Toldeo Health Insurance

DHS may delay expanding children's health program

Iowa doctors and nursing homes would receive less money when they care for poor people, if the governor approves the plan the Department of Human Services submitted. And the state might have to delay its goal to provide health insurance to all children.

But administrators said they took special care to prevent cuts to already strained social workers who try to prevent child abuse.

The Iowa Department of Human Services would lay off 79 employees as part of its effort to cut $145 million. Most would be workers at the juvenile detention centers at Eldora and Toledo.      The department also proposed delays in efforts to streamline procedures families go through to have children covered by the Medicaid or Hawk-I health insurance programs. Administrators wanted to make that easier as they try to fulfill Gov. Chet Culver's pledge to cover all Iowa children.

DHS Director Charles Krogmeier also proposed delaying by a year or two a program in which families could sign up for subsidized dental coverage under Hawk-I, which is aimed at children of moderate-income families. The Legislature voted last spring to let such families sign up after experts noted many families have medical insurance but lack dental insurance.

The department would need legislative approval for both delays, and for Krogmeier's proposal to cut Medicaid pay for health care providers, such as nursing homes, physicians and dentists.

Most health care providers would lose 5 percent of their pay from Medicaid, a state and federal program that covers poor people. Many providers already have complained for years that they lose money on every Medicaid patient they treat because the pay rates are so low.

But Krogmeier said he was optimistic they would understand the state needed to make a temporary cut to save $15.5 million. He said he doubted many would stop providing care to Medicaid recipients.

DHS also would save $1.3 million by dropping Medicaid coverage for chiropractic treatment, which the department said about half of states decline to cover.

Krogmeier said he and his staff considered lowering income limits on who is eligible for Medicaid and Hawk-I, which would have cut the number of people on the programs. In the end, he said, "we didn't want to go there."

Originally, the governor's office estimated the department would have to cut $132 million. But that didn't include an $11 million cut in the health care trust fund, plus cuts in a couple of smaller funds. So the true state cut is $145 million, spokesman Roger Munns said.

Krogmeier said he avoided more layoffs by planning to spend several million dollars that would have been left in various funds at year's end. He acknowledged that decision could make it even tougher to budget for the next fiscal year.