Advocates react to proposed mental health reforms

A piece of legislation recently introduced by State Sen. Kevin Kinney, (D-Oxford) titled Senate File 2118, aims to adjust controversial reforms to Iowa’s Mental Health and Disability Service regions before they take effect this summer.

“We are very pleased with Sen. Kinney’s efforts here to help us out,” said Ryanne Wood, CEO of Southeast Iowa Link (SEIL,) the Mental Health and Disability Service region for eight counties including Washington, Jefferson and Henry. “We view it as a friendly amendment, as a follow-up to Senate File 619 that modified the funding of the region system.”

While SF 2118 would not address every objection Wood and others voiced to SF 619, she said it was a drastic improvement.

“Easier hoops to jump through is the easiest way to put it,” she said. “We are still in the process of de-linking costs … to make clear what is county obligation and what is region obligation. This does not remedy that, but it helps us manage it more efficiently.”

SEIL Vice Chair and Washington County Supervisor Jack Seward Jr. said Kinney’s bill would help minimize administrative costs and headaches added SF 619, which is set to take effect in July.

“It minimizes payments and claims and checks crossing paths internally between our county-level accounts and the Fiscal Agent,” Seward said in an email. “This is more efficient and seamless, enabling regions to (maintain) funds in the locations needed to fund designated county employees.”

Wood said that improved flexibility would help reverse what she called “disincentives” for local control in earlier legislation.

“The last thing the region wants to do is reel things in and centralize things, because in centralizing on a region basis, that pulls things out of areas which were an access point.” she said. “Keeping the region employees at the county level does provide our local boards of supervisors … more local control, making sure their citizens are taken care of by somebody that knows what their citizens’ needs are.”

Southeast Iowa officials are not alone in their concerns. County representatives across the state said they had the same complaints going into the next fiscal year, and no lobbyists have yet registered in opposition to Kinney’s proposal.

“We still have employees that do work for the regions but are also county-based employees,” said Jamie Cashman, government relations manager for the Iowa State Association of Counties. “We’re very pleased with it, that Sen. Kinney brought this bill forward. We know how important it is … that these adjustments are made and this legislation is passed.”

Another component of SF 2118 is a section that would allow regions to carry over 25% of their annual allowance from year to year, rather than the 5% outlined by SF 619. That clause in particular has already drawn support from lobbyists across the state.

“Regions need to have cash on hand to make sure providers get paid on time and there are not delays in getting people with disabilities the services they need, when they need it,” said Amy Campbell, a lobbyist for the Polk County Board of Supervisors. “Current law drops our ending fund balance to 5%; that’s just not enough to make sure we pay our bills on time.”

In the longer term, SF 2118 includes rules that would establish a work group to recommend “data-driven and outcome-based … modifications to required core services” for the regions, with representatives from each region comprising the group.

SEIL officials have complained the current standards lock regions out of more attainable core-plus services.

“What they need in Sioux City, Cedar Rapids, Des Moines, we don’t need down here,” Seward said. “What we need down here is the jail diversion and the drop-in centers. That’s what our local, rural population really needs … If we get any amount of money cut from our budget or what we need, we are not allowed to put it in those because it has to go into core services.”

Wood applauded the legislation’s aim to include regional input for that re-evaluation.

“This language allows the regions to be a participant in that process, and gives a point that we really need to use data to drive those processes,” she said. “Nobody knows what goes on in the regional level like a local person participating in that. Being able to contribute to the conversation and identify the different processes that are the background for why each region functions they way that they do is very helpful.”

Some sticking points, however, remain unaddressed. SF 2118 does not reverse earlier legislation’s ban on counties levying their own mental health funds like they have been able to do in the past.

“The proposal here, from our fiscal analysis, doesn’t make any modification to the actual financing of regions,“ Wood said. ”The state appropriation is on a per capita basis. Moving from the five to the 25%, all that addresses is cash flow issues as the regions cross fiscal years. It’s not more money, it’s not less money. It just allows us to have money where the money is needed.“

While advocates tout the bill as a win for local control of regional budget uses, concerns remain about ongoing state control of those budgets’ size.

“We’ve seen it time and time again where the state falls on hard times, and it ultimately comes back to the counties to basically cover the tab,” Cashman said. “So while it allows some funds for control through the county boards of supervisors, we still have some concerns in the future if the state can’t meet their commitment.”

State Sens. Dan Dawson, (R-Council Bluffs,) who introduced SF 619, and Kevin Kinney, who introduced SF 2118, did not immediately respond to requests for comments.

Comments: Kalen.McCain@southeastiowaunion.com