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Regulation and Compliance > State Regulation

Iowa holds hearings on coverage expansion proposal

By Catherine Lucey

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DES MOINES, Iowa (AP) — Iowa officials today started to put their state’s Patient Protection and Affordable Care Act (PPACA) Medicaid expansion proposal through a public hearing process required by PPACA.

Gov. Terry Branstad, a Republican, and state House Republicans hammered the compromise proposal out after sometimes dramatic debates with Senate Democrats.

Originally, Senate Democrats simply wanted to take PPACA Medicaid expansion funding and expand eligibility for Medicaid.

Branstad and the House Republicans wanted to use the money to expand another Iowa program.

The compromise proposal — which was recently approved by both the House and the Senate — calls for Iowa to use federal money to put  residents with incomes up to 100 percent of the federal poverty level to go into a new state-run health plan with benefits similar to those offered to state workers.

Residents with incomes from 101 to 138 percent of the poverty level would get private health plans through the new PPACA health insurance exchanges. Federal dollars would  pay for the PPACA exchange premiums.

The proposal should improve access to coverage for as many as 150,000 low-income childless adults who earn too much to qualify for Medicaid, officials said.

Many of those people are now in a state-run program that offers limited benefits.

PPACA requires the state to put the coverage expansion proposal through a public hearing process before submitting an application to the U.S. Department of Health and Human Services (HHS). The hearings started today.

One possible sign of lack of public interest in the hearings: Only a handful of people have filed hearing comments ahead of time, according to Roger Munns, a spokesman for the Iowa Department of Human Services.

State Sen. Jack Hatch, a Des Moines Democrat who helped push for efforts to expand Medicaid, said he expects limited criticism.

“I think everybody is going to be supportive,” Hatch said.

Matthew Covington, an organizer with advocacy group Iowa Citizens for Community Improvement, said the group’s members will attend the public hearings. The organization had lobbied for Medicaid expansion, but Covington said they are cautiously optimistic about the compromise.

“At face value it appears to have the elements of the original plan,” Covington said. “But what we want to get out of the hearings, we want to know more of the details.”

It’s too soon to know if the state will get the federal backing, but a spokesman for HHS said the agency was supportive of state flexibility.

“HHS stands ready to work with Iowa to explore options that improve care and lower costs in the Medicaid program,” said Fabien Levy in an emailed statement.

Another key issue for the state in the coming months will be how to promote this plan and let eligible residents know it is available.

Munns, the DHS spokesman, said in an email that the state is in the early stages of working on a plan to notify the public about the coming changes. Munns said that while the Legislature has provided some funding for the transition process, the state will likely “rely on providers and volunteer community partners to help get the message out, along with mailings and website materials.”

Hatch said proper promotion is important for the effort to work.

“The governor has not outlined how he is going to inform, educate and enroll Iowans in these programs and that is a big black hole that we have to eliminate,” Hatch said.

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