Group asks DMC Supes to not cut levy - needs not being met for mentally ill and disabled

Feb. 04--At a meeting Tuesday, people who are or who serve the mentally ill or developmentally disabled urged Des Moines County supervisors not to cut the property tax levy set aside for mental health services.

The board recently held two budget meetings for the Community Services Department budget for the fiscal year beginning July 1 and ending June 30, 2016.

The problem is too much cash.

At the half-way mark of the current fiscal year, the county's Central Point of Coordination spent about $500,000 of $2 million budgeted. CPC Administrator Ken Hyndman anticipates it will grow to a $3.3 million cash balance by the end of next fiscal year, the one under discussion.

The state recommends 25 percent of expenses as an ending cash balance, which would be $500,000, Hyndman and the board of supervisors said.

Although the department is flush with cash, Hyndman asked the board not to cut the property tax levy.

He said the county MHDS department and its regional, eight-county organization, Southeast Iowa Link, still are unsure where they start and the state ends, what programs are needed and what the state will fund.

The state took over Medicaid services last year, and the county's main mission, as handed down by the state, is to meet the needs Medicaid doesn't cover, Hyndman said.

Since the state takes a long time to deliver Medicaid and Social Security services, ministering to those waiting may or may not be part of the mission, he added.

There also is what supervisors and Hyndman call "cost shifting."

An example is Gov. Terry Branstad's recent announcement he seeks to close the Mount Pleasant Mental Health Institute and the Clarinda Mental Health Institute in July.

Service providers, patients and caregivers won't have six months to find alternate treatment. On Monday, the Department of Human Services Public Information Officer Amy McCoy confirmed no more acute psychiatric patients will be taken at Mount Pleasant and substance abuse patients no longer will be admitted at the end of two months.

Last week, McCoy said Mount Pleasant MHI had 47 patients, and this week, she said there are 21.

The supervisors have tried to gauge the cost shift of the state's Medicaid waiver program, which has a waiting list of more than 10,000 people.

McCoy said recently the 10,000 people waiting, which still is growing, will be reduced by 50 percent, the other half not meeting program guidelines and qualifications.

Hyndman estimated there are five people with intellectual disabilities, defined by the state as those with IQs less than 70, who are on the state's ID waiver waiting list, which has accrued since October. Hyndman recommended people on the waiting list be covered by the county.

The board estimated the number would grow to about 15 in a 12-month period, but only half would qualify and estimated it would take about $300,000 to help about eight people. The ending cash balance could be put toward the expense, the board said, for this and next fiscal year.

The board said the budget that must be sustained year-to-year is $1.9 million, since it is the SEIL agreed amount in the regional plan of services.

SEIL also asked the county to provide $144,000 more in services, which is the county's share of the state's equalization payments, based on a Branstad-led, state-instituted incentive to keep county MHDS property tax levies down.

Still flush with too much money at the second budget session, the board agreed to cut the levy from $1.25, producing $1.8 million, to about 60 cents, which generates $900,000, because property values have risen.

Supervisors agreed the state would take the excessive ending balance or cost-shift of added services on to the county otherwise.

At Tuesday's meeting, Hope Haven Executive Director Bob Bartles said the county should assess unmet needs in the community before cutting the levy and also spend down more of its extra cash on the disabled.

Hope Haven serves 400 people in the area, most of them in Des Moines County, who have mental or developmental disabilities. The company is reimbursed by Medicaid for much of what it does.

But Bartles said Magellan Health, the state-hired Medicaid managed care provider, recently changed its criteria, including how much it pays for services. Now, Magellan assesses clients and places them on a six-level continuum of care. Magellan matches the reimbursement to that level, whether it covers the care or not.

Bartles said disabled clients have a growing gap in funding and needed services, without which they cannot stay in a community setting.

The county could cover this gap, Bartles said, which is a service one regional MHDS in the state is funding.

Bartles said permanent and transitional housing is another unmet need in the community.

For example, Hope Haven runs the crisis intervention center in Des Moines County, but it is funded by two counties, which is a new service that is less than half the cost of a psychiatric-ordered hospital stay, saving money.

The turnover is not as it should be because there is nowhere for the clients to go that is affordable in the community, Bartles said.

Transportation is another need, Bartles said, suggesting the county buy a bus for Southeast Iowa Regional Planning's bus service, SEIBUS, or for Burlington's bus service.

Bartles suggested the county also cover autistic clients' needs, which the state does not.

He asked them to speak to the county's own case managers and to case managers and providers in the community, such as Hope Haven and Bridgeway, to find out who is on their waiting lists, which all are carrying.

Hyndman responded transportation is not one of the services SEIL agreed to fund.

On the other hand, he said the county is funding autistic clients. If there are other needs not being met, Hyndman said people should come to the county and apply for services.

After the meeting, Bartles said the county stopped funding autism a year ago. If it is again being funded, he said it's unknown in the community.

Supervisor Tom Broeker said the county's MHDS funding must be "sustainable." One-time expenses that don't fit into the architecture of the SEIL and county plan, approved by the state, can't be funded.

"You can't sustain anything on an ending fund balance," Broeker said.

He said services will not be cut.

Hyndman, after the meeting, however, said the county used to cover those earning 200 percent of the poverty level set by the state, and now, as decided by SEIL, only funds those earning up to 150 percent of the poverty level.

Broeker said the county has not only not cut but has expanded services. The crisis intervention center, the jail diversion program and the mental health assessment program are new.

The ongoing costs for these programs, he said, cannot be gauged until they have been operating at least a year, so until that's quantified, new or one-shot services will have to wait.

Funding brick-and-mortar affordable housing, for example, could not be sustained by the county, Broeker said.

Bartles said, "I respectfully disagree."

He said the SEIL plan could be reworked and changed to include one-time costs or to increase funding and services for housing the mentally ill or disabled from transitional to permanent housing by contracting with providers, for example.

"The state is one thing. It is going to do what it does. But we don't have to be like the state at the county level," Bartles said.

Broeker, made aware that Mount Pleasant MHI is rejecting placement attempts and is down dozens of patients within a week, said he would study the issue and make several calls.

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