Iowa officials launched the state's new behavioral health system this week. It is a significant overhaul of the previous system and is aimed at better connecting Iowans with mental health and disability services.
Gov. Kim Reynolds signed the changes into law in May of 2024, replacing the state's previous system of 13 Mental Health and Disability Services Regions and 19 Integrated Provider Networks for substance use disorders.
The new system consists of seven behavioral health districts that also cover substance use disorders. Disability services have moved to go with the state's aging services under the Aging and Disability Network. Both are overseen by the Iowa Department of Health and Human Services (HHS).
How does the new behavioral health system work?
The new safety net system is more centralized than the state's previous Mental Health and Disability Service Regions, which were all run by different organizations.
"Some of the most common concerns that we heard from the Mental Health and Disability Services regional space was services that stop at the county line," said Marissa Eyanson, the behavioral health division director with Iowa HHS.
She said the new system aims to remove the boundaries and silos under the old regional districts so Iowans can get care wherever they need.
"It also helps us think about how we organize our budget, ultimately, to really get some of the funding targeted into spaces of great need and really moves us away from having boundaries to how people access [care]," she said.
Funding for the system goes through Iowa HHS, and as part of the law, the state has contracted with the Iowa Primary Care Association (PCA), which serves as the "administrative service organization" to oversee the seven districts.
Under the new system, the districts will each have an advisory council made up of three local elected public officials, three people with lived behavioral health experience, three people with experience or education related to behavioral health, and one law enforcement member to give input on resources.
Iowa PCA is also in charge of securing provider contracts so they are reimbursed by the state for services they provide to Iowans who are uninsured or underinsured.
Aaron Todd, CEO of Iowa PCA, said the organization will also work with navigators at Your Life Iowa to help direct Iowans to the resources they need.
"So whether that's ... a behavioral health provider, or if it's a community support, it really is dependent on what that person needs," he said. "They can help them with paperwork. They can kind of walk with them along that journey."
As of this week, the organization has finalized more than 80% of provider contracts, and Todd said he expects to work out the final details on the rest soon.
Iowa PCA is also working on filling advisory council seats. As of the system's launch, 12 of the 70 seats remain open. Six of the vacant seats are for someone with lived experience and six are for elected officials.
Todd said the organization wants to make sure they have representation from as many counties as possible, which can make filling some seats more challenging.
"That meant that sometimes we were unable to see folks who were otherwise well-qualified and super interested. But we wanted to make sure that within a particular district that we had good representation," he said.
What's happening to disability services?
Services for Iowans with disabilities used to be coupled with mental health services under the previous system. Under the new system, disability services will be with aging services.
Disability services are moving to Disability Access Points, which are run by four different organizations across the seven regions that were selected by Iowa HHS. They are part of the Aging and Disability Resource Center Network, which includes the state's Area Agencies on Aging.
Iowans of any age who need help with disability services can now call either their local Disability Access Point, the Aging and Disability Resource Center network or Your Life Iowa to figure out how to get help, according to Zach Rhein, the aging and disability services division director at Iowa HHS.
Rhein said the change was made to better help Iowans with disabilities. Prior to the change, the state's Aging and Disability Resource Centers only included Area Agencies on Aging.
"If you are a family with a child with a disability, why would you ever think to a place called an Area Agency on Aging to get services?" he said. "It's calling out we serve people with disabilities, and having a system that is focused on serving those individuals."
How is the system funded?
Iowa HHS said it has $250 million "safety net" dollars to cover the first year of disability and behavioral health services for those who are uninsured or can't get the services covered through their insurance plan.
It has $146 million for behavioral health services and $56 million for disability services that are a combination of state and federal dollars, as well as $45 million left over from the budget for the previous Mental Health and Disability Service regions.
Eyanson of Iowa HHS said lawmakers did not allocate additional funds to the new system. The focus right now is getting it up and running to evaluate it before deciding whether to ask the state for additional funding.
"What we really need right now is time. We need time to be able to evaluate those investments. We need time to be able to see where that stable state is going to be before we would be in a right place, I think, to come forward with any additional ask for additional money," she said.
What are mental health advocates saying?
Leslie Carpenter, the co-founder of Iowa Mental Health Advocacy, said she's nervous about the start of the new system.
"There's a lot of concern for provider stability, for patients continuing to have access to the services that they've needed," she said. "The words coming out of HHS at the town halls is that the patients won't experience any adverse effects from the transition. But in listening to providers report on different funding levels for some of the services, and with pending federal Medicaid cuts, we don't know what it's going to turn out to be."
However, Carpenter said state officials have been communicative and responsive to her concerns throughout the process of setting up the system.
"I do think that there are very good intentions to have it work as smoothly as possible. And I'm just hoping that as individual cases come up, they'll continue to be as responsive moving forward," she said.
How do I access services?
Officials said Iowans who were receiving services under the old system shouldn't see any interruption.
Iowans who need help and are unsure of where to go should contact Your Life Iowa to connect with a navigator.
