Last session was another big one for mental health and disability services across the state. House File 2456 added new services that the mental health regions will be required to provide in addition to the existing core services. While regions are still working on building these and the original core services, we are also being forced to spend down our fund balances, following Senate File 504, which was passed in 2017. This is causing many regions to be on unstable financial footing moving into the 2019 legislative session. The ECR is in a fairly good place financially, and we have identified a number of legislative priorities for the upcoming session to ensure we remain stable.
Here are the ECR’s 2019 Legislative Priorities:
- Stable, long-term funding for both adult and children’s mental health services – Last session, the legislature mandated yet another set of core services for the regions to provide but did not appropriate funding to support these services. Additionally, the children’s mental health group has suggested the current regions could take on the children’s system, as well. While it does make sense for one entity to oversee the delivery of mental health services across the age spectrum, the regions are currently struggling to implement the required services for adults and cannot be expected to shoulder the burden of creating and funding a new set of services for a new population without significant, stable funding assistance from the state.
- Fund balances – SF504 mandates that the regions spend down fund balances to not more than 20 percent of operating budgets by fiscal year 2021. HF2456 adds new services to the mandated core services. It won’t be possible to establish these new services if regions are required to spend down funds that should be used for the establishment of new mandated services.
- Regions being asked to pay the delta on Medicaid eligible services – In September, regional CEOs were informed by the Department of Human Services (DHS) at the monthly CEO meeting that they were going to be asking the regions to pay the delta for Medicaid eligible services. The delta is the difference between the rate that DHS sets for a particular service and the actual cost of the service. This will allow DHS to set a rate that they know is artificially low and expect local taxpayers to pick up the difference. While DHS can’t require the regions to pay this difference, they can set a rate that effectively requires the regions to either pay the difference or be unable to find a provider willing to provide the service. When DHS now claims managed care is saving money, they may just be shifting the cost to local taxpayers. We know DHS currently uses this policy for the Assertive Community Treatment Teams and are being told that regions will be expected to cover the delta on more services in the future.
- Children’s mental health services – Currently Iowa has no coherent system to provide mental health care and crisis services for children. Regions may agree that it does make sense for one entity to be responsible for mental health care across the age spectrum; however, any regional involvement in creating and operating mental health services for children must come with a stable, reliable commitment from the state to provide the resources for the creation and operation of the system.
- Report dates – DHS requires the annual report from regions by Dec. 1 of each year. We would like to change that date to make the report due on Dec. 5. That would give the counties and regions time to gather the data and make sure the numbers are calculated accurately.
You’ll notice a theme in our legislative priorities for the upcoming session. It’s all about funding. The regions have been continuously asked to provide more and more services with fewer and fewer resources. We will be asking legislators to start funding these initiatives. Keep these in mind as you meet with your local legislators. Talk to them about how this directly affects your organization and your clients. Or, if you are a client, how are you being affected by changes in care that are directly related to reimbursement rates and lack of financial support from the legislature.
I’ll be keeping you updated throughout the session. Please let me know if you have any questions.