Politics & Government

Mathis: State Awaits Cue From Counties on Funding Needs for Mental Health

If Iowa opts out of the Medicaid expansion, poor Iowans with severe mental illnesses – one in six, according to a recent study – could be harmed.

Editor’s Note: This is the last in a series of three articles in Iowa Patch’s look at the state’s mental health system, its deficiencies and whether a spate of mass shootings should change the conversation. 
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A prickly debate over Medicaid expansion as part of the Affordable Care Act could influence how Iowa’s mental health system overhaul is funded.

A bipartisan panel of legislators said last week that $20 million is needed to implement the redesigned mental health system, which is 13 times more than the $1.5 million the Iowa Department of Human Services thinks is needed. Iowa is moving away from a system under which Iowa’s 99 counties each ran their own programs to a system of 15 regional authorities. 

The new system shifts responsibility for funding mental health care from county property taxpayers to Medicaid.

State Sen. Liz Mathis, D-Cedar Rapids, said the true costs for the mental health reorganization won't be known until next year. This is a transition year, she said, and she is waiting for word from counties on what the bill is after Medicaid's share.

"These are the things we have to iron out. 'How many kids are falling through the cracks?'" Mathis said, noting that she has already started to hear those concerns. "That's perhaps the biggest flaw in the redesign, but we have to remember this is a transitional year."

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Mental health-care advocates say that without Medicaid expansion, Iowa’s most vulnerable residents could encounter the same problems that prompted overhaul of the old mental health care delivery system – limited access. 

First-term representative Daniel Lundby, D-Marion, said the needs of the state will be aired during the session, so he doesn't yet know his level of support for mental health funding.

"I won't be able to say without going out and seeing how much money there is, and where it's needed most," he said.

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One in six currently uninsured adults with incomes below 133 percent of poverty has a severe mental disorder, according to a 2011 study in the American Journal of Psychiatry on the effects of health-care reform on severely mentally ill adults.

"I agree in the past that the Iowa Legislature might have a poor track record," Rep. Walt Rogers, R-Cedar Falls, said of providing consistent funding for mental health. "We don't want to underfund any of our core values."

Rogers said House Republicans are committed to funding it "appropriately and more than it has been." He and Rep. Bob Kressig, D-Cedar Falls, both stopped short of saying they support covering the full bill. Kressig said the true cost of the redesign is not yet known, so he can't predict if it will be fully funded.

Gov. Terry Branstad has said he’s reluctant to commit Iowa to the five-year Medicaid expansion outlined in the Affordable Care Act because he doesn’t think it’s sustainable. The federal government pledges to pay 100 percent of the cost of each state’s Medicaid expansion from 2014 to 2016. The federal share would be reduced to 90 percent by 2020.

Rep. Chris Hagenow, a Windsor Heights Republican, said Medicaid expansion should be approached cautiously. At this point, he said, lawmakers don’t know exactly what they’re committing to in terms of future resources.

“We have a federal government a lot of us think can't meet obligations for the Affordable Care Act,” Hagenow said last week when he and other lawmakers representing West Des Moines, Waukee, Clive and Windsor Heights met at a public forum.

“We're not necessarily drawing lines in the sand,” said Hagenow, the majority whip in the Iowa House, “but we want to be careful.”

“I respect that,” said Sen. Matt McCoy, a Democrat representing Des Moines and West Des Moines, “but that said, we've had an election and that has consequences – the Affordable Care Act is the law and the state has the responsibility to follow that directive.”

The U.S. Supreme Court has given states more flexibility in implementing the Affordable Care Act and Branstad is one of a host of Republican governors asking that their states be allowed to “opt out” of Medicaid expansion.

McCoy said expanding Medicaid is imperative to make sure Iowa’s uninsured residents have access to health care, including mental health care.

“Medicaid can play an important role in helping people who have illnesses and accidents that are unforeseeable,” Schneider agreed.

Some studies, he pointed out, show that Medicaid expansion could be less expensive than continuing coverage for uninsured Iowans under IowaCare, which provides medical coverage for Iowans who don’t qualify for Medicaid.

Read Part 1 of the series: 

Read Part 2 of this series: Legislators Say $20 Million in Mental Health Funding Needed; DHS Says Only $1.5 Million Required


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