Rod Sullivan, Supervisor, Johnson County, Iowa

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May 18, 2017

Sullivan’s Salvos     5/23/17

In this edition:

*Mental Health Background
*Mental Health Update
*Did You Know?

*Mental Health Background
I have an update on Mental Health funding, but I thought it might make sense to first offer some background. The following was published in Salvos on 3/31/15.

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. 90% 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.

         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!

*Mental Health Update
         So here we are. After 4 or more years of lobbying, the Iowa Legislature actually passed a Bill (SF504) that allows Johnson County to raise our levy rate.

         In one way, the timing could not be better. If nothing had changed, Johnson County would be unable to meet our financial obligations to people with disabilities. This situation would have occurred about a year from now, in the 4th quarter of FY18.

         In another way, the timing could not be worse. The county budget was turned in to the state in early March. The process is over. If we go back and add the necessary funds (about $1.5 million) to MH/DS, taxes will be higher than we than the totals we just reported.

         To be honest, I did not think the Legislature would pass anything. They had failed to do anything for four straight years. It required GOP votes, and they have been unwilling to do anything that would raise any tax at any time for any purpose. Luckily, several legislators (including our own Joe Bolkcom) helped craft a plan that kept the total amount of taxes levied statewide the same, while allowing individual counties to raise their levies. And guess what? It passed!

         SF504 gave counties that want to raise their levies 30 days from the date the bill was signed to reopen their budgets and pass new levies. That means it must be completed by June 4.

         I had originally hoped that perhaps we could wait on the budget, see what happens in FY18, then fix it all in FY19. Unfortunately, the State says this option is not available to us. The options we do have?

1.   Reopen the budget, raise the MH/DS levy, and be done.
People will see their taxes go up, but it is for a very good cause, and Johnson County will be paying its’ fair share.

2.   Reopen the budget, raise the MH/DS levy, make other cuts.
Taxes would not go up, but other things already approved in the budget will be cut. I spoke to many people at the recent NAMI Walk, and no one wanted to see MH/DS scapegoated as the cause for cuts to the Sheriff, County Attorney, SEATS, food banks, etc.

3.   A combination of options 1&2.
Taxes will go up some, but we will drop the amount the County keeps in reserve to fund the rest. Then we “pay ourselves back” over a few years.

4.   Do nothing.
If we do nothing, Johnson County runs out of money, and gets sued by the other 8 counties in our Region as well as local people with disabilities.

After good discussion, the Board will be voting on option #3. We follow through on our promises and fund MH/DS services, but also lessen the single year impact.

         Questions about any or all of this? Please let me know!

*DID YOU KNOW?  The East Central Region served 2800 people in FY16, at a cost of $18 million. This is in addition to all the services funded by Medicaid.

Anyone interested in learning more about County government should take a look at the County website-

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As always, feel free to contact me at 354-7199 or I look forward to serving you!



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