Vetoes for mental health and disability services were the most disturbing

By Lisa Heddens

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On June 20, Gov. Terry Branstad signed several bills along several line-item vetoes. The vetoes for mental health and disability services were the most disturbing to me.

While the Legislature has invested a significant amount of funding into our mental health and disability system, much of that has been to play “catch up” for years of underfunding and to ensure a smooth transition to the new regional system without reduction of services and to maintain the integrity of programs provided.

The mental health and disability bill that passed in 2012 included a provision that established an equalization tax levy rate of $47.28 per capita. Counties below that rate would receive money from the state to bring them up to the $47.28 level.

The 45 counties above that rate were forced to reduce property taxes. For those counties, the only options were to decrease services, institute waiting lists, or eliminate services all together.

The old system had money in a “risk pool” that counties could apply for to meet the needs of their constituents.

The risk pool dollars appropriated during the 2013 legislative session would have assisted counties who were forced to reduce their levy rates, yet maintain services for their constituents, while we transitioned to the new regional system. Because of the governor's vetoes, some counties will now be forced to reduce services and create waiting lists for services for vulnerable citizens.

In addition to the veto of the $13 million for the risk pool, the governor also vetoed $8.7 million to eliminate waiting lists for services under the Home and Community Based Services (HCBS) Waivers. Iowa has seven HCBS Medicaid waivers - intellectual disability, health and disabilities, children's mental health, brain injury, physical disability, AIDS/HIV and elderly.

Medicaid is available to certain low-income people. Of those enrolled in Medicaid, 57 percent are Children, 16 percent are adults, 8 percent aged, and 19 percent are individuals with disabilities. Seniors and people with disabilities make up 69 percent of the expenditures.

Home and Community Based Services are Medicaid programs. The term “waiver” means that some of the federal Medicaid rules have been “waived.” It also means that there are more choices of what services are provided and where you can receive them. While the counties may pay for some services for eligible individuals, these are Medicaid waivers and in 2012 the state took over all Medicaid funded services from the counties.

In the governor's veto message, he stated, “Past history demonstrates that funding specifically earmarked to buy-down the waiting list is not a long-term solution.” I couldn't agree more!

I do disagree with his statement that the new Health and Wellness Plan will provide access to Home and Community Based Services. While both are Medicaid services, each is a different plan with different eligibility criteria and services provided.

The only way to eliminate waiting lists is to have the resources available to provide services to every eligible individual who applies for services. It boils down to money.

What we need to do is to continually move forward with the full understanding that our disability system, both at state and county level, doesn't fund only mental health services, but also services and supports for people with intellectual disabilities. In addition, while the Legislature is moving to a more equitable system, we must also consider that there are many other individuals with disabilities who do not fall into a waiver category and are receiving very limited services or no services at all.

As a parent of a child with a disability, I understand the needs and concerns. As a legislator we need to continue to move forward for the betterment of their lives.

Lisa Heddens, D - Ames, is a ranking member, Health and Human Services Budget, and serves House District 46. Comments: Lisa.Heddens@legis.iowa.gov