Iowa’s mental health system is crumbling. And it’s only going to get worse until voters elect new leaders dedicated to reforms.
Approximately 70 percent of Iowans being treated for a mental illness are covered by Medicaid. For those individuals, accessing the appropriate care has never been more difficult thanks to privatized managed care and the for-profit companies running Iowa’s $5 billion mess of a Medicaid program.
Their illnesses vary: schizophrenia, bipolar disorder or severe depression and anxiety. Some need round-the-clock care and support to live in their communities instead of institutions. Others require less staff support. Their symptoms are manageable when treated appropriately, but their conditions are often chronic.
They are a population that for decades we as a state and nation worked to move from institutions and into communities, efforts touted by former Gov. Terry Branstad’s administration when it closed state-run mental health institutions.
But less than a year later, the Branstad/Reynolds administration adopted Medicaid managed care, outsourcing the state’s program to for-profit companies that have stripped the care of this medically needy population in the past two years.
Take for example individuals who receive supports that help them overcome the physical and mental limitations caused by chronic mental illness. They receive services that can include case management and social and communications skill building. Other supports include developing work, budgeting, personal hygiene and shopping skills.
The more severe the illness and disabilities, the more money Medicaid provides to cover the higher level of needed services.
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Managed care organizations in Iowa, however, cut necessary habilitation services — against doctor’s orders at times — for some of the state’s most severely mentally ill to a tune of $22.4 million, which represents a 28 percent decrease in funding, according to figures from the Iowa Department of Human Services obtained through a Freedom of Information Act request (A disclaimer: DHS officials could not attest to the accuracy of the state’s data).
Additionally, the number of Medicaid members receiving the highest level of habilitation supports dropped by more than 230 people in the past two years. During that same time span, the total number of Iowans receiving habilitation services increased by more than 200, according to DHS records.
Those numbers are expected to continue to drop, as UnitedHealthcare is currently reviewing the funding levels of all recipients who currently receive the highest level of care. For one of the state’s largest providers, the first round of those reviews has resulted in additional people having their services cut.
This puts service providers in a bad position. They face increased liability serving individuals with poorly managed symptoms due to inadequate services. Some opt to continue providing supports at the needed level and eat the loss. Others have gone out of business or stopped serving these high-need populations all together.
The Department of Human Services assembled a work group last year to address many of the mental health service issues that have worsened under managed care. Iowa ranks almost dead last for its number of psychiatric beds. A big part of the problem is people who are ready to be discharged instead sit in the hospital because there isn’t anywhere for them to go, an increasingly familiar problem.
Members of the group developed a proposal and lawmakers in both the Iowa Senate and House approved it unanimously. Gov. Reynolds signed it into law and has touted it as a major accomplishment in fixing Iowa’s mental health problems. There’s only one problem. It was only funded at 5 percent, making it impossible to effectively implement.
Until Iowa has leaders who are invested in fixing managed care for people who need long term supports and services, we will face a worsening crisis.
• Susan Martin is chief operating officer of Optimae Services.