DES MOINES, Iowa (AP) — State legislators approved a dramatic change in Iowa's mental health system last year, but while officials work to fully implement the new system, some who oversee county programs said they may have to make drastic cuts during this transition period.
The Legislature approved changes to Iowa's system last May, shifting from a system run by counties to a more regional approach in which counties pool their money.
The new approach was meant to minimize differences between urban and rural areas, but county officials said until the regional system is fully implemented in 2014, they may be able to reach fewer of the estimated 150,000 Iowa residents with mental health issues.
"We have had to reduce the amount of services people get in order to stay within the budget," said Ken Hyndman, who oversees mental health programs for Des Moines County.
That's because before the redesign, counties used 50 percent of their budgets to provide the local match for Medicaid. Now that the state provides the local match to Medicaid, local governments see mental health as an area to reduce spending.
And some counties are quickly cutting mental health programs not covered by the federal dollar to pay the state back for late and unpaid Medicaid bills.
Hyndman saw his budget reduced from $5.5 million to $1.7 million this year and was forced to put patients on waiting lists for services.
Iowa redesigned its mental health system to make it more standard, but last month's mass killing of children and educators in Newtown, Conn., has focused national attention on issues surrounding the mentally ill.
State Sen. Jack Hatch said the best way to avoid a Newtown incident is for the state to help fund crisis intervention centers, which operates around the clock to observe and help people having a mental crisis.
"If there's an immediate mental health crisis, counties would have a program with trained professionals to assess the situation and resolve it," Hatch says.
Waterloo has such a facility, and police are trained to recognize if a violent offender has a mental illness and take them to the center instead of putting them in jail.
Crisis centers are one mental health service the new law expects regions to fund on their own.
If regions want to add more services than what's required by state law, that will depend on the wealth of the counties.
Dawn Mentzer, who oversees mental health programs in Buena Vista County, said the redesign has created competition among weaker counties that want to regionalize with those that have a surplus in their budgets.
"Our county supervisors are concerned they will have to pay other counties' debts with our taxpayer's dollars," she said.
A few counties with big mental health budgets want to stand-alone as regions.
Money is the largest unanswered question on the minds of officials working on the issue.
Lawmakers recommended a $20 million, one-time assistance fund to help counties continue services through this transition year.
Counties need that money now but they're still waiting on the Legislature to approve it.
This legislative session, lawmakers will decide at what rate counties can levy tax dollars to support their mental health systems and anticipate how nationwide changes to Medicaid will affect Iowa.
The state has promised to cover what it believes are the basics and in 2014, it will be up to the regions to decide how to better serve their mentally ill.