Who's Picking Up The Tab For Children's Mental Health?

Jul 15, 2019

As of this month, Iowa has a new children’s mental health system. Lawmakers have set up a system much like the adult’s mental health system to ensure there are much-needed core services for uninsured children across Iowa. But the legislation the governor signed in May came without long-term state funding and now that it’s officially in place -- one major question still looms: Who’s going to pay for it?

Lori Elam, the CEO of the Eastern Iowa Mental Health and Disability Service region, said she’s proud of the new mental health services recently rolled out in eastern Iowa.

"We have crisis hotline. We have a warm line," Elam said. "We have care coordinators who help families coming into the the emergency room. We have care coordinators in our communities working with the mental health centers."

Elam said she’s ready to expand services to children. But she’s already worried about how to fund it.

"Many of those services are 24/7 type services that are costly," Elam said, "and, you know, we want to do well for all of our citizens, but we just have to have the funding there to do that."

These mental health services are funded through county property tax levies. Elam said the counties in her region are at their levy cap, and she doesn’t think this will bring in enough to cover the new mandated services.

"It's kind of a scary unknown. We don't know, necessarily, who's out there and who needs help and what this is going to cost us," she said.

Other regions have similar concerns.

"We figured out what it would take for our region to survive for two years, and at the end of that two years, we would have, I think it was $161 in our balance," said Bill Leupold, who's on governing board for the Northwest Iowa Care Connection region.

Unlike the eastern Iowa district, the six counties in Leupold’s district have not hit their levy cap. Leupold says many county supervisors voted against raising their levies after the bill passed -- because they think the state should kick in more funding.

"I agree with them they should, but how are you going to get them to do that?" Leupold said.

"It's kind of a scary unknown. We don't know, necessarily, who's out there and who needs help and what this is going to cost us." - Lori Elam, CEO, Eastern Iowa Mental Health and Disability Service region.

State lawmakers say the law is just the first step in creating the system.

"We are just beginning," said Sen. Liz Mathis, D-Hiawatha. "This would be like laying the first brick in the foundation of a house."

Mathis said one of the next steps is to address funding in the next legislative session. But she says first, it’s critical that the regions assess their services and budgets.

"They're saying you're asking us to do one more thing that will burden our county or our regional taxpayers," she said. "But what we're saying is, this is a responsibility that we have to look at."

Mathis said the state will already be funding many of these services -- through Medicaid.

This is something also emphasized by Rep. Joel Fry, R-Indianola, who chairs the House health and human services budget committee.

"Only 3 percent of Iowa children are uninsured," he said, "and therefore, only 3 percent of Iowa children across the state, do the mental health regions have to worry about picking up on the back of that region."

Fry also pointed out that last session the state allocated $2.1 million to address the backlog of nearly 1,000 children waiting for mental health waivers and $1.2 million for the state's area education agencies to provide mental health training in schools.

But some mental health advocates say it’s not that simple.

Peggy Huppert, the director for the National Alliance on Mental Illness Iowa, said there are a lot of mental health services that insurance doesn’t cover.

"There are huge gaps, and somebody has got to pay for that," she said.

Huppert says she’s concerned things aren’t moving forward fast enough to deal with these complex financial issues by next session. Just last week, the governor’s office announced the new state children’s mental health board--a board that was supposed to be in place by July 1.

Huppert’s been reappointed to this board and is ready to get to work.

"We need to start hearing from the regions about what they're doing, or what they're not doing, and understand what's going on with that." Huppert said.

Under the law, Iowa’s 13 mental health regions are required to submit their plans for the children’s system by April next year.

Natalie Krebs is IPR's health reporter.  Funding for her work is provided by the Mid-Iowa Health Foundation.