Lawmakers hear from officials, Iowans on limited access to mental health services

Iowa lawmakers meeting Tuesday said they recognized the need for expanding access to subacute mental health services in Iowa — but said there are no specific plans on how to tackle the issue yet.

The Subacute Mental Health Care Services Interim Study Committee met Tuesday, the week before the 2026 legislative session is set to kick off, to discuss concerns and issues with certain services in Iowa’s mental health system.

Subacute mental health programs are for people who do not need emergency hospitalization but need more intensive support than is available through outpatient care — a type of care that Iowans and officials said is extremely limited and difficult to access in the state.

Mary Neubauer, a former spokesperson for the Iowa Lottery, said her family had extensive experience in the subacute mental health care system as they pursued care for their son, Sergei, who died by suicide in 2017. Sergei, who was adopted by Neubauer and her husband in 2009, struggled with major depression, anxiety and post-traumatic stress disorder after an abusive childhood in Russia. Neubauer said their family knew he would need “more support” as he transitioned to life in the U.S., but that after his second inpatient psychiatric care hospitalization, “it was obvious he would need longer-term care if he were to have a chance to regain his health.”

When Neubauer and her husband asked the psychiatrist treating their son where they could find such care, she said “the doctor’s answer was that there were great subacute care programs out there, but he did not know of any in Iowa, and we would have to find them.”

“I do not denigrate that doctor,” Neubauer said. “He was doing the best he could in the state with few resources at the time, but for us as parents who were so scared and stressed, that answer was devastating.”

After extensive research, Neubauer said, her family found two subacute mental health treatment centers that they believed would be a good fit for Sergei, located in Arizona and Wisconsin. Sergei received care in the Arizona treatment program for five weeks, and then went on for three months of “step-down care” in California.

After completing these programs, he returned to Iowa. While he appeared to be doing well in his first weeks home, Neubauer said, he eventually died in September 2017.

“I don’t know if Sergei’s story would have been different, would have had a different outcome if more mental health treatment options would have been available for him here in Iowa,” Neubauer said. “But I do know that his journey to regain his health was made that much harder by having to go halfway across the country to receive that care, and it made our journey as his parents trying to support him absolutely excruciating. If we can keep another family from having that experience, we will have done something good.”

The committee members heard from officials with the Iowa departments of Health and Human Services and Inspections, Appeals, and Licensing about why there is a dearth of subacute mental health programs in Iowa.

One of the major difficulties identified in Iowa’s current oversight of these subacute mental health care was a provision in Iowa Code stating these services “shall be limited to a period not to exceed ten calendar days or another time period determined in accordance with rules adopted by the department for this purpose, whichever is longer.”

Sara Throener, legislative liaison for DIAL, said the 10 days marked in this section was not meant to be a hard limit for receiving subacute mental health services, but a period for receiving “rolling assessment” on the patient’s condition. While there is the ability to provide longer care, Throener said it is possible the 10-day language is “misconstrued by payment providers or by providers thinking that’s all that they can offer.”

Neubauer said as their family looked at treatment options for their son, subacute mental health treatment programs typically ranged from six weeks to three months in length.

The perceived 10-day limit was also brought up by providers in a Request for Information from Iowa HHS, according to Cory Turner, HHS division administrator for state-operated specialty care.

“It’s not a fault of the rules or HHS at the time, it’s just the way in which it’s written and the way in which it’s interpreted, providers see it as a detriment,” Turner said. “… It doesn’t ensure that there’s viability in their business model. If you have a 10-day limit on someone, and that 10th day comes and goes, the individual may already be discharged by the time they receive payment, or they may not get payment for services at all.”

Turner said these issues on time limits may be part of why Iowa’s currently available subacute mental health care provisions are being underutilized. There are currently at least 30 beds at six health care providers in Iowa that provide this treatment, according to HHS data — but Turner said in one RFI response, a provider said of the 16 beds available in their program, only two were being used.

Other issues were funding and reimbursement streams for these programs, he said, as well as difficulties recruiting qualified staff.

Turner said investing more in subacute programs could help lessen the burden on other parts of Iowa’s mental health care system. At several of Iowa’s mental health care institutes, he said, there are significant numbers of patients “in the facilities for longer lengths of stay than are necessary.” He said some of these individuals likely would benefit from moving from an emergency, acute level of care to a subacute treatment program, that would help “unkink” the system and free up resources for others in crisis.

There are also other rules, like higher professional requirements for practitioners in subacute facilities than in crisis facilities, as well as lower limits on how many patients at a time can be cared for in these programs, that officials said make it less economically viable for health care providers to offer these services in Iowa.

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Though the committee discussed several issues, the panel did not move forward with any suggestions at the meeting. Rep. Gary Mohr, R-Bettendorf, who co-chaired the committee, said “it sounds like there is sufficient interest that we are going to move something forward.” However, he said any potential legislation on this issue is far from finalized.

“Many of you are going to think as a result of today, we’re going to come out with a grandiose, multimillion-dollar plan — don’t count on it,” Mohr said. “Some of you expect us to come out with virtually nothing, and maybe one or two recommendations — don’t count on it. We’re going to get as far as we can moving this issue forward, based on the knowledge we have now and the questions we still have yet to ask. But it’s an issue that seems to be important, and we will move this forward through our committee structure probably, the Legislature — again, you know how things work here, there’s no definite path for it.”

This article was first published by Iowa Capital Dispatch.