$2.9 million earmarked for Linn, Johnson mental health access centers

HIAWATHA — The nine-county regional board that manages mental health funding passed a budget Thursday that allocates $2.9 million in fiscal 2024 for the Linn and Johnson County access centers.

While the increase was unanimously supported by the regional governing board, discussions continue over how to better cover the costs for the facilities and providers to operate around the clock.

In the revised budget for fiscal 2024 — spanning July 1 to June 30, 2024 — the East Central Mental Health Region’s regional governing board voted to boost funding for the Linn and Johnson county centers from the $2.5 million initially proposed.

The budget approval came after several county supervisors who make up the governing board said at last month’s meeting they would oppose passing a budget that underfunded the access centers.

They expressed frustration with the proposed funding, given that the mental health region projects it will have a $5.5 million surplus by June 30, the end of the current budget year.

County officials and providers raised concerns that funding the facilities below the requested amounts — $1.875 million for Linn County and $1.4 million for Johnson County — would result in reduced services or force the facilities to close altogether.

The budget that Regional Chief Executive Officer Mae Hingtgen first proposed set aside only $1.25 million for each center.

At the regional board’s meeting at the Kirkwood Regional Center, the board passed a budget that allocated $1.45 million each toward the Linn and Johnson centers.

Linn ‘asterisk’

Hingtgen said Linn County’s allocation comes with an asterisk because of uncertainties surrounding the cost of preparedness, also referred to as the “firehouse model” — the ability to reimburse providers for the cost of being ready with staffing and services when beds aren’t at full capacity.

County officials have argued that regional funding and low Medicaid reimbursement rates don’t cover the cost of services, and for Linn County the resource gap hinders the center’s expansion to 24/7 hours.

A committee of regional CEOs across the state will discuss developing a formula establishing a uniform cost of preparedness, Hingtgen said. Because that formula is not yet determined, Linn County’s allocation is tentative and could increase.

Hingtgen said there are placeholders in the budget for Linn County to cover 24-hour operations and residential crisis stabilization. Before those can be funded, she said, either Medicaid reimbursements or the regional preparedness formula have to address those services.

The region should support the losses these services sustain, Hingtgen said.

“I don’t believe that our access centers can be 100 percent self-sustaining until Medicaid agrees to pay for all the services that are in an access center,” Hingtgen said.

Regional centers

Since the two access centers receive funding from the region, they are open to individuals from nine counties: Benton, Bremer, Buchanan, Delaware, Dubuque, Iowa, Johnson, Jones and Linn.

The Linn and Johnson facilities, which both opened in 2021, are the only two state-designated access centers in the region.

The Linn County Mental Health Access Center is at 501 13th St. NW in Cedar Rapids. Johnson County’s GuideLink Center, managed by Abbe Mental Health Center, is at 300 Southgate Ave. in Iowa City.

The facilities offer crisis triage, crisis stabilization and sobering services, among others. The centers take walk-ins as well as referrals from law enforcement — providing a place other than jail or a hospital emergency room to take people who are experiencing a crisis.

Access hubs in Dubuque and Benton counties, which are not state-designated and offer a smaller scope of services, received $550,000 and $100,000, respectively, in the regional budget. Clients who need higher levels of care are typically referred to an access center.

Benton’s request was fully funded, but Dubuque’s was not pending receipt of grant funding.

Collectively, the two access centers and two access hubs will receive $3.55 million, less than the $4.34 million originally sought.

Funding authority

Linn County Supervisor Ben Rogers, the county’s representative on the regional board, placed an item on the agenda to discuss the funding authority that the managing entities — Linn County and AbbeHealth — have over the access centers.

The board moved to approve changing contracts with access centers and access hubs to allow managing entities to draw down unspent dollars for services that were already provided but not previously eligible for reimbursement. That power is contingent upon the regional board’s attorney signing off on the spending authority, as members wanted to study whether they had the legal authority to make such a change.

Johnson County Supervisor Rod Sullivan said he’d be furious if regional staff, a year from now, come to the board and say the panel can’t spend down its surplus dollars if they’re too high.

“I want to spend every damn thing because we’re going to have to give it back (to the state) otherwise,” Sullivan said.

Hingtgen cautioned against spending too much of the surplus and said some of those funds likely will be needed next year.

But Dubuque County Supervisor Ann McDonough countered: “We have to survive through this year to keep these services intact to be able to get through next year to worry about a budget hole then.”

Overall, Rogers said he was pleased with the discussion and decisions made Thursday to ensure communities could access these services in a timely manner.

“It shows a continued commitment to access centers and the creation of access hubs,” Rogers said. “The board showed support for expanding services and tried to meet the greater needs that each of our communities are experiencing.”

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