Iowa’s mental health, substance use care faces big changes

DES MOINES — A plan from Gov. Kim Reynolds that supporters say will address Iowa’s splintered treatment systems for mental health and substance abuse moved forward Thursday after two Republican lawmakers agreed with the proposal.

The bill, House Study Bill 653, calls for dissolving Iowa’s differing treatment networks — one that provides mental health services and another one that provides substance use disorder care. In their place, the proposal would establish a new network of regional behavioral health providers that provides health care services for both. Under the proposal, Linn and Johnson counties would be in different districts.

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In her Condition of the State address in January, Reynolds said there is “little coordination” between the differing districts now, causing problems for Iowans seeking treatment for both. “Over 25 percent of adults with serious mental health challenges also suffer from substance use,” she told lawmakers.

Officials with the Iowa Department of Health and Human Services and the governor’s office echoed that Thursday, telling lawmakers on the subcommittee that Iowa’s current systems for mental health and substance use disorder treatment are inefficient and lead to inconsistent services across the state.

Department Director Kelly Garcia said the system now is too complicated and difficult to navigate for Iowans. She said the proposal would offer the same services but in a more efficient and accessible way.

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“What we see today is a system that is fractured,” Garcia said. “It is fractured; it is not serving Iowans. And so we are taking a really significant step forward to really cure that issue.”

Molly Severn, the legislative liaison for Reynolds’ office, said millions in unspent funds for Iowa’s mental health regions are evidence the current system is inefficient.

Last year, for instance, the East Central Mental Health Region that now includes Linn and Johnson counties was faced with losing millions if plans were not made to spend a surplus. That came about because the state’s Health and Human Services Department allocated state tax dollars to the regions — but if regions carry too much of a surplus under the law, the agency withholds further dollars that could have gone to providers.

“This system is broken,” Severn said. “The regions have done the best they can with a fractured system, but now is the time to fix it.”

What does the bill do?

Rep. Joel Fry, R-Osceola, said lawmakers have made strides in addressing Iowa’s mental health care, and he hopes the bill will continue to improve those services.

“We are excited to work with the governor on how we might move this bill forward and continue to enhance services,” he said. “Don’t want to leave any of those services that we currently have out. We’ll take advisement and continue to be open for discussion as we move this bill forward.”

Iowa has 13 Mental Health and Disability Service regions that provide care for people with mental health issues and intellectual disabilities. There are 19 Integrated Provider Networks that deal with substance use disorder and gambling addiction.

The bill would dissolve those regions and networks, and instead create a Behavioral Health Service System consisting of seven Behavioral Health Districts under the Department of Health and Human Services. Those districts would be responsible for prevention, education, treatment, recovery and crisis services related to both mental health and substance use disorders.

Disability services provided by the state’s Mental Health and Disability Service network would be shifted to the state’s Aging and Disability Services.

The seven new regions would be administered by an organization selected by the state through a bidding process. The organization could be the existing agencies that oversee mental health regions, or another public or private agency in the district.

Under the bill, the Iowa Department of Health and Human Services would receive all federal block grants for mental health and substance abuse services, and would then direct it to agencies in the seven regions. The region administrators would develop and follow behavioral health plans to provide those services.

The bill would remove from the law the core services that Iowa’s regional mental health providers must offer. Instead, the required services would be set out in contracts between the department and the regional agency.

The transition between systems would take place over a year, and the new system would become fully operational in July 2025.

Health providers weigh in

Flora Schmidt, executive director of the Iowa Behavioral Health Care association, spoke on behalf of several of the organizations and providers that make up Iowa’s substance use networks and a number of mental health and behavioral health clinics.

She told lawmakers the providers were “cautiously optimistic” about the change, but had major concerns about the yearlong transition period and how services would transfer over between the old and the new systems.

Other health care provider groups said they were concerned that the removal of the core services from law could lead to a weakening of those services.

“Our members, they’ve got a lot of angst right now,” Schmidt said. “They just don’t know what it’s going to mean to their workforce, their funding, and ultimately their ability to maintain a continuity of services over the next 18 months and then into that first couple of years into the process.”

HSB 653 was passed out of a House subcommittee with support from the two Republican members. It now goes to the full House Health and Human Services Committee. Democratic Rep. Beth Wessel-Kroeschell of Ames did not vote to advance it, saying she had questions about how the bill would be implemented.