New system must meet Iowa’s mental health challenges

Iowa’s mental health system is changing again.

Up until 2013, Iowa had county-by-county mental health management paid for with a property tax levy. In counties with larger metro areas, such as Linn and Johnson counties, residents had better access to services funded by larger county budgets.

Iowa then scrapped the 99-county model in favor of a system where multiple counties would pool resources in regions to cover mental health and disability services. The goal was to improve services in smaller counties.

Now, as of Tuesday, Iowa’s mental health and substance abuse system will be organized into seven large districts and paid with dollars allocated by the state. Local property tax funding was removed from the equation, providing a tax break for property owners.

With the new system, the Department of Health and Human Services will determine required services, implement performance metrics and oversee the system. Districts oversee prevention, education, early intervention, treatment, recovery and crisis services.

The Iowa Primary Care Association will be the system’s administrative services organization, which will oversee management and operations in the seven districts. Iowa PCA has been building a statewide network of providers who will contract to provide a wide array of services.

Again, one of the main goals of the new system is making mental health treatment more consistent and accessible regardless of where clients live,

The words “smooth transition” are being used often to describe the change.

“Nothing will change for Iowans who have Medicaid or private insurance, services and providers will stay the same,” Iowa HHS states on its website. “Iowans who do not have insurance or very limited insurance will be able to get help through the Behavioral Health Service System.”

We, of course, hope the transition is smooth, and that Iowans won’t lose critical care. Having watched the battle for state K-12 school funding many times, we hope funding the mental health system is a bipartisan process based on actual needs.

But dramatically changing a complex system with many moving parts yields uncertainty. Providing consistent services, integrating counties into the new system and filling funding gaps are among the obstacles the new system must overcome.

The state’s rate sheets for providers are 15% less than Medicaid rates, according to reporting by The Gazette’s Tom Barton.

"According to the state, they have only so much money, and they basically did their calculations and came up with, in order to provide all the services that the regions had been providing, they could only pay 85 percent of Medicaid for most services,” Rich Whitaker, CEO of Vera French, a Davenport-based nonprofit that provides mental health and housing services, told the Quad-City Times.

That’s a concern, especially as Congress is on the verge of passing a budget reconciliation measure that would cut hundreds of billions of dollars from Medicaid, leaving millions of Americans without health insurance. Without coverage, any care they receive will come out of revenues for hospitals, community health clinics and other providers.

And as a series of multi-billion-dollar income tax cuts have full effect, there are serious unanswered questions about how much funding the state can provide.

We would hate to be stuck with another poorly funded state system, especially with how much is at stake in providing quality care. Iowans deserve a stable, consistent mental health model. Allowing it to become just one more state budget line item is unacceptable.

(319) 398-8262; editorial@thegazette.com