Mental health forum details changes in state funding, service

A shift in funding for mental health and disability services has prompted local agencies to brainstorm problem solving efforts.

Representatives from Iowa Development Disabilities Council and Marshall County Community Services held a presentation followed by an open public forum Thursday afternoon at the Marshalltown Public Library. The community conversation handled redesigning mental health and disability services and addressed some of the issues raised by a 2012 Senate filing.

“When it comes to changing what’s wrong it’s really the people that work most closely with it that makes the difference,” said Becky Harken, director of the Iowa Development Disabilities Council.

The filing increased the state’s responsibility for funding and management of mental health and disability services by converting the service system to regional, instead of county, service areas.

A major change includes requiring financial information submitted to the state by a county to segregate expenditures for purchase of service, administration and enterprise costs. Also, regions will be responsible for funding existing non-Medicaid expenditures, which the county must fund from property tax revenue.

The state will provide for new expenditures for Medicaid, but it will also recollect the money it has allocated to counties to pay for existing Medicaid services.

The filing also requires counties to begin using a standardized assessment to determine services as well as requires the Department of Human Services to collect and analyze data to estimate the cost of serving additional populations and providing core disability services throughout the state.

Rik Shannon, public policy manager with the Iowa Developmental Disabilities Council, said services could change as availability shifts when regions are created and core requirements are established. Also, the bill lowers the guidelines for billing from 200 percent of the federal poverty guideline to 150 percent.

However, Marshall County imposed the 150 percent guideline a number of years ago, said Jill Eaton, director of Marshall County Community Services. She added that the county also covers the cost for transportation, something Shannon said is another common concern.

Rep. Mark Smith, D-Marshalltown, said he was crestfallen that he was unable to attend the conversation, saying that this issue is one that is important to him.

“Clearly we are trying to sort out a number of changes,” he said. “There are some major problems in mental health. I didn’t feel the bill last year corrected the system it has to be hit from several angles.”

Too often, Smith said, those in need of mental health services are treated through the justice system. That needs to change. The social cost is too high. The state needs more treatment facilities and mental health professionals.

The state has targeted two populations as the focus for mental health services: those with intellectual disabilities and mental illness. As regions develop later this year, counties will have the option to partner with counties that do not meet the requirements of being contiguous.

Eaton said Marshall County has already submitted a waiver to be a part of a region that would also include Madison, Boone, Story, Hamilton, Hardin and Franklin Counties.

Because the new system also imposes an equalizing measure, Marshall County will lose $200,000 previously allocated.

“The numbers only tell part of the story,” Shannon said, adding that several counties will see an increase but still be unable to provide the services they want to provide.

Eaton said $200,000 is not a huge loss, and the county will look to see which services it can cover by Medicaid. Although the program also aims to set up one time transition funds for counties, Marshall County did not qualify for consideration of such a fund.

Shannon said the best way for citizens to make a change in the areas of mental health services they care about is to educate themselves and lobby their legislators. In other words, put a face to the money that politicians spend.

Much can change between now and July 2014 when the system is set to be fully implemented, he said.