State reorganizes mental health regions

MARENGO — The State of Iowa is reorganizing its Mental Health Regions, tentatively moving Iowa and Johnson Counties out of the east and into the southeast.

Mae Hingtgen, East Central Region chief executive officer, told Iowa County Supervisors last week that Iowa and Johnson County mental health representatives are lobbying to keep Iowa and Johnson Counties together and to keep them in the eastern district with Linn County.

The realignment bill, House File 2673, eliminates the current mental health regions June 30, 2025, Hingtgen said. Mental health services will be governed by several behavioral health districts with administrative services offices managing them.

Health and Human Services must have a final map of the new Districts by Aug. 1, 2024.

The proposed division splits Iowa and Johnson County from the counties they’ve been working with in East Central Region and moves them to the southeast Iowa group, said Hingtgen.

“That’s not what we want.”

To convince HHS to keep Iowa and Johnson Counties in the east, mental health officials have shown HHS the relationship between Iowa and Johnson Counties, Hingtgen said.

“We really need to show collaboration.”

HHS looks at where people go for services, said Hingtgen. Officials have shown HHS that Iowa County residents go to Johnson County for services, so the two counties should stay together.

Because Johnson and Linn Counties coordinate in the northeast district, they should also stay together, Hingtgen said.

The ties between Iowa City and Cedar Rapids are unique in Iowa, said Hingtgen. Therefore Johnson and Linn Counties should stay together. She hopes the argument will be enough to keep the three counties together when HHS approves its final map.

HHS will release a map — or two or three — for public comment July 1, said Hingtgen. That leaves a month for comment before the final map is approved Aug. 1.

“We are sill a region until next June,” said Hingtgen.

Between the time the map is approved and the time the new districts must be operational, the districts will be organizing. Administrative services organizations will be established for each district.

The administrative organizations can be private nonprofits or the current regions, said Hingtgen. East Central Region plans to submit a proposal to administer the new district, she said.

The administrative services organization will have an advisory council which will be different from the governing board the regions currently operate under, Hingtgen said.

Whether the new district have a 28E agreement with the counties it serves or whether it develops a 501c3, it will still have to have a board, she said.

“It’s pretty confusing.”

Iowa County Supervisor Chairman Kevin Heitshusen asked about the purpose of restructuring. Mental Health services were under county control, then they were under the control of fewer, larger regions. Now the State is giving control to seven larger districts.

“To what end?” Heitshusen asked. “I don’t get the whole point.”

Some regions have not developed the services they were supposed to, said Hingtgen. And they haven’t gotten down to the fund balances required by the State.

The mental health regions are supposed to spend their money for services, not maintain balances. The State implemented a gradual plan to lower account balances.

By the end of the last fiscal year, regions were supposed to have balances of less than 20% of their budgets. Some were in the mid 60s, said Hingtgen.

Regions are supposed to be at 5% by the end of this fiscal year. Unspent money is sent back to the State, and that practice will continue under the new structure.

Iowa County Supervisor Abby Maas said that the State is trying to help regions that weren’t performing well by putting counties that did perform well — such as Iowa County — with them.

“You’re not strengthening them,” said Heitshusen. “You’re just weakening us.”

Hingtgen said that some regions may not have performed as well because of geography or workforce or reimbursement rates. Counties aren’t situated the same.

Maas said the southern district Iowa County is currently destined for won’t have the workforce the East Central Region has.

“Your law enforcement agencies felt pretty strongly about staying [with the East Central counties],” Hingtgen said.

The State plan will also add substance use services. Right now it’s illegal for the region to pay for substance abuse treatment, said Hingtgen.

Under the new districts, the administrative services organizations will be able to accept black grant money for treating substance abuse, she said.