DES MOINES, Iowa --- State budget makers will be facing pressure to spend money early in the 2013 legislative session to cover Medicaid and mental health costs through June 30 even before they tackle expanding needs in the fiscal 2014 state spending plan.

County officials say they need millions of transition dollars in the next six months to make the switch to a regional delivery system for equalized mental-health services or they will be forced to reduce their help for recipients or create waiting lists to receive services.

The problems haven't affected Black Hawk County or any of its 17 partner counties in a consortium set up to share mental health costs and services.

"County Social Services did not request transition funding," said Bob Lincoln, administrator of the consortium. "We project having enough money to maintain through this fiscal year 2013 and into fiscal year 2014. We will not be using a waiting list or reducing services."

The split-control Legislature pushed the Medicaid financing issue into the 2013 session when an impasse over public funding of abortion services stalled action on a budget piece that now will require a supplemental appropriation estimated as high as $45 million.

On top of that, counties say the state will have to pick up county costs ranging anywhere from about $1.5 million recommended by the state Department of Human Services to $48 million under a worst-case statewide scenario. A decision will have to come early next year because counties will have to certify their budgets by March and the state has set an April 1 deadline for counties to form regional delivery partnerships.

"This issue has to get resolved, and it's got to get resolved now," said Rep. Dave Heaton, R-Mount Pleasant, a member of a legislative panel studying the fiscal viability of the mental health and disability services redesign. Committee members requested more information regarding transition costs before they meet again on Jan. 11. "We're going to have to find a solution to this so we can get our resources in line to take care of the Medicaid care that we've got out there."

Bill Peterson, executive director of the Iowa State Association of Counties, said his association has contended for the past five years that state funding has left mental health services short by $40 million to $50 million, so "it's not that surprising to us when we looked at the aggregate number."

DHS analysis of 32 county requests for transition funds found that those counties owed about $22.1 million in undisputed state bills as of Oct. 31. Similarly, about $26 million was owed by the remaining counties, but they did not request state transition funds to balance their ledgers. State officials projected three scenarios for addressing the projected expenses for non-Medicaid mental health services that ranged from $1.5 million to $11.6 million in state help.

"I think we need to make sure that as we transition to this regional service delivery approach we make sure all the counties have the resources they need and they don't throw people out in the street who need mental health services," said Sen. Joe Bolkcom, D-Iowa City, a committee co-chairman.

Sen. Jack Hatch, D-Des Moines, said the state is going to have to come with "gap" funding to get through the transition of moving from a county-based to a redesigned regional service delivery system that maintains the goal of not ending core services or creating waiting lists.

Staff writer Tim Jamison contributed to this article.

(1) comment


One of the biggest problems with mental health care is lack of providers. Those most in need of help are on title 19, but few doctors accept it. Even fewer accept minors. Many of those minors are in foster care because of abuse and especially need mental health treatment. Many are potential mass shooters like the Columbine boys. We need a system where mental health workers go to a different county seat town each day. Otherwise we risk more mass killings.

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