An overhaul of Iowa’s mental health and substance use disorder treatment systems proposed by Gov. Kim Reynolds is pending in the Iowa Legislature, and health officials and lawmakers say they are hopeful the changes will break down regional boundaries in services and funding to make it easier for Iowans to get help.
Reynolds’ bill would get rid of the state’s 13 Mental Health and Disability Service regions and 19 Integrated Provider Networks that oversee substance use disorder and gambling addiction treatment. In their place, the bill would create seven behavioral health districts that include mental health and substance use disorder services.
Current funding for all of those services would be merged into one behavioral health fund to be controlled by the Iowa Department of Health and Human Services.
Mae Hingtgen, CEO of the East Central MHDS Region, said she was “thrilled” to hear that because many people experience mental health and substance use issues.
“It is actually illegal for MHDS regions to pay for substance use services out of our funds,” she said. “So eliminating that requirement and making sure that the funding and the policy are integrated will go a long way to making sure that people get services,” she said.
Hingtgen said there is not equitable access to behavioral health services across the state, with most counties considered mental health service deserts.
The state would hire an “administrative services organization” to oversee each of the seven districts, and each district would also have an advisory council to get stakeholder input. If signed into law, the new system is supposed to be up and running on July 1, 2025.
Speaking Monday on IPR’s River to River, DHHS Director Kelly Garcia said a main goal of the effort is to identify a “bright line front door” for Iowans to more easily find behavioral health services.
“I don’t want Iowans to have to think about a boundary map to understand where they go,” she said. “So the first really significant movement that happens in the shaping of this legislation is we remove those boundaries. Iowans can go to a service provider of their choice. The second piece is that we add to those brick-and-mortar locations so that Iowans understand that really clear entry point.”
Garcia said the state submitted an application to the federal government last week to start certified community behavioral health clinics as part of that effort. She also said the seven behavioral health districts are not meant to restrict where people can access services, but rather to focus on ensuring equitable access to services all over the state.
Rep. Beth Wessel-Kroeschell, D-Ames, said it’s “extremely exciting” that mental health and substance use disorder treatment will be combined into one system.
“It does put more power in Des Moines as a state program, and this is probably, though, one of those things that should be a state program that needs to have the consistency across the state,” she said.
The House Appropriations Committee amended Reynolds’ original bill last week to keep current requirements for what kinds of mental health services must be provided, to specify that services for children must be a focus of the new system, and to require stakeholder involvement in developing a state behavioral health plan, among other changes.
The amended bill got unanimous support from the committee.
Behavioral health fund would combine different sources of money
Reynolds’ bill would not increase mental health funding. It would combine several different sources of state funding for an estimated total of $206 million, or a total of $228 million when federal funds are included.
Bethany Kohoutek, communications and advocacy director for the National Alliance on Mental Illness Iowa, said she sees the bill as a reorganization of the system, not system growth—and both are needed.
She said she is grateful that the legislature gave a boost to mental health services covered by Medicaid last year, but she said the need for services is increasing.
“I’m almost looking at this as kind of two separate things,” Kohoutek said. “This is sort of rearranging the cards to make it a better hand almost, and then separately we need to address how we continue to give the system the resources it needs to keep pace with what Iowans really need.”
Garcia said in addition to last year’s action by the legislature, this bill would free up existing funds for behavioral health care not covered by Medicaid.
“Do we need more money? Possibly,” she said. “But right now, we’re sitting on fund balances, so I need a little bit more time to assess that. But you absolutely should be assured that we will move forward with a recommendation [to the legislature] once we make this change and assess what’s needed.”
Garcia said the state has more access to data about statewide behavioral health than ever before, and the bill has performance measures to help evaluate treatment outcomes.
Wessel-Kroeschell said she supports making it easier to use existing unspent funds.
“At this point, with having that extra $41 million that will actually be available, I think that is a good start for the services themselves,” she said.
Wessel-Kroeschell said the state may need to eventually spend more to address the critical mental health workforce shortage and to help transport people to services.
Children’s mental health highlighted in amended bill
Garcia said the amendment to Reynolds’ plan would ensure there’s a focus on services specifically for children and young adults delivered in a “home-like environment.”
“Not enough Iowans have access to statewide services,” she said. “We recognize that, and that has to change.”
Garcia said the department has developed specialized programs for youth at state-run mental health institutes, and she is discussing with lawmakers how to build up children’s services so that Iowa kids with severe mental health challenges don’t have to leave the state.
“What we’re looking to do as a state agency is to have a specialized network for that higher-end, out-of-home placement need that really stabilizes youth and allows them to come back home,” she said.
Wessel-Kroeschell said she is concerned about the impactmajor changes to the state’s Area Education Agencies could have on the ability to identify children’s mental health issues as early as possible.
“Schools are where children are, and that’s where you’re going to start seeing some of the behaviors if the parents haven’t seen them before,” she said.
What would happen to the disability services that are part of the MHDS regions?
Disability services would be taken out of the mental health regional system and put under the DHHS Aging and Disability Services division.
Garcia said one aspect of that would be building out aging and disability resource centers.
“We have a minimal network today performed by our Area Agencies on Aging. They do amazing work, but they’re really heavily focused on aging,” she said. “And while that’s incredibly important, we’re leaving families that need access to services on the disability side without a really clear front door.”
Wessel-Kroeschell said she thinks these changes make sense.
“I’m sure there will be confusion at the beginning, and there always is when there’s change,” she said. And there are some people I know who are a little worried about the change. But logistically, I think it’s probably the right place.”
Overall, Kohoutek said DHHS officials have been collaborating with advocates and providers on the bill and its amendment.
“Is this legislation the end all, be all to fix Iowa’s mental health and substance use challenges?” she said. “No. But is it a step in the right direction? We think it is.”
If you are in need of help, you can call 988, the Iowa Warm line at 1-844-775-9276, the Iowa Concern hotline at 800-447-1985, or Your Life Iowa at (855) 581-8111 (call) or (855) 895-8398 (text).
Para obtener ayuda en español, llame al 531-800-3687.
