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Tuesday, Sep. 27, 2016

Mental health reform leads to local budget shortfall

Thursday, June 28, 2012

Editor's Note: This is the first of two stories about impacts of the Iowa Legislature's decisions to regionalize mental health services for county-funded clients. See Friday's Daily Sentinel for a closer look at how budget cuts will affect local services.

The Iowa Legislature's decision to regionalize mental health services has left many county mental health budgets -- including Plymouth's -- in the red.

That means services for individuals whose mental health needs are paid for with county dollars will face cuts starting July 1, the beginning of the 2012-13 fiscal year.

Sharon Nieman, Plymouth County central point of coordination and general relief director, said the county is facing a $600,000 shortage in the next fiscal year.

"That is because the department of human services has taken all of the state money, roughly $40 million, to pay for Medicaid services," Nieman said. "None of the counties will receive those dollars."

Part of the legislation passed this year requires the state to begin paying for all Medicaid services whereas before counties paid a portion, Nieman explained.

Because of the budget shortfall, the Plymouth County Supervisors approved a waiting list starting July 1 for all new county-funded non-mandated mental health services.

Last month the supervisors approved an initial waiting list for the current fiscal year, which ends June 30, Nieman said.

"During that time, two individuals have been placed on the waiting list for outpatient services, however Plains Area Mental Health covered those costs with block grant dollars," she said.

Patrick Schmitz, Plains Area Mental Health executive director, said the center receives federal block grant dollars, an allocation from the federal Substance Abuse and Mental Health Administration, to help people in need.

He said Plains receives about $52,000 a year split 50/50 between adults and children from the block grant for the four counties it serves as designated community mental health center.

However, those block grant dollars cannot cover the entire shortfall in the Plymouth County mental health budget, making it necessary to cut some individual services, Nieman said.

For example, the 25 county-funded people working at Life Skills Training Center, in Le Mars, will see a reduction in the number of days they can work, she said.

To help counties through the transition year, the Legislature reinstated counties' individual tax levy rates, said Plymouth County Supervisor Jack E. Guenthner, who has been part of the mental health reform process.

However, that doesn't help Plymouth County because its mental health tax levy rate is one of the lowest in the state, Guenthner said.

Currently the county can only levy taxpayers for a total of $363,771 for mental health.

That amount is not enough to cover mental health services for county-supported individuals without the additional state dollars, Nieman said.

The Iowa Legislature also set up a transition fund to aid counties in continuing to provide services.

"It gives counties authority to move money within funds in their budgets," Nieman said.

Previously counties were not allowed to borrow dollars from other funds within the county budget for the mental health fund, she said.

The transition fund option does not alleviate the budget shortfall in Plymouth, Nieman said.

"I still have to pay it back to the other department," she added, noting there wouldn't necessarily be dollars available to do that.

The Legislature set aside $20 million that counties could potentially apply for, however, those dollars will not be appropriated until the legislators' January session.

"It's there in the legislators' eyes that it can be appropriated," Nieman said. "In my eyes it's not accessible at this point."

Both she and Guenthner noted there may be newly elected lawmakers come January and they could choose not to appropriate the $20 million.

"The fact of the matter is we don't know if we are going to get the money back," Guenthner said.

Nieman said the Iowa Department of Human Services is in the process of writing emergency rules to look for other money in the state budget that could be utilized by counties.

"If extra money is found, counties can apply for it so they can maintain current services," she said. "It's not been publicized when we could apply for it or the parameters."

In the mean time, many individuals receiving mental health services paid for by Plymouth County will see a decrease in their services, starting July 1.

"We don't have money to pay for it because the state didn't appropriate it," Guenthner said. "People need to talk to their legislators."

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