Health care providers and not-for-profits across the state are scrambling to carry out even tighter budgets come July 1 after the Iowa Department of Public Health notified them this week that it is making an additional $1.3 million in cuts.

They come after the state’s public health department’s general fund budget was slashed by more than 13 percent during the 2017 legislative session, to $51.3 million.

The extra cuts come as a shock to the organizations, who provide what they believe are necessary services for disabled and sick Iowans, as well as to the legislators who toiled over the budget.

“This reduction will be particularly difficult for us and our local and state partners who provide critical services protecting the health of Iowans,” said Gerd Clabaugh, director of public health, in an letter sent to local public health agencies on June 13. “As was true with the first set of reductions in fiscal year 2017, we will continue to focus on retaining service to Iowans as a priority.”

IDPH spokeswoman Polly Carver-Kimm told The Gazette that these outside organizations are absorbing the majority of the additional cuts because “nearly 90 percent of the department’s total general fund budget flows through the department to local contractors.”

“As such, the reductions do impact local contractors. The reductions also will have impacts for department employees,” she said.

In addition to extra cuts to more than 20 programs — some internal and some external — Carver-Kimm said state funding has been eliminated for the following programs:

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• $156,482 was eliminated from audiological services for children, which helped pay for hearing aids, accessories and audiological services to more than 100 children in fiscal year 2016.

• $150,000 reduction to melanoma research provided by the state to University of Iowa Health Care.

• More than $153,000 was cut for Phenylketonuria (PKU) Assistance through the Iowa Metabolic Formula Food Program. PKU is a rare inherited disorder that puts individuals on very rigid diets. Insurance doesn’t always cover the cost of formula, which is expensive and necessary for individuals to get the needed nutrients.

• More than $144,000 was eliminated from the Epilepsy Foundation of Iowa, an organization that advocates for 28,000 individuals through research programs, education and direct services.

• $384,552 was eliminated from the University of Iowa’s child health specialty clinics’ regional Autism Assistance program, which supports children and families dealing with autism.

• More than $96,000 was removed from Prevent Blindness Iowa, a program that provides training, certification and vision screening materials for school nurses and others to conduct vision screening.

The University of Iowa Hospitals and Clinics will see about $752,000 or 60 percent of the cuts, said Jennifer Harbinson, director of health policy at UIHC, in a letter to legislators.

“I wanted you to know that these cuts will impact Iowans with disabilities, autism, cancer and diseases, such as Phenylketonuria,” she said.

UIHC said in a statement that it was notified of the cuts on Thursday and currently is assessing the potential impacts.

For smaller organizations, the cuts are even more detrimental. The $144,000 funding cut to the Epilepsy Foundation amounts to 58 percent of the not-for-profit’s budget, said Dale Todd, the board’s legislative chairman.

“For our organization, it was a real sucker punch,” he said.

The not-for-profit trains first responders, medical professionals and schools as well as provides support and education to families dealing with epilepsy. The programs keep individuals out of the emergency room, which is ultimately more costly, Todd said.

“It really is unprecedented,” he said. “It is unprecedented in a way that the department is stripping the money and reallocating it based on a personal agenda.”

Todd said the organization is working on a “doomsday” scenario but hopes a solution can be found before July 1, the start of the new fiscal year.

“It would be our hope that the governor can rectify this situation,” Todd said. “If there is no intervention, we are preparing to explore some legal options.”

The further reductions don’t sit well with legislators, including Sen. Liz Mathis, D-Robins, the ranking member of the Senate Human Resources committee, and Rep. Dave Heaton, R-Mount Pleasant.

Mathis said Friday that a move such as this betrays the trust of providers and agencies who work with special populations.

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“We voted and agreed on a budget,” Mathis said. “The governor signed it.”

For the providers and not-for-profits to find out now, weeks before the new fiscal year is to begin, that they no longer will receive any department of public health funding is “hard to recover from,” she said.

Heaton, Health and Human Services Appropriations Subcommittee chairman, said it wasn’t the budget panel’s intent that funding for programs and services be cut.

“There are things I held harmless, and I had a reason to hold harmless,” he said.

“I thought I had exhausted all my options,” so Heaton left it up to department director Clabaugh to find about $1.2 million in savings. “I expected him to honor my appropriations, but he didn’t.”

It’s bad enough that budget the Legislature approves are subject to the governor’s line item veto authority, Heaton said, “but this is even worse.”

“If I let the director of an agency rewrite my budget, that’s bull crap,” he said.

Heaton will head to Des Moines Monday to meet with Gov. Kim Reynolds to find a way to reinstate the funding lawmakers approved for these programs.

“I’m trying to find a deal so we can get out from this under this and everyone gets half a loaf,” he said.

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