Gov. Kim Reynolds signs overhaul of Iowa mental health, disability services into law. What’s next?

CEDAR RAPIDS — Gov. Kim Reynolds signed into law Wednesday a plan to streamline and combine Iowa’s delivery system for mental and behavioral health services — which advocates hope will improve access for patients.

“For too long and for too many Iowans in need of help, navigating and accessing services across the system has been too difficult for patients and providers alike,” Reynolds said.

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.

The result, Reynolds said, has led to duplicative and inconsistent programs, an inefficient system and poor outcomes.

“And we can do better for Iowans in need and we are. We will,” she said. “By bringing services together in this way, we will enable better coordination of care supporting the best possible outcomes for each individual. It’s what Iowans deserve, and it’s what we intend to deliver.”

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New system aims for equitable statewide access

The new law combines Iowa’s total of 32 mental health and substance use regions into seven unified behavioral health districts, while placing disability services under the jurisdiction of the Iowa Department of Health and Human Services. The proposal aims to improve a system that both state officials and advocates agree is badly fractured.

Each district will be required to provide a standard set of core services, ensuring consistent care systemwide, Reynolds said.

The Department of Health and Human Services will define district boundaries and required services, implement performance metrics and provide oversight of the system.

The districts would handle prevention, education, early intervention, treatment, recovery and crisis services related to mental health and substance use disorders.

Funding for those services would also be merged into one behavioral health fund overseen by Iowa HHS.

“For the first time we will have an intentionally planned system that includes, in statute, prevention, treatment and recovery,” said Kelly Garcia, the state’s director of health and human services.

Each district would be overseen by an advisory board of local providers and government officials to “identify opportunities, address challenges and advise the administrative services organization.”

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The governor signed the bill, House File 2673, at Foundation 2 Crisis Services and toured the nonprofit’s new headquarters after a $5.4 million renovation of the Witwer Building in downtown Cedar Rapids.

The organization operates a 24/7 crisis support line, emergency youth shelter, crisis mental health support and other services.

Emily Blomme, chief executive officer of Foundation 2, said the merger of the two regions is a step in the right direction to ensure every Iowan has access to comprehensive mental health and substance use support.

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“This legislation is an opportunity to make meaningful changes in the system, which translates to meaningful changes in the lives of Iowans,” Bloome said, by helping them “achieve stability and remain mentally well.”

The legislation states the new behavioral health services system shall provide equitable statewide access to all services and offer specialized services with a focus on at-risk populations. That includes children, young adults, individuals with disabilities, pregnant women, older Iowans and those with limited access to financial resources.

The bill passed the Iowa Legislature with large bipartisan support, and was backed by the Iowa Hospital Association, Iowa Mental Health Advocacy, National Alliance on Mental Illness, Coalition for Family and Children's Services in Iowa and others.

Some, though, worry the proposal does not go far enough to address underlying issues that hinder access to treatment and services, including Iowa Medicaid reimbursement.

While the change could be a win for how mental health and substance use services are administered in Iowa, advocates say underlying gaps in care persist.

Rural Iowans often face long drives to seek treatment or struggle to access telehealth in sparsely populated areas where internet connections are weak. Children can’t use Iowa’s access centers — like those in Linn and Johnson counties — and there’s a limited supply of crisis beds and shelter space.

Garcia said the Health and Human Services Department is considering building out a pipeline for providers and brick-and-mortar spaces to handle complex behavioral health needs, including launching certified community behavioral health clinics. She also emphasized the importance of a comprehensive approach to addressing social issues, recognizing that a single solution will not be sufficient.

“And so the concept here is that we have a true statewide planning effort,” Garcia told reporters following the signing.

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What’s next?

The state would contract with local organizations to carry out the services in each of the new seven behavioral health districts. The state would solicit proposals from existing agencies that oversee mental health regions, or another public or nonprofit entity in the district, to administer the regions. The law specifies the new districts be created by Aug. 1, and organizations selected by Dec. 31 to administer services.

The bill specifies the state’s transition to a unified behavioral health system be completed by July 1, 2025. A state timeline calls of initial implementation in summer 2025 and full implementation by July 2026.

Garcia said the department plans to conduct public forums and community listening sessions over the summer to provide more details, take questions and gather feedback.

Law also includes ‘monumental shift’ in disability services

The law also moves disability services provided by the state’s Mental Health and Disability Service network to the state’s Department of Health and Human Services division of Aging and Disability Services.

“It will set up a system with clear access points for Iowans with disabilities,” Reynolds said.

Garcia said that work will center on enhancing Aging and Disability Resource Centers, developing a comprehensive and connected system to address long-term care options for Iowans with disabilities, and building coalitions for aging and disability resources.

“We're planning to build on existing infrastructure, and we will build truly accessible one-stop-shop locations for individuals with physical disabilities,” Garcia said. ”We plan for co-location with our ADRC partners, our Area Agencies on Aging, our centers for independent living, community action agencies and the like. … We have an opportunity to invest in capacity, establishing a higher level of care and specialized care, which is needed now more than ever. This is a monumental shift and a once-in-a-lifetime opportunity.“

As with behavioral health, the goal is to eliminate duplication and provide more focused, coordinated support for Iowans with disabilities. While Iowa’s mental health regions also provide disability services, “it's a maybe a lowercase ‘d’,” Garcia said.

“It's not the full focus and that's because the call to action of the day is behavioral health,” she said. “And so we don't want our Iowans with disabilities to get a back seat in that ride. And so we have the opportunity, through our own state agency alignment, to think about a strengthened way (of providing services) — still in very clear partnership with the behavioral health side, because a lot of individuals especially with intellectual and developmental disabilities also have a co-occurring mental health need.”

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