Health

Questions remain on Iowa mental health access centers

County officials moving ahead with plans; will modify to state's direction

Mechelle Dhondt 

Mental Health and Disability Services of the East Central Region
Mechelle Dhondt Mental Health and Disability Services of the East Central Region
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Officials in Eastern Iowa counties are not waiting for direction from the state to establish access centers for individuals in need of crisis intervention — a need they say is growing in urgency as mental health treatment becomes more complex and more closely tied to substance-use disorders.

But as planning moves into the new year, officials in Linn and Johnson counties say they still need further clarity from state lawmakers, particularly when it comes to funding for services within the access centers.

“We’ll be set up to meet their definitions, but knowing how legislation works, we’re not going to wait and wait until they decide what an access center is,” Linn County Supervisor Ben Rogers said. “The need is pretty clear in the community to divert these individuals out of jail or the emergency room.”

An access center is a short-term care facility for individuals experiencing mental health or substance-use crises. These 24/7 facilities contain intervention services for adults who do not need inpatient psychiatric care and allow individuals in need of detoxification or sobering to stay out of jail cells.

The hope is to divert individuals from expensive emergency room beds or jail cells, and into the care of health care providers who could best address their long-term needs.

David Thielen, director of community services for Linn County, the goal also is to save money in the long-term for other related social services, such as housing and food assistance.

In March, Gov. Kim Reynolds signed House File 2456 into law, which mandated the addition of “at least six regional access centers” in the state’s Mental Health and Disability Services regions that provide care for adult Iowans.

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The law laid out mandates for these facilities, such as the services that must be offered within the center itself — requirements county access centers will meet, said Mechelle Dhondt, chief executive officer of the East Central Region.

However, Eastern Iowa county and regional officials say there has been no direction from state lawmakers on some major steps in the establishment of access centers, including governance, long-term funding and reimbursements for substance-use services versus mental health services.

It’s also unclear if Corridor facilities will qualify as one of the six centers.

So Linn and Johnson counties — both part of the nine-county Mental Health and Disability Services of the East Central Region — are taking “a walk of faith” and moving forward with their plans, said Kathy Johnson, executive director of the Abbe Center for Community Mental Health in Cedar Rapids.

Officials in those two counties — as well as those from Dubuque County, where work for another access center is underway — will meet with consultants from Texas, a state that has been a model for access center services Iowa is observing in this effort, at the end of this month to coordinate planning efforts.

FUNDING

Even as planning moves ahead, dollars remain the biggest concern.

Matt Miller, project manager for the Johnson County access center, said the law mandates Mental Health and Disability Services regions — which are funded by taxpayers — pay for the establishment of access centers.

“If state gives us some additional money, we’ll use it, but we’re not planning on it,” he said.

For now, counties are taking on start-up costs.

Linn County Board of Supervisors, for example, approved the use of $3.5 million in “surplus dollars” for renovation of an existing building and the first year of capacity.

“It’s like a fire department,” Rogers said. “You have to be staffed and ready to go for a five-alarm fire or a cat in a tree. So we dedicated those dollars to have these services available.”

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These surplus dollars originate from new state rules — voted into law this past session — that require county savings for mental health services, capped at 20 percent of the yearly budget by fiscal year 2020.

Scott Hauser, project manager of Linn County’s access center, said the hope is to open doors by late 2019.

In Johnson County, supervisors have agreed to pay $1.35 million for more than five acres of land at 270 Southgate Ave., just east of South Gilbert Street.

Miller said Coralville, Iowa City and North Liberty have agreed to provide funding for the facility’s operational costs in its first year, or at least until insurance reimbursements kick in. He declined to disclose the exact amounts.

Dhondt said some start-up costs for the access centers also will be on the regions.

The East Central Region intends to cover the cost of patients who do not have Medicaid or private insurance.

Johnson County Supervisor Lisa Green-Douglass said in the first few years the county would pick up as much as $400,000 a year for unreimbursed services at the Iowa City location.

Officials also are concerned about how services for substance use will be paid for, Miller said. When Mental Health and Disability Services regions were established, law stated they could not reimburse for services related to substance use — leaving county officials wondering how providers will be reimbursed for patients without insurance coverage.

It also leaves officials worried for a potential gap in services.

Other questions exist on whether the county itself or the Mental Health and Disability Services region would oversee and maintain the access center.

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In addition, the passage of a law establishing a children’s mental health system is in the back of officials’ minds, said Rogers. Access centers they are currently establishing would not serve children, but it’s unclear if the county facilities will play a role in those services.

l Comments: (319) 368-8536; michaela.ramm@thegazette.com

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