Countdown is on for Iowa’s new behavioral health districts

Eastern Iowa nonprofits are preparing for change as the Iowa Department of Health and Human Services works to finalize details of its new behavioral health districts, which will go into effect July 1.

The goal of the redistricting, signed into law last May by Gov. Kim Reynolds, is to unify behavioral health services across the state to more seamlessly provide care for those with mental health or substance use issues — or both. The plan combines Iowa’s disparate 32 mental health and substance use regions into just seven behavioral health districts that oversee providers for both.

While Iowa’s mental health regions are funded by the state, they’re not aligned with the substance use disorder system, even though more than 25 percent of adults with serious mental health challenges also suffer from substance abuse, the governor said when signing the bill. The result, Reynolds said, has led to duplicative and inconsistent programs, an inefficient system and poor outcomes.

The new districts will be overseen by the Iowa Primary Care Association, a Des Moines-based health care association awarded a contract in December to be the administrative service organization for all seven.

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East Central Region transitions

The Mental Health/Disability Services of the East Central Region, which previously partnered with agencies in a nine-county region to provide behavioral health services, had applied to be the administrative service organization for the seventh district, which includes Linn and Johnson counties.

Mae Hingtgen, chief executive officer of the East Central Region, said she was concerned after not receiving the contract that the nonprofit would have to close. But in February, it was awarded a contract to be the seventh district’s disability access point, which is also part of the new district plan.

“The primary responsibility of the disability access point will be to provide service coordination for people with disabilities, whether those people need short-term assistance or long-term assistance, and so that will be our primary focus,” Hingtgen said. “We have a group of employees called regional social workers, and we're hopeful that a lot of them can evolve into that role of service coordination with the disability access point.”

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There will be a lot of evolving to do as the East Central Region adjusts to its new role, but Hingtgen said that several of the responsibilities outlined by the state for the disability access point are things that the nonprofit already is doing, but under a different name — like options counseling, in which the nonprofit helps people with disabilities understand what services are available to them in Iowa.

“We do that already, but we don’t formally call it options counseling,” Hingtgen said. “So, there are some prescribed activities that are very similar to what we do that we’ll just effortlessly be able to move into.”

The harder part of the change will be adapting to the new partnerships that the region will have in the seventh district. The East Central Region currently serves nine counties — Benton, Bremer, Buchanan, Delaware, Dubuque, Iowa, Johnson, Jones and Linn — but will now be losing three of those counties to other districts and picking up seven new counties. The seventh district will cover Black Hawk, Buchanan, Delaware, Dubuque, Linn, Jones, Jackson, Johnson, Cedar, Clinton, Muscatine, Scott, Louisa and Des Moines counties.

“We have such a great network of mental health and disability services providers in our nine-county area. We have really good relationships with them, so I do have a lot of people reaching out to me, asking, ‘What does this mean? What does this mean?’” Hingtgen said. “It’s a time of uncertainty, still. HHS is committed, and I have no reason to believe that this isn't true, that they're committed to continuity of care for people, to ensure that there is a smooth transition here.”

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A part of the transition that Hingtgen is not looking forward to is reducing staff. Since the East Central Region will no longer be doing the behavioral health work it was doing before, because it wasn’t chosen as the administrative service organization, it likely won’t need as many employees, Hingtgen said.

In December, when she thought it was likely the East Central Region would be closing, Hingtgen started encouraging the 34 staff members that the organization had then to look for other jobs. As of early April, five people had left the organization or had given notice, but Hingtgen said more staff reductions likely will be needed.

The nonprofit still is working with the state to determine exact contract details that will affect its budgeting and staff, but Hingtgen said she anticipates starting July with less than two-thirds of the region’s previous staffing level.

“There’s a lot of uncertainty still. Even though the entities have been named … there’s still a lot of uncertainty about what the actual implementation looks like. This is a process, and we’ll be rolling that out with direction from the Department of Health and Human Services over the next few months,” Hingtgen said.

‘Learning process’ for new administrator

Other nonprofits that will be affected by the redistricting are also waiting for answers about how the change will affect their funding.

Emily Blomme, chief executive officer of the Foundation 2 crisis services in Cedar Rapids, said that she’s not expecting to have a finalized contract with the state until May or June for the next fiscal year, which starts in July.

“The (Primary Care Association) is in this learning process. They’re exploring. They’re learning what contracts currently exist, what services are where in the state, and they need to get through that process before they can figure out what it’s going to look like moving forward,” Blomme said. “I'm optimistic that all of the services that we have provided traditionally under the regional funding mechanism will continue.”

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Despite the slow contracts, Blomme said she’s excited about the redistricting. Foundation 2 has stayed closely involved with the process, attending every meeting they’ve been invited to and making sure state officials know the importance of the work they do.

Foundation 2 is a nonprofit that focuses on crisis prevention and is one of the organizations in Iowa that responds to calls and texts sent to the national suicide lifeline, or 988.

Blomme said she’s confident that nothing is going to change for the foundation’s staff or clients, except that they will have access to more resources when referring people for further care, and coordination between agencies should be easier.

“I firmly believe that the Department of Health and Human Services, and the PCA and providers, we are all working for the same outcome, which is that Iowans have the right level of care that they need for their mental wellness when they need it, that there's clear care coordination, and that generally our communities are more mentally well than they were before,” Blomme said. “I want this system overhaul to work well, because it can save lives.”

Comments: (319) 398-8328; emily.andersen@thegazette.com