Linn, Johnson counties joined in new behavioral health reorganization map

Linn and Johnson counties will be together after all when the state is divided into seven regions for the delivery of behavioral health services next year, according to a map published Thursday by the state.

The Iowa Department of Health and Human Services is working to implement a reorganization of the state’s delivery of behavioral health services. The new plan combines Iowa’s total of 32 mental health and substance use regions into seven unified behavioral health districts.

The restructure aims to improve a system that both state officials and advocates agree is badly fractured. It was approved by state lawmakers and signed into law by Gov. Kim Reynolds earlier this year, and goes into effect July 1, 2025.

Each of the seven districts under the new system will be required to provide a standard set of core services, ensuring consistent care system wide, Reynolds said.

Advocates cheered the plan, saying they hope it will improve access for patients. But they say questions remain over how funding will be spread across the new districts as well as how providers and Iowans seeking care will be affected in the transition.

How the state created the new map

Under an earlier proposal, Linn and Johnson counties were put into separate regions: Linn was grouped with counties that extended to the state’s Northeast corner, while Johnson was grouped with a batch of counties that extended to the Southeast corner.

Area advocates expressed their preference that the two counties remain in the same district because of existing partnerships among providers and law enforcement agencies and reliance on access centers — one in Iowa City and one in Cedar Rapids.

In the map published Thursday, Linn and Johnson counties are in a 14-county region that extends east to the Mississippi River, and includes Scott, Dubuque and Black Hawk counties. It encompasses Iowa’s second through fifth most-populous counties.

The new district containing Linn and Johnson did lose Bremer, Benton and Iowa counties — three of the nine counties that currently make up the East Central Mental Health Region.

Health and Human Services said when creating the final map, it considered stakeholder feedback in addition to data-driven criteria, including access to care, high-need areas, city and county boundaries, prevalence of doctors, dentists and mental health providers and the rate of Medicaid patients.

“This tool helped create balanced and compact districts that reflect the varied, data-driven needs of the population while considering existing administrative boundaries and potential collaborations,” it says in a seven-page report prepared by department Director Kelly Garcia and published Thursday with the new map.

“The district map, in combination with the development and utilization of a data-informed funding formula, will ensure that resources are allocated effectively to support the full array of behavioral health needs of Iowans.”

Under the newly designed system, the department will define required services, implement performance metrics and provide oversight of the system, while the districts handle prevention, education, early intervention, treatment, recovery and crisis services related to mental health and substance use disorders.

Funding for the services will be merged into one behavioral health fund overseen by the state. The funding formula hasn’t been announced yet.

Linn, Johnson in most populous district

Nearly one-third of Iowans — 1,038,782 people — live in the new district containing Linn and Johnson, said Mae Hingtgen, chief executive officer of the East Central Region.

“There’s an advantage of the fact that we have so many populous counties,” Hingtgen said. “Because it’s such a large population in this district, we also have more people who have need. It’s going to be our responsibility to find that balance between available resources and distribution according to need.”

While residents will benefit from this populous district being full of behavioral health resources, Linn County Mental Health Access Center Director Erin Foster said, she questioned what impact this concentration of resources will have on other districts.

“My fear is there are some of these districts that really do not have a lot of services and options for services in them,” Foster said. “You look at the region that we are in, and it is very resource rich. There is an advantage to being in this district, but what does that look like for the other districts? … How do we make sure that they have an equitable amount of resources that all the other districts do?”

Foster pointed to resources like Foundation 2 Crisis Services, which employs law enforcement liaisons in the sheriff’s offices in Linn, Buchanan, Benton, Delaware and Dubuque counties, and police departments in Cedar Rapids, Marion and Dubuque. She said it was uncertain how such programs would be impacted when its administrative districts are split.

Foundation 2 officials declined to comment as the redistricting’s impact on services is unknown at this point.

Foster said she and other area providers hope to better understand the state’s rationale behind this map next Tuesday, when Health and Human Services will host a virtual discussion launching the new districts.

“The purpose of the realignment was to increase accessibility and increase effectiveness of people getting services,” Foster said. “I hope when we have the opportunity to hear the rationale behind where this district landed that's explained to us.”

Hingtgen said the state has been focused on defining outcomes of services — for instance, that people who have interactions with law enforcement should have behavioral health support. It’s possible different districts could meet the same outcome with a different service, she said.

Hingtgen thinks there will be an impact to organizations like Foundation 2 with a footprint spread across multiple districts, but standardized expectations for services could ensure people have access to the support they need.

“If we equalize things, that should be something that does not have a direct impact on the clients that we serve,” Hingtgen said.

What’s next?

Now that the districts are formed, the state will use a bidding process to select groups to administer the seven new regions. These organizations could be the existing agencies that oversee mental health regions, or another public or private entity in the district. Organizations will be selected by Dec. 31.

Hingtgen said having this map is a step toward collaborating with the counties that will be part of the new district.

Staff with the East Central Region are gathering input from impacted partners within the district such as law enforcement and mental health providers. The region is applying to be an administrative service organization of the area encompassing Linn and Johnson.

Ultimately, Hingtgen said providers still have to “wait and see” to determine impacts until the state outlines consistent care standards later this year.

“The maps shouldn’t really matter to providers and more importantly for people who get services,” Hingtgen said.

Tom Barton of The Gazette Des Moines Bureau contributed to this report.

Comments: (515) 355-1300, erin.murphy@thegazette.com

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