By Rod Sullivan and Linda Langston / Guest Editorial
There has been a lot of attention recently on mental health services and the changes and reductions in service that have occurred across the state. Change of any kind can be difficult, and changes in the mental health system have been particularly challenging. One of the challenges we face is helping people understand why the changes and service reductions are necessary. Hopefully, the following information will assist the community in understanding where we are going and why.
Iowa state law requires funding for MH/DD (mental health/developmental disabilities) services to come from a separate MH/DD levy. This means Iowa counties have a set budget for MH/DD services that is funded by this separate levy. We must provide services within that budget, and that budget alone. Counties cannot use money from other department budgets or sources to fund MH/DD services, nor can counties increase property taxes to fund MH/DD.
Another change facing MH/DD is the Mental Health and Disability Services redesign bill passed by the Iowa Legislature last session (2012). The redesign bill, also known as SF 2315, proposes to assist in reestablishing funding for the system and to make services more equitable statewide.
The purpose of the redesign has four main parts: 1) change the management of the system from individual counties providing services to county regions 2) establish the county of residence as the county responsible for managing and paying for a person’s services, rather than the county where the person was born 3) establish the core services that are to be available statewide to all who need MH/DD services, and 4) set a per-capita mental health levy rate that is consistent across the state.
Currently, colleagues in nine neighboring counties are forming a region and working out the details involved with that kind of partnership. Regions needed to be formed by April of this year and the new system fully operational by July 1, 2014. The new region for this part of the state will include Dubuque, Bremer, Buchanan, Benton, Delaware, Jones, Iowa, Johnson and Linn counties. An agreement has been signed and a letter of intent has been submitted to Iowa’s Department of Human Services (DHS), indicating that the nine counties agree to work together. All members of the region are working diligently to put business and management plans in place to be ready for implementation as of July 2014.
As we work our way through the redesign and defining what services the regions will provide, we expect more changes to how people and families receive services. This transition may be challenging, but we will work with our colleagues in neighboring counties, our partners in the mental health system, the legislature and families to minimize disruption as much as possible. We are optimistic that the MH/DD system for the region will benefit from the financing changes when redesign is finalized in this year’s legislative session.
It is critical as redesign moves forward that it is funded appropriately, giving this new system a chance to work effectively and benefitting all nine counties in our region and in other regions across the state. We commend the state legislators for the work they have done thus far, particularly Sen. Joe Bolkcom (D-Iowa City) and Sen. Jack Hatch (D-Des Moines) as well as Rep. Dave Heaton (R-Mount Pleasant). Now it is critical that the final pieces of equitable funding be put in place. This funding formula must address both the inequities of funding that exists in various counties and must allow counties to come into a regional system with a level playing field.
It will also be critical for the success of redesign for the discussion on Medicaid expansion to be resolved. While we are appreciative of the governor’s efforts to come forth with a plan, our concerns far outweigh the benefits of his plan. We are hopeful, along with many of the hospitals and providers across the state, that every consideration will be given to Medicaid expansion.
We expect the redesign to ultimately lead us to more evidence-based practices, to help us continue moving from institutional settings to more community-based settings, and to provide steadier, more predictable funding that will create a functional, regionalized system that offers equitable services statewide.
Rod Sullivan is Johnson County Supervisor. Contact him at email@example.com.
Linda Langston is Linn County Supervisor. Contact her at firstname.lastname@example.org.