Six ways the GOP budget shortchanged Iowans with disabilities

The biggest stories of the Iowa legislature's 2023 session are well known. Before adjourning for the year on May 4, historically large Republican majorities in the Iowa House and Senate gave Governor Kim Reynolds almost everything on her wish list. They reshaped K-12 public schools; passed several bills targeting LGBTQ Iowans; enacted new hurdles for Iowans on public assistance; cut property taxes; reorganized state government to increase the power of the governor and "her" attorney general; and undermined the state auditor's ability to conduct independent audits.

Many other newsworthy stories received little attention during what will be remembered as one of the Iowa legislature's most influential sessions. This post is the first in a series highlighting lesser-known bills or policies that made it through both chambers in 2023, or failed to reach the governor's desk.


As the Iowa House and Senate debated one appropriations bill after another last week, Democrats repeatedly objected to plans that imposed status quo budgets or small increases (well below the rate of inflation) on services for disadvantaged Iowans.

Iowans with disabilities or special needs were not a priority in the education and health and human services budgets that top Republican lawmakers negotiated behind closed doors.

A BIG CUT TO AREA EDUCATION AGENCIES

"Kids don't get to relive a year of learning, or a year of development"

Senate File 578, commonly known as the "standings" bill, allocated roughly half of the total $8.58 billion budget for fiscal year 2024, which begins on July 1. The largest line items were about $3.7 billion for "state foundation school aid," which mostly supports K-12 public schools, and $107.4 million for the new "Education Savings Accounts" (school voucher) program.

Since 1974, a portion of state school aid has gone to nine Area Education Agencies (AEAs), which provide a range of services to children from ages 0 to 18, as well as special education and media services for many smaller school districts.

The nonpartisan Legislative Services Agency created this map in December 2022 to show funding and enrollment for each AEA during the current fiscal year. Each agency serves tens of thousands of children.

State law lays out a formula for calculating how much funding will go to the AEAs. Senate File 578 reduces that amount by more than $22 million. The nonpartisan fiscal note on the bill comments,

In addition to the $22,057,131 State aid reduction for FY 2024, the AEAs have an annual statutory reduction of $7,500,000. The State aid reduction to the AEAs will total $29,557,131 for FY 2024. Funding was reduced by $24,557,131 in FY 2023.

The legislature has been cutting AEA funding for many years. But Bill Decker, chief administrator of the Mississippi Bend AEA, told the Quad-City Times that the coming reduction "will be the highest additional cut the AEAs have ever received."

Senate Appropriations Committee chair Tim Kraayenbrink, who floor managed the standings bill, asserted during the Senate debate that data from fiscal year 2020 indicated about 42 percent of AEA expenditures "went to support staff and administration staff," which he characterized as a high ratio. He also denied AEA funding was being "cut," since the AEAs received $241.5 million for FY2023, and will receive $244.6 million for the year beginning on July 1.

But the plain text of Senate File 578 reads that state funding for AEAs "shall be reduced by the department of management by twenty-two million fifty-seven thousand one hundred thirty-one dollars," on top of the $7.5 million reduction they were already due to receive. Anyway, an increase of $3.1 million from a base of $241.5 million works out to 1.2 percent—far below the rate of rising costs for AEAs, which have to pay for staff salaries, travel to private homes or school districts, and many other expenses.

According to Democratic State Representative Sharon Steckman, AEA staff warned members of the House Appropriations Committee that every AEA would have to cut eight to ten staff at the funding level proposed by Republicans.

When the Senate debated the standings bill on May 3, Democratic State Senator Pam Jochum focused on the cut to agencies that "provide immense services to children who have different abilities."

Many people fail to recognize the value of a child "who is different," said Jochum, who raised a daughter with developmental disabilities. "But our AEAs do." They provide services not only to children with intellectual disabilities, but also to those who need occupational therapy, physical therapy, speech therapy, or other assistance. Jochum read out the most recent enrollment figures to remind colleagues how many children receive some assistance from each of the nine AEAs. Those include kids under age 3, who can't yet attend preschool.

Jochum expressed gratitude to those who made sure federal law opened the doors of schools "to every child regardless of their ability. And we stand on their shoulders today. And we are letting those children down."

When the House debated Senate File 578 later on May 3, Steckman highlighted the "vital role" of AEAs in rural Iowa, where school districts typically can't afford to hire full-time speech therapists or staff to provide the special education services required by federal law.

She offered an amendment to take out the $22 million cut to the AEAs, and add $4 million earmarked for services to rural schools.

Republican State Representative Taylor Collins, who was floor managing the budget bill, urged the chamber to reject the amendment. He gave no rationale other than noting it would add about $26 million in spending. House members voted down Steckman's proposal along party lines.

It was too much for Democratic State Representative Beth Wessel-Kroeschell. She rose a few minutes later to decry what she called a Republican "hoarding problem."

The majority party budgets for a $1.9 billion surplus in fiscal year 2024, leaves $1.1 billion unspent from federal American Rescue Plan funds, and lets billions more pile up in the state's reserve and "taxpayer relief" accounts, adding up to some $8.6 billion in available funds, Wessel-Kroeschell said. Meanwhile, "we are cutting services that help keep kids with learning disabilities learning. We are cutting speech therapists. Social workers. Physical and occupational therapists. We are cutting school psychologists."

"Kids don't get to relive a year of learning, or a year of development," the Democrat reminded colleagues. "They are expected to make goals every year. Each year is important to their success. And we are taking away their opportunities for success."

"We have the money. We don't have the will. Cutting services to kids who are struggling to learn," Wessel-Kroeschell said, is one of the most "unbelievable" things she's seen from the GOP trifecta.

Like their counterparts in the state Senate, House Republicans approved the standings bill along party lines.

LONG WAITS FOR DISABILITY SERVICES

"It's egregious...Imagine that's your kid"

The Iowa Department of Health and Human Services administers seven waivers that are part of the Home- and Community-Based Services Waiver program under Medicaid. The stated purpose is to provide "service funding and individualized supports to maintain eligible members in their own homes or communities who would otherwise require care in a medical institution."

It's not news that Iowans with disabilities (adults as well as children) often face years-long waits to receive those services. The situation isn't improving; around 17,000 Iowans are on wait lists for waivers now, compared to some 16,000 two years ago.

Democratic State Representative Josh Turek zeroed in on this problem when the Iowa House debated Senate File 561, the health and human services budget, on May 2. Turek had a few questions for the Republican floor manager, State Representative Joel Fry.

How much new funding was the state planning to invest in these waivers for the coming fiscal year? Fry said $7.4 million. It's not clear how he arrived at that number. The nonpartisan fiscal analysis states that Senate File 561 provides "An increase of $5,500,000 for Home- and Community-Based Services (HCBS) waiver programs."

Turek reminded Fry that during a Health and Human Services Budget subcommittee meeting, Iowa's Medicaid director told lawmakers that funding was the only barrier to the state reducing the wait lists. Fry countered that Republicans have included money "multiple years to buy these waiting lists down as far as we can. We continue to do that again this year."

Turek then asked about the current wait time for the Health and Disability waiver. Fry offered to get that information, but the Democrat already knew the answer: four years.

How about the Brain Injury waiver? Fry told Turek to go ahead and share the numbers, so he did: five years, eight months. For the Intellectual Disability waiver: four years.

"To me it's egregious," Turek commented, after Fry sat down. "Seventeen thousand individuals in this state with disabilities, some of these not moving for four years, or five years. Imagine that's your kid."

Under Senate File 561, Iowa's total health and human services budget for fiscal year 2024 will increase by about 2.7 percent compared to the current fiscal year, but that's deceptive, since the governor's reorganization plan added several entities to agencies covered by this bill. The state appropriation for Medicaid alone will increase by about 2 percent, to some $1.54 billion. Many programs within the Department of Health and Human Services will make do with status-quo funding, even as some rising costs (e.g. for staff salaries) are unavoidable.

The Iowa Senate approved this bill along party lines. The House vote on Senate File 561 was similar, with only two Democrats (Ken Croken and Art Staed) joining Republicans to vote yes.

UPDATE: Fry did not respond to Bleeding Heartland's inquiry, but the Iowa Department of Health and Human Services explained the confusion over funding in a May 17 email. Last year, the legislature and Reynolds approved "agreed to increase funding for HCBS waiver providers ($14.6 million) and $7.4 million for additional HCBS ID waiver slots (reducing the waiting list)" using one-time American Rescue Plan dollars that were designated for increasing the federal medical assistance percentage for Home- and Community-Based Services programs.

Since those American Rescue Plan dollars must be used by March 31, 2024, the legislature approved $5.5 million in state funding in this year's budget bill to fund the fourth quarter of state fiscal year 2024.

NO STATE FUNDING FOR K-12 BRAILLE MATERIALS

"One more time this body has failed Iowa's blind and visually impaired community"

A controversial provision of Reynolds' plan to reorganize state government gave the governor the power to hire and fire the director of the Iowa Department for the Blind. For generations, the director had answered to the state Commission for the Blind, whose members have firsthand knowledge about living with that disability.

Blind Iowans turned out in large numbers for the Senate and House subcommittees hearings, pleading with lawmakers to remove the proposal from the governor's bill. Although some Republicans had indicated they were open to changing that language, most GOP members of the House and Senate voted down Democratic amendments that would have preserved the commission's authority to select and fire the department director.

When the Iowa House debated Senate File 560, an education appropriations bill, on May 2, Democratic State Representative Elinor Levin highlighted a decision by the majority party that may do far more direct harm to blind or visually impaired Iowans.

The Department for the Blind used to be able to purchase braille and large-print K-12 educational materials, using funds from the U.S. Department of Education. But in the past year, Levin said, the onus moved to individual school districts.

That's a problem, because few school districts have staff with the expertise to identify high-quality materials for blind or visually impaired students. They would not know whether braille material was well-produced, easy to read, or even correctly printed.

In addition, Levin said school districts may not see the difference between providing audio-only materials and braille materials, "despite braille proficiency being documented to dramatically improve comprehension and reading speed." She expressed concern that districts may acquire audio-only materials, which could be used for sighted as well as blind children, whereas braille and high-visibility or large-print materials "are directly targeted toward giving the best educational outcome for blind or visually impaired students."

For those reasons, the Department for the Blind requested a $500,000 line item to create an Instructional Materials Center and fund monthly purchases of braille and large-print materials. Senate File 560 will increase the department's FY 2024 budget by $150,000 and one full-time position, compared to the current fiscal year. The Senate floor manager, State Senator Jeff Taylor, said the extra funds would support the department's general functions and their Instructional Materials Center. But GOP negotiators didn't earmark any new funds for the educational materials.

Levin said it was "one more time this body has failed Iowa's blind and visually impaired community this session."

SUPPORT FOR DEAF CHILDREN ONLY PARTLY FUNDED

"Children are not born with American Sign Language"

Advocates for Deaf Iowans lobbied state lawmakers for at least six years to adopt a policy designed to help Deaf and hard of hearing children be ready for kindergarten. Radio Iowa reported last year, "Studies show the majority of deaf children who enter kindergarten without knowing American Sign Language never catch up academically."

In 2022, the legislature approved and Reynolds signed a provision establishing a Language Equality & Acquisition for Deaf Kids (LEAD-K) program, which supports American Sign Language as well as English language learning.

Republican lawmakers did not allocate any funding to LEAD-K during the 2022 session. The fiscal note on the bill estimated that it would cost about $300,000 for the Iowa School for the Deaf to set up and run a Family Mentoring Program, including one full-time staff equivalent position.

The state government reorganization plan moved the Iowa School for the Deaf from the Board of Regents to the state Department of Education, which requested $300,000 in fiscal year 2024 funding for LEAD-K. Republican negotiators agreed on $200,000 for that line item in Senate File 560.

Democratic State Representative Art Staed, an original sponsor of LEAD-K legislation in the Iowa House, pointed out that families need support and mentoring services to communicate with Deaf children, who "are not born with American Sign Language." He had questions for the Republican floor manager, State Representative Carter Nordman.

Staed wondered about the rationale for only partly funding the program. Would the Iowa Department of Education supplement the funds for this program? Or would money be expected to come from local school districts or AEAs serving Deaf or hard of hearing kids and their families?

Nordman said House and Senate Republicans agreed on this starting amount. Staed asked again about the rationale for not fully funding the program. Nordman said, "This is what was agreed on as we did the budget as a whole. This is the amount that we were able to get for the new program."

Staed warned that these services are mandatory, and asserted that if not funded by the state, local school districts and AEAs would bear the cost.

Communications staff for the Iowa Department of Education have not responded to Bleeding Heartland's inquiry about whether other funding will support LEAD-K services during the coming fiscal year, or whether Iowa families of Deaf children will simply receive fewer services.

UPDATE: The Department of Education referred inquiries to the Iowa School for the Deaf. John Cool, superintendent of that school and Iowa Educational Services for the Blind and Visually Impaired, confirmed to Bleeding Heartland in a May 17 email,

We did receive $200,000.00 and are pleased to be able to initiate this program and provide services to families throughout the state who have children who are deaf or hard of hearing. Our first step will be to advertise for a full time position, possible title being Family Resource Coordinator, to oversee the program. This position will be a part of the Outreach Department here at ISD. 

As the Coordinator of this program, the staff member will provide mentoring services as well as recruit and train other deaf or hard of hearing adults to be family mentors. The key is to match the family member’s needs. The degree of hearing loss and interventions introduced to the family, as well as other factors, will help determine the best fit for the family and their child(ren). 

Because this program is in its infancy, we will be able to build on the progress we make this year and will be asking for the additional $100,000.00 in next year’s budget. ISD does not have the resources to fund this additional cost. 

In response to a follow-up question, Cool indicated that local school districts and AEAs will not be expected to make up the $100,000 not approved by the legislature this year.

MEDICAID OVERSIGHT MEETINGS MAY STOP HAPPENING

Past meetings allowed Iowans "to come in and speak to us about the issues that are affecting them or their loved ones"

After then Governor Terry Branstad's administration privatized Iowa's Medicaid program in 2016, many recipients and their families began to report harmful service cuts. Iowans with disabilities were the most adversely affected, as the for-profit companies the state selected to manage care for Medicaid recipients reduced spending on home-based health care, medical equipment, and transportation services.

State lawmakers responded by creating a Health Policy Oversight Committee. Current law states that this committee "shall meet at least two times, annually, during the legislative interim to provide continuing oversight for Medicaid managed care, and to ensure effective and efficient administration of the program, address stakeholder concerns, monitor program costs and expenditures, and make recommendations."

State Representative John Forbes, the ranking Democrat on the Health and Human Services Budget subcommittee, noticed that Senate File 561 would alter the code to read as follows (emphasis added): "The legislative health policy oversight committee may meet annually to provide continuing oversight for Medicaid managed care, and to ensure effective and efficient administration of the program, address stakeholder concerns, monitor program costs and expenditures, and make recommendations."

Forbes has served on the committee since 2015 and expressed concern during debate on the appropriations bill that the oversight meetings will stop occurring once they are not mandatory. He said past meetings "have been very beneficial in allowing the public to come in and speak to us about the issues that are affecting them or their loved ones" after managed-care organizations took over responsibility for Medicaid recipients.

NO INCREASE TO ALLOWANCE FOR IOWANS IN RESIDENTIAL FACILITIES

"This rate has not been raised since 2001"

When the Iowa Senate first debated the health and human services budget in late April, Democratic State Senator Claire Celsi offered an amendment to increase the monthly personal needs allowance under Medicaid. Many nursing home residents receive that allowance, but as Celsi explained, it also goes to people living in intermediate care facilities, or people in residential care due to intellectual disabilities or mental illness.

Recipients can use the allowance for a wide range of personal care items, such as "clothing, shoes, vending machine snacks, specialty food, multivitamins, haircuts, cosmetics, toiletries, magazines, books, knitting needles and yarn, greeting cards, postage, cigarettes, and cell phone bills."

Celsi noted that Iowa hadn't raised the personal needs allowance since 2001. Her amendment would have increased it from $50 to $85 each month.

The GOP floor manager, State Senator Mark Costello, urged senators to oppose the amendment, which he said would cost almost $5 million per year (some $3 million in federal funds, $2 million from the state). That "doesn't fit into our budget," he said.

Republicans rejected Celsi's amendment in a party-line vote.

Know of an Iowa legislative story that stayed mostly below the radar in 2023? Laura Belin welcomes reader tips.

Top image: kids with special needs develop their fine motor skills. Photo by Olesia Bilkei, available via Shutterstock.

  • Creating more barriers to Iowans with disabilities

    Thanks Laura. And to think that Tom Harkin was a leader in the bi-partisan passage of the ADA, signed by Pres. Bush in 1990. There appears to be other examples on how the Republican leadership have been negligent to Iowans with disabilities and their families. 1. SNAP. According to the Center for Budget and Policy Priorities, more than 31% of SNAP recipients are in families with members who are older adults or are disabled. Republicans have made it more difficult to apply and maintain SNAP benefits. Family members will have to spend more time away from their home (work or volunteer) to be eligible to feed their family--maybe send a non-disabled child to work in a factory, under loosened child labor laws. 2) Private voucher program may be inaccessible to students with disabilities. While rules still have to be drafted, it appears voucher programs will not be a viable education option if they fail to adequately serve and protect the rights of students with disabilities. If private schools receive federal funding, they are specifically prohibited from discrimination. The Governor talked about parental choice--not if you or your child has a disability.

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