In Iowa we have a long proud history of taking care of our families and community members. Over the past two years this has changed under the current administration and its policies surrounding Medicaid privatization.
Our mental health system in Iowa is crumbling. And it’s only going to get worse unless our newly elected officials understand the need to reform our system and take care of our most vulnerable citizens.
Approximately 70 percent of Iowans being treated for a mental illness are covered by Medicaid. For those individuals, accessing the appropriate care has never been more difficult thanks to privatized managed care and the for-profit companies running Iowa’s $5 billion Medicaid program.
Their illnesses vary: schizophrenia, bipolar disorder or severe depression and anxiety. Some need round-the-clock care and support to live in their communities instead of institutions. Their symptoms are manageable when treated appropriately, but their conditions are often chronic and cyclical.
They are a population that for decades we as a state and nation worked to move from institutions and into communities, efforts touted by former Gov. Terry Branstad’s administration when it closed state-run mental health institutions.
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But less than a year later, the Branstad/Reynolds administration abruptly adopted Medicaid managed care, outsourcing the state’s program to for-profit companies that have stripped the care of this medically needy population in the past two years to pay dividends to their stockholders.
Take for example individuals who receive supports that help them overcome the physical and mental limitations caused by chronic mental illness. They receive services that can include case management, symptom management support and skill building. Other services include developing work, budgeting, personal hygiene and shopping skills.
Managed care organizations in Iowa, however, cut necessary habilitation services – against doctor’s orders at times – for some of the state’s most severely mentally ill to a tune of $22.4 million, which represents a 28 percent decrease in funding, according to figures from the Iowa Department of Human Services obtained through a Freedom of Information Act request (A little disclaimer: DHS officials could not attest to the accuracy of the its own data).
Additionally, 230 people receiving the highest level of habilitation supports had their level of services dropped significantly in the past two years. This decrease is due to denial of authorization of those needed services and has reduced services and supports to the most symptomatic members of our community.
This puts Iowa’s human service providers in a bad position. They face increased liability serving individuals with poorly managed symptoms due to inadequate services. Some opt to continue providing supports at the needed level and attempt to absorb the loss. Others have gone out of business or stopped serving these high need populations all together.
What has Governor Reynolds’ response been to this crisis in our communities? She championed a plan that was unanimously approved by both the Iowa Senate and House. There is only one problem, it was only funded at 5 percent making it impossible to effectively implement. We need to understand that there are other ways to support these members of our communities and families.
Supporting individuals with chronic mental health and physical needs is complex and the most cost savings doesn’t always come from just cutting costs and services. These individuals could be served through a specialized MCO (often called a carve out) that specializes in long term support services and understands the specific needs of this population. We could also amend the contracts of our current MCO’s to ensure that they are held accountable to the values we, as Iowans, hold so dear.
Now that the elections are over we need to send a message to all of our newly elected officials that we need reform in our Medicaid system. That taking care of all Iowans is what we do.
Susan Martin is a human services senior executive with 25 years of experience in supporting people with a wide array of disabilities. She currently serves as chief operating officer of Optimae Services, which has a local office. She graduated from the University of Northern Iowa with a Bachelor of Social Work and the University of Iowa with a Master of Social Work.