Johnson County Legislators Back Funding for Mental Health Reform in Transition Period

Editor’s Note: This is the last in a series of three articles in Iowa Patch’s look at the state’s mental health system, its deficiencies and whether a spate of mass shootings should change the conversation.
__________________

As you read in Part One of this series, Loretta Siemens, a mother whose son died after he lost his battle with mental illness, believes that the tragedy of the Sandy Hook shooting might be enough to get state lawmakers to get serious about mental health reform. 

Congressman Dave Jacoby (D-- Coralville) agrees that there may be a chance.

Jacoby said that representatives on the far left and far right of the aisle who hardly see eye to eye on anything might be able to find a way to compromise this session on mental health reform: with the left pushing for more effective social services, and the right wanting to change the conversation away from gun control.

"It makes for strange bedfellows," Jacoby said. "Suddenly you have a common denominator."

But for that to work, Jacoby said legislators will have to pick up from where they left off last year: with funding the transition to a new system.

"That's where the mental health redesign completely fell apart last year," Jacoby said.

And it doesn't look like it's going to be any easier this legislative session, which opened officially for business in 2013 on Monday.

Lawmakers last year completed an overhaul of the mental health care delivery system, moving away from a system under which Iowa’s 99 counties each ran their own programs to a system of 15 regional authorities. 

This idea was originally created due to the inequity of care provided from some counties compared to others. This led some counties-- that either did not have the money to pay for mental services or refused to levy the money for them -- to rely on more prosperous or generous counties nearby for their mental health services.

During this transition process, counties will be able to ask for an exemption from participating in the system if they can show state administrators they have the resources to pay for their own programs. Otherwise, they will be required to join with at least two counties under the regional system. Counties are encouraged to pick adjacent counties to team up with, but county supervisors have discretion to pick where they want to go. 

Jacoby said that it's up to state legislators to help counties find their way through this "free-for-alll" transitional period into joining up into regional centers.He said one method outside of direct state funding could include the state changing the rules for levy rates that cap the amount counties can raise for mental health.

He said with local control being given to the counties to provide mental health care, he supports more county control be given to the mechanisms that will fund it.

"I think we at the state level should back off and let them do what they need to do,"

He said Johnson County, which may pair up with Linn County in its region, could find itself bearing the burden of providing services for nearby counties as it did under the old system, but the new regions ideally will make this process more formal.

Several other members of the Johnson County delegation concurred with Jacoby's feelings that the counties need help making sense of this transition period when they were interviewed on this subject by Mitch Schmidt of the Iowa City Press-Citizen.

This included newly minted congresswoman Sally Stutsman (D-- Hills), who previously served a long stint on the Johnson County Board of Supervisors. She told Schmidt that funding the transition is just the first step, the next step is for decision makers at the state level to give the counties and mental health providers some sense of what they want out of this reform:

Once the budget is fleshed out, Stutsman said legislators should then be able to focus more on structuring exactly what the reform will look like. 

“I’d like to see more direction from the state as far as what they intended with this whole redesigned system,” Stutsman said. “I think a lot of people are still unclear with what the end result is supposed to be.”

This uncertainty has arisen because the new system also contains other wrinkles that may greatly affect the quality of mental health care. For example, it shifts responsibility for funding mental health care from county property taxpayers to Medicaid, and the state of Iowa's possible expansion of Medicaid is in flux.

Gov. Terry Branstad has said he’s reluctant to commit Iowa to the five-year Medicaid expansion outlined in the Affordable Care Act because he doesn’t think it’s sustainable. The federal government pledges to pay 100 percent of the cost of each state’s Medicaid expansion from 2014 to 2016. The federal share would be reduced to 90 percent by 2020.

Mental health-care advocates say that without Medicaid expansion, Iowa’s most vulnerable residents could encounter the same problems that prompted overhaul of the old mental health care delivery system – limited access. 

One in six currently uninsured adults with incomes below 133 percent of poverty has a severe mental disorder, according to a 2011 study in the American Journal of Psychiatry on the effects of health-care reform on severely mentally ill adults.

Jacoby said this, and other aspects of the Affordable Care Act, are just one of the many variables that will need to be worked out this session

"The bottom line is we really need to have a way to address it this year," Jacoby said.

Read Part 1 of the series: 

Read Part 2 of this series: Legislators Say $20 Million in Mental Health Funding Needed; DHS Says Only $1.5 Million Required