Iowa DHS chief suggests incentives to increase number of practicing pyschiatrists in state

CEDAR RAPIDS - Iowa might consider incentives to recruit or keep psychiatrists in the state in light of almost certain additions to the Medicaid rolls, the chief of the Iowa Department of Human Services said.

Charles Palmer, who was re-appointed as DHS administrator this year after serving in the post from 1989 to 1999, said Friday that the agency is preparing for health care reform changes, regardless of pending lawsuits.

One of those changes could add up to 100,000 Iowans  – mostly single men or childless couples – to the Medicaid caseload, which currently stands at 400,000.

Current rules require that low-income Iowans also have a qualifying factor, such as a disability or pregnancy, to be eligible for Medicaid.

Under federal health care reform measures, people who earn below 133 percent of the federal poverty level and don't have those qualifiers would be eligible for Medicaid in 2014.

“We're doing things today to get ready,” Palmer said during a meeting with The Gazette Editorial Board.

Palmer said one area being examined is increasing the number of psychiatrists who practice in the state. He noted that Iowa ranks near the bottom nationally in the number of psychiatrists per population.

State officials are in “thoughtful discussions” with training institutes, such as the University of Iowa, about ways to increase those numbers, he said.

One idea would provide educational incentives or scholarships for students who commit to practicing in rural Iowa or other underserved areas of the state.

The concept is one he might recommend to the state Legislature next year, Palmer said.

Overall, the Medicaid additions might just be a budget shift, he said, as some of those who will be eligible likely are already receiving services at the county level, for example.

Budget cuts are also an area of concern to the DHS.

Palmer said until the budget is known, hopefully by May 1, how many positions might be cut is unclear.

Early figures suggested potential layoffs could number 130, in addition to keeping 120 positions vacant.

Palmer is hopeful that the number of beds available for psychiatric patients in state mental health institutes will not be cut, though some at facilities in Eldora, Clarinda and Mount Pleasant that serve substance abuse patients and others could be cut.