Staff Columnist

Don't leave mental health half done

Iowa fixes vulnerable to shifting national focus

The House Chambers in the Iowa Capitol Building in Des Moines on Wednesday, Mar. 7, 2018. (Stephen Mally/The Gazette)
The House Chambers in the Iowa Capitol Building in Des Moines on Wednesday, Mar. 7, 2018. (Stephen Mally/The Gazette)

Every lawmaker in Iowa is on board with significant and desperately needed mental health expansions. Now, they just need to fund them.

It took a month for House File 2456 to work its way through the Iowa Legislature. It was introduced Feb. 21 as a proposal that had already benefited from widespread input. Amendments followed, not all approved. At least one was withdrawn amid pressure it would kill the bill.

The measure passed the House without a dissenting vote Feb. 27, and the process began anew in the Senate. And, once again, last Wednesday, the bill stood without dissent.

For those who may have forgotten, that’s how this process of lawmaking is supposed to work. It begins with well-vetted ideas, needs and wants gathered from Iowans. Lawmakers have time to read the proposal, to discuss it with constituents and experts in the field.

Proposals are made, public debates take place. In the end a bill emerges that most — in this case, all — lawmakers believe is the best path forward.

The next step is the governor’s desk, and there’s little concern that this bill will get scuttled in this final step.

“Thanks to the Iowa Legislature for sending mental health care bill to my desk! Strong step to improving compassionate care for all Iowans #iagov #ialegis #iapolitics,” Gov. Kim Rey-nolds’ official twitter account announced Wednesday.

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Specifically, HF 2456 authorizes the creation of six “access centers” that provide immediate care to Iowans in a mental health crisis, relieving a burden now placed on local jails and emergency rooms. It adds more flexibility to the law, allowing those seeking care to benefit from access to least restrictive options, and better coordinating information sharing between mental health providers and law enforcement.

The state’s cap on sub-acute psychiatric beds will be lifted. Expanded treatment teams are expected to better monitor and assist residents with chronic disease. Mobile response teams as part of community-based crisis services are expected to keep people close to established support systems.

None of this is unnecessary. In fact, it’s long overdue. But it all also comes with a price tag.

A rough estimate of how much it will cost is included in a fiscal note prepared by the Legislative Services Agency. The state’s general fund will take a roughly $1 million hit in 2019, which increases to $6 million in 2020. But the bulk of the cost has been shifted to Iowa’s 14 Mental Health/Disability Services regions, which are funded primarily through a mix of property taxes and Medicaid (state and federal).

“The startup and ongoing expenditures are estimated to cost the MHDS regions $4.3 million in FY 2019 and $10 million in FY 2020,” the Legislative Services Agency projected.

Development of many of the promised core services hinges on federal matching funds through the Iowa Health and Wellness Plan. That means without federal support, Iowans won’t see “access centers,” assertive community treatment services, expanded community-based crisis services or intensive resident service homes for those with severe illnesses.

Although not reflected in the $1.3 trillion, 2,300-page omnibus spending bill passed by Congress, the Trump administration’s proposed budget called for significant cuts in health care spending, specifically targeting several key behavioral health programs. That might be a clue as to where federal leaders hope to save money long-term, which wouldn’t be good news for state programs built to depend on federal money.

Spending approved by Congress that will keep the federal government chugging forward through September includes new spending on the opioid crisis, and a few new expansions of mental health supports:

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• $1.4 billion to the Substance Abuse and Mental Health Services Administration, including $1 billion for a new State Opioid Response Grant program and a $160 increase in the Mental Health Block Grant;

• $700 million to the Department of Education to fund a mental health program and new school counselors;

• $500 million for additional opioid research through the National Institutes of Health;

• $500 million to the Department of Veterans Affairs for mental health services;

• $415 million for the Health Resources and Services Administration to bring addiction treatment to underserved and rural areas;

• $350 million to the Centers for Disease Control and Prevention for overdose prevention, opioid surveillance and state prescription drug monitoring programs;

• $299 million to the Department of Justice for grants to combat opioids;

• $100 million to the Administration for Children and Families to help kids whose parents are addicted to drugs;

• $94 million to the Food and Drug Administration for illicit drug mail surveillance.

Critics already — and rightfully — are complaining that the bill doesn’t do enough to combat opioids. But as national focus shifts to the drug epidemic, it’s likely dollars will shift from overall health care services, including mental health. Because cost-sharing reduction payments were ended by the Trump administration and the tax reform package eliminated the individual mandate, health insurance companies took a hit on plans provided to poor Americans. An effort to shore up gaps was railroaded by social conservatives who refused to come on board without new abortion restrictions.

Not only does it remain unclear how long a state plan so heavily dependent on federal supports can remain viable, the latest omnibus package underscores the dismal reality of federal overspending.

That’s not good news for a state such as Iowa battling its own declining state revenues and strapped with lawmakers unwilling to make difficult decisions about a bloated system of tax giveaways.

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Passing a mental health bill was the first step, and lawmakers put together a package of services that will, after upfront costs, save taxpayers money and better provide for Iowans in crisis or living with chronic conditions.

The larger battle of paying for and maintaining those services is just beginning.

• Comments: @LyndaIowa, (319) 368-8513, lynda.waddington@thegazette.com

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