SPIRIT LAKE - To say that mental health redesign in Iowa is totally up in the air would not at all be an exaggeration.
That was the impression anyone would have after attending a meeting Wednesday at the Dickinson County Courthouse Board Room. County representatives from Lyon, Osceola, Dickinson, O'Brien, Clay, Palo Alto and Emmet counties attended.
The meeting was in response to state-mandated mental health redesign in which counties will be required to form regions of at least three counties.
One huge negative impact on Emmet County is that all counties will be held to a mental health levy cap equivalent to $47.28 per county resident which will slash the county's mental health budget by about 40 percent.
Dickinson County supervisor Bill Leupold convened the meeting at which Linda Hinton, government relations manager for the Iowa State Association of Counties, outlined the upcoming changes. Hinton, who manages ISAC's lobbying efforts, has also been lobbying on disability services since 1993. Most of what Hinton discussed dealt with the impact on counties of Senate File 2313, better known as the mental health redesign bill.
Hinton said problems started in the mid-1990s when the state went to a county-managed system and did not provide funding it had promised for people with disabilities and people with mental illnesses lost services.
The current redesign, under SF 2315, calls for mental health service regions that will take up the "bumps in the road".
According to Hinton, regions must be comprised of three contiguous counties, have the capacity to provide core services and administrative functions, have a common mental health center or be able to contract with a qualified provider and have a psychiatric unit within 100 miles.
For a timeline, counties have until April 1 to form regions and exemption requests are due by May 1. Full implementation must come by June 30, 2014, with regions operational by July 1, 2014.
Hinton said one problem that has already occurred under redesign is that the state did not follow through with its promise to pay Medicaid bills for services delivered before last July 1, but with the bills coming after that time.
Another is the per capita mental health property tax levy target of $47.28 a person. Hinton said counties above that target would have to reduce services by $10 million statewide. Counties below the target would supposedly receive an equalization payment from the state - provided the state follows through as promised.
"The legislature will not consider anybody's property tax increasing," Hinton said. That leaves 66 counties eligible for state funding with 33 having to reduce services. Hinton said a legislative interim committee is now discussing how counties are to make up the difference.
Hinton said the interim legislative study committee is looking at whether per capita levy financing of the system will work, impacts of a per capita equalization fund for each county and issues raised by the Transition Committee that may require legislative change.
Hinton said 32 counties had applied for transition funds. While the best-case scenario called for $20 million in transition funds, only $1.4 million was approved - most of which would go to Scott County since it used the money it had to pay Medicaid rather than local bills. The hitch for other counties now is that federal money can't be used to pay Medicaid bills, Hinton said.
Hinton then addressed a number of questions audience members had written in advance.
n Counties can't control geography but they can apply for an exemption. They also need to compile finances and services available.
n While the legislature does not require pooling assets, Hinton recommended it - while adding that it should be a local decision. She also advised that region counties establish a risk pool to help counties that have trouble providing services. She also noted that counties in a region can't have a waiting list and that they can't cut services.
n As for hiring an administrator, Hinton said the legislature does not require regions to do so. She said member counties need to be able to make that decision.
n Hinton said ISAC will be able to provide counties with information about how other counties work through the regionalization process.
n Hinton said it is not mandatory that counties within a region share funding at this point. She said property tax dollars should not have to be shared.
n As for who pays the bills, Hinton said each region's 28E agreement will have to make that decision.
n Hinton also said regions should decide job descriptions.
n As for how counties should plan their budgets, Hinton noted that Linn County has prepared two budgets - one presuming a $47.28 levy cap and the other without.