Counties come together on mental health redesign
Representatives from seven northwest Iowa counties considering a partnering relationship in the new state-mandated mental health care and disability services redesign met together as a group for the first time Wednesday morning in Dickinson County.
Dickinson County Supervisor Bill Leopold, who was charged with moderating the morning program, asked each person in the room to "write down what you hope we accomplish today."
Leopold quickly added, "Repeal of 2315 is not an option."
SF 2315, the focus of the meeting, is a complete redesign of the way the state of Iowa will provide mental health care and disability services for the future. Counties are being asked to form partnerships under the new model, which still offers more questions than answers.
Linda Hinton, government relations manager for the Iowa State Association of Counties, presented a history of the bill and offered some direction for the future of the group.
Clay County Supervisor Chairman Ken Chalstrom said he was happy to see the counties come together on the effort to get the ball rolling, although he maintains some concern about the long-term impact of their efforts.
"There are no rules or standards," Chalstrom said. "This could all change down the road. Each county has different situations and different issues. We've been saying for three to four months there's plenty of time. The time has gone by and nothing has been done. No rules. No guidance from the state."
"It seems like it's still up in the air," Kim Wilson, Clay County central point coordinator, said. "Without administrative rules, it's hard to move forward."
"What makes this meeting important is getting six or seven county representatives together to get started," Chalstrom said. "We need to get started. It's a long process."
The redesign framework requires three or more contiguous counties to form a regional system of care for clients. In order to be a viable "region," each system must have the capacity to provide "core" services to the client base - complete with a staffed community mental health center or federal qualified health center. Each region must also have a psychiatric unit accessible within a 100-mile radius.
Specifics around a key element of the project - funding - are still being formulated.
"We're not really solving any problems," Chalstrom suggested. "The main problem with our system is there is not enough money to provide services. That still remains. Will the state step up?"
"The big concern is that we're doing what we're doing in the best interest of the clients. That, and the appropriation of the proper funding to make sure their services can be provided," Wilson said.
One representative from each of the seven counties - Clay, Dickinson, O'Brien, Osceola, Emmet, Palo Alto and Lyon - met briefly following the morning session to set a date for the developmental committee's first official meeting. It will reconvene and begin formulating a plan to present to the counties on Friday, Jan. 25 at Barb's Corner in Everly. Clay County Supervisor Linda Swanson represented the county, and will continue to do so throughout the process.
Pieces of the process will include a letter of intent from the counties in the region, creation of a 28E Agreement - with focus on funding mechanism and procedures - between partnering counties, and establishment of a regional governance board to oversee the provision of care and subsequent responsibilities going forward.
With regard to funding services, Hinton pointed out, "The legislation does not require pooling."
While some have argued that was the original intent, Hinton stressed she would argue against mandated pooling of county property tax levy funds, calling it a "local decision."
She continued, "I think five years down the road, you're going to start recognizing clients as regional clients."
Buena Vista, Ida, Sac, Calhoun and Crawford counties, along with Carroll, Polk and Jefferson counties, presently don't have a recognized region developing. Carroll is seeking an exemption, and many expect Polk County to follow suit.
Pocahontas and Kossuth counties are part of an 18-county region that stretches east to Fayette and south to Tama County.
The process includes the voluntary formation of a region by April 1, submission of exemption request by May 1 if a county so desires, with redesign ready for full implementation by June 30, 2014.
Counties who aren't part of a voluntary region by April 1 are expected to be placed in a region.
Leopold, referencing the old joke about the best way to eat an elephant being one bite at a time, told the group, "The state's given us a big elephant. I think we need to start eating."