SULLIVAN'S SALVOS
March 27, 2015
Sullivan’s
Salvos 3/31/15
In this edition:
*Mental Health Update
*Did You Know?
*Mental Health Update
It
is probably time that I offer up a Mental Health/Disability Services (MH/DS)
update. As you may know, the MH/DS system has been in a state of flux for a few
years. I’ll try to let you know where things stand now.
First,
some background. The history I’m about to give is specific to Iowa; each state
does things differently. Up until the early 1990s, counties funded all MH/DS
services through local property taxes. Starting in the early ’90s, Iowa began
to rely much more heavily on Medicaid (otherwise known as Title 19) to fund
services. Other states had begun doing this almost a decade earlier – Iowa was very
late to the game.
Why
utilize Medicaid services? The reasoning is simple; Medicaid services are
funded primarily by the federal government. There is a “local match”, which
varies depending upon the relative wealth of your state. So in the early ‘90s,
Iowa began enrolling every eligible person in Medicaid, and assigned counties
to pick up the local match.
This
had an extremely positive impact for people with disabilities. Many more people
became eligible for services, and many more people received them. Additionally,
Medicaid picked up the health insurance for these folks, providing coverage
where little had been available. So the ‘90s were good times for people with
disabilities.
The
‘90s were TOO good for people with disabilities if you asked the Iowa Farm
Bureau. They saw the roles of people served tripling and quadrupling, and
became very concerned about their future property taxes. This led the Iowa
Legislature to pass a 1996 property tax relief act known as Senate File 69,
which limited the amount of property taxes going into MH/DS funding. The idea
was that counties would be capped at a hard dollar amount, and the state would
pay for any growth in the system.
Unfortunately,
this promise only lasted two years. After 1998, the state began to renege on
this promise. Meanwhile, the MH/DS levies changed depending on which county you
were in. In some western Iowa counties they were losing both population and
taxable valuation. In those same places, people with disabilities often moved
to more urban areas, where they had greater access to services, medical care,
transportation, etc. In those counties, the MH/DS levy went up every year in
order to generate that same capped dollar amount.
Johnson
County was the opposite. Population skyrocketed, and taxable valuations went
up. People with disabilities moved here in droves. So in Johnson County, the
levy rate required to generate our capped amount went down every year. Soon,
Johnson County could not meet the demand for services. Because of this, the
State had to step in and prop us up financially. Statewide, county budgets were
under pressure, and services varied wildly depending upon the county in which
you lived.
Let’s
fast forward to a couple years ago. The Iowa Legislature and Department of
Human Services decided to undertake a huge MH/DS redesign. (One of the key
architects was Johnson County State Senator Joe Bolkcom.)
Under
redesign, counties were forced to merge into MH/DS regions. These regions were
charged with pooling their property tax dollars, and providing equivalent
services to every county in the region. In exchange, the State would pick up
the local match – the nonfederal share – of all Medicaid services. This came along
at the same time as the Affordable Care Act (aka Obamacare), which made
Medicaid available to many more people. The State also continued to prop Johnson
County up financially due to our low levy rate.
So,
Johnson County needed to create a region. There was a bit of discussion about being
our own region, but DHS made it quite clear that only Polk County would be
allowed to go it alone. DHS wasn’t alone in feeling this way; our own
Legislative delegation also wanted us in a region.
I
mention this, because you will still hear people say that Johnson County should
have gone it alone. I am 100% certain that this was NEVER an option. Had we not
chosen our own partner counties, DHS would have done it for us.
And
it gets worse! DHS wanted Linn County to anchor a group of counties to its
north; they wanted Johnson County to anchor a group of counties to our south.
The problem is, the counties to our south are MUCH more anti-government and
anti-services. I am convinced that the people we serve would have been harmed
by Johnson County playing games and getting assigned to a region to our south.
So
– you may hear people say that we had other options. I am firmly convinced that
any other options would have been MUCH WORSE for the people we serve.
The
way things did play out were interesting. Iowa County came calling right away.
95% of the Iowa County MH/DS budget was spent in Johnson County anyway. Benton
County had a very similar relationship with Linn County. Meanwhile, Linn and
Johnson Counties had worked together well on previous issues.
So
we moved forward with a group of 4 contiguous counties. Jones County wanted in,
and that made sense. Then, suddenly, we heard from Dubuque County. While we
were not familiar with Dubuque County, they did bring a history of similar
politics to the table, in addition to a variety of resources. We let Dubuque
in. Finally, in a last second move, Buchanan and Bremer Counties requested to
join. After some deliberation, we let both in. That gave us a 9 county region,
home to about 600,000 people, making us the most populous of Iowa’s 15 regions.
We
soon created an intergovernmental agreement, and officially set up a governing
board of one Supervisor from each county. (I am the Johnson County appointee to
the regional board.) Each county then began the process of pooling our MH/DS
funds. Jones County was selected as the fiscal agent for the region, meaning
that for a small fee, they collect the dues and pay the bills.
All
things considered, I feel our region has worked pretty well. The Supervisors
have created a framework, staff have worked well together, and advocates have
kept everybody honest.
Meanwhile,
the fact that the State and ACA have picked up much of the cost of services has
freed up money to do things that were only dreams just a few years ago. The
region is relatively flush right now, and ready to spend on long overdue
services.
Within
the next month, we will have jail diversion programs in all 9 counties. That
will be coupled with mobile crisis response. We will have telepsychiatry
available at our rural hospitals. We will have crisis phone, text, and chat
services. We will have crisis stabilization beds in each of the more populous
counties. Family psychoeducation will be available. All this, plus our previous
menu of services. This will amount to the biggest expansion of services since
Medicaid came into play in the ‘90s. We are poised to usher in the best era for
MH/DS services in quite some time!
While
I am excited by what the future holds, there are still a few issues to watch:
First,
Iowa must maintain its’ commitment to the Medicaid program. States have great
latitude in terms of what they do with Medicaid programs. We must keep ours
broadly available. Should Iowa make more folks ineligible for services, those
same people will fall to regional funding. That will impact our ability to
expand services.
Secondly,
Iowa has committed to a system of managed care for Medicaid services. I don’t
know about you, but when I think of managed care, I think of bureaucrats
denying services to sick people in order to increase corporate profits. I hope
Iowa can prove me wrong.
Finally, the State must help regions establish a long-range plan
for funding. Remember how I was talking about the differences in levy rates?
And how the State has been propping up Johnson County of late? Well, the State
money is gone this year. The regions must figure it out on our own.
Some counties in our region have per capita rates that are double
Johnson County’s rate. (We are still frozen at those 1996 rates.) If nothing
changes, those counties would pay double what Johnson County pays. This is
obviously unfair, and needs to be corrected. Johnson County should pay a bit
more, while other counties pay a bit less.
This
is another area in which you are going to hear complaining. No Supervisor wants
to be the one who raises taxes, right? Thing is, almost every individual who
has run for Supervisor since 1996 has said that she/he would raise taxes to pay
for MH/DS services if only the State would allow it. Just check the record –
everybody who has been elected has said this! Well, be careful what you wish
for - the State just may allow it.
Personally,
I don’t fear this. There is nothing we do that is more important than providing
services to our MH/DS population. If we have to raise taxes a bit to do so, I
am OK with that. Yes, the State screwed counties for 15+ years. They probably
will again. But we still need to provide services.
Some
Supervisors are going to try to play elaborate games with this. Make the State
raise the taxes. Give the region taxing authority and make them raise the
taxes. Basically, do ANYTHING but ask us to raise our property taxes.
Personally,
I am not so afraid of raising taxes for MH/DS services. Like all my peers, I
have spent years stating that I’d raise taxes for this purpose if given the
opportunity. I don’t need political cover. I don’t need to blame anybody. I am willing
to raise taxes for the people that need it. Let’s just get this done.
So,
that is where the MH/DS system sits today. Please let me know if you have any
questions!
*DID YOU KNOW?
For more information on our MH/DS region, visit the regional website at:
http://www.ecriowa.us.
Anyone
interested in learning more about County government should take a look at the
County website-
"Sullivan’s
Salvos" is sent once per week to any interested party. It will give a
brief update on issues of interest to Johnson County residents.
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come solely from Rod Sullivan, and neither represents the viewpoints of the
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As always,
feel free to contact me at 354-7199 or rodsullivan@mchsi.com. I look forward to
serving you!
---Rod
posted by Rod Sullivan @ 4:10 PM
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