Fairfield Ledger
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Neighbors Growing Together | Oct 26, 2014

County pressured to change mental health care delivery

By DIANE VANCE, Ledger staff writer | Dec 18, 2012

Iowa has redesigned mental health care delivery and its 99 counties are working to implement a regional delivery system by April.

Jefferson County Board of Supervisors has not taken any action to join with any of its neighboring counties to create a region, mostly because supervisors don’t agree to send Jefferson County residents’ taxes to another county, which could come into play under the regional redesign.

“I’m being pressured by Linda Hinton [Iowa State Association of Counties government relations manager] to make a decision about redesign or our county getting into a regional health group,” said Sandy Stever, Central Point of Coordination Jefferson County Mental Health Coordinator.

“Linda also said when setting our budget not to count on the back-fill,” Stever told the board of supervisors Monday.

The back-fill refers to the state’s decision that every county should have a per capita tax of $47 to fund non-Medicaid mental health services. Jefferson County levies a $36 per capita tax for this, and the state had proposed making up the difference of $11 per capita in Jefferson County.

“After meeting with ISAC, I don’t want to join a region,” said supervisor Lee Dimmitt.

Stever said counties have not been given rules yet about how regional delivery systems will run, nor has anyone received rules for counties that want to remain stand-alone mental health service providers. Counties can apply for exemptions to join a region if the county can prove it can meet the minimum standards of care and remain cost-effective on its own.

“No rules and funding are difficulties,” said Dimmitt. “The state said it put aside $20 million to help counties transition to regions but of 32 [county] applicants, 28 were denied. Only four counties were given funding and Scott County is getting a big chunk of $1.4 million divided among those four.

“We’ve been told on multiple occasions not to count on the state’s help with the $47,” said Dimmitt.

He said the real problem has not been addressed by the Legislature — bed space.

“Sometimes a mental health provider has to call all over the state for a few hours, looking for a space,” he said.

Dimmitt shared a report he read earlier about space issues for mental health clients that “goes beyond ridiculous.”

“A mental health services provider in Keokuk, down in Lee County, called all over for a bed space for a client,” he said. “A vacancy was found in Sioux City, clear across the state. The client was being transported when a space opened up in Lee County, but once reserved, he was taken up to Sioux City. In the meantime, a Sioux City client also needed a bed space and he was transported to Lee County.”

Dimmitt said under the regional plan no county is allowed to have a waiting list to serve clients unless each county in that region has a waiting list.

“If we were in a region with another county that developed a waiting list, but Jefferson County did not, that’s when we’d be required to send Jefferson County funds to that county,” he said.

Supervisor Dick Reed said area clients should not worry about not receiving care during this transition.

“We’re still taking care of our clients,” he said.

Dimmitt agreed. “We’ll continue to meet consumer needs.”

Supervisor Steve Burgmeier wondered why ISAC was asking for a decision now when the plan will not be implemented until April.

“As it stands now, we’ll stand alone,” said Dimmitt.

Reed advised Stever to reply to ISAC that the board of supervisors is still considering options.

plan no county is allowed to have a waiting list to serve clients unless each county in that region has a waiting list.

“If we were in a region with another county that developed a waiting list, but Jefferson County did not, that’s when we’d be required to send Jefferson County funds to that county,” he said.

Supervisor Dick Reed said area clients should not worry about not receiving care during this transition.

“We’re still taking care of our clients,” he said.

Dimmitt agreed. “We’ll continue to meet consumer needs.”

Supervisor Steve Burgmeier wondered why ISAC was asking for a decision now when the plan will not be implemented until April.

“As it stands now, we’ll stand alone,” said Dimmitt.

Reed advised Stever to reply to ISAC that the board of supervisors is still considering options.

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