Iowa on June 30, 2005. The facilities impacted by the federal governments threatened cut are:

• University of Iowa Hospitals and Clinics, paid through a $27 million annual state general fund appropriation to the indigent patient care program, also known to many of us as “State Papers”;
• Iowa’s four Mental Health Institutes ($30 million); and
• Broadlawns Medical Center in Des Moines (a public hospital serving a low-income population in Polk County), supported through Polk County property taxes ($34 million).

Last week, Governor Vilsack received a letter from the new Secretary of Health and Human Services, Michael Leavitt, (former Governor of Utah). Secretary Leavitt approved, in principal, Iowa’s proposal make better use of currently unmatched public expenditures for health care in Iowa. The new approach holds out the possibility of making it possible to extend Medicaid coverage to thousands more low-income residents.

Iowa appears to be the first state to obtain tentative approval on this IGT issue. Iowa Medicaid officials were receiving phone calls from their counter-parts in California and other states late last week, asking how Iowa obtained the waiver. Secretary Leavitt wrote that he welcomes the chance to work with Iowa “on ways to improve access to quality health insurance while achieving greater value for taxpayer dollars.”

It is ironic that while Iowa is wrestling with Medicaid problems, much of the nation’s attention was focused on the controversy surrounding the Terri Schiavo situation in Florida. Health care funded by Medicaid has helped her remain alive. The good news is that her situation has resulted in a healthy discussion about the need for people to be clear about their end of life medical wishes. Contact your attorney or go to the Iowa State Bar Association web site: http://www.iowabar.org/main.nsf for information on creating your own living will and medical power of attorney.

We must be certain to preserve the health care benefits currently in Medicaid. I will continue to work in a bi-partisan way to maintain our commitment to Iowans who depend on our public systems of access to health care. And, hopefully, I will be reporting in the next several weeks that we were able to increase Medicaid reimbursements to health care providers.

You are welcome to visit me at the Capitol. Or, you can write me at the State Capitol, Des Moines, IA 50319; call 515/281-3221 or e-mail me at ro.foege@legis.state.ia.us.

Ro

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