With deadlines approaching for county governments to set up mental health service delivery regions, Palo Alto County's Supervisors took an opportunity to visit with a pair of State lawmakers to express their frustrations and concerns. The session took place during the Dec. 27 meeting of the Supervisors at the Palo Alto County Courthouse.
State Senator David Johnson of Ocheyedan, who now represents Palo Alto County after the last re-districting, was joined by Representative-elect Megan Hess of Spencer in a visit to introduce themselves to the board prior to the start of the new Legislative year.
It was perfect timing for the visit, as the Supervisors were meeting with Judy Curry of Kathleen's Residential Care in Emmetsburg about problems the proposed mental health service redesign was posing for her facility.
"The costs per person for services are increasing because residents are being removed by their home counties because of the re-design, and we're not seeing reimbursements like we should,"?Curry explained to the lawmakers. "Now, I have to try to decide what to do to meet this re-design, but there are no rules telling us as providers how the re-design will work. It's just like Obama Care - no one knows anything about it."
"That's the biggest concern we as a county have as well,"?noted County Mental Health Director Maureen Sandberg. "We don't know what the rules are in the re-design for residency or legal settlement of clients. And, if we are funded at this $47.28 figure that has been talked about, Palo Alto County will lose $250,000 in funding."
"The problem with the re-design is that there are people in the state who want folks out of institutions and living out in the real world,"?Senator Johnson said. "Because of that, residential care facilities are on the radar in Des Moines. But, those who see these people and know them know that thinking is just not realistic"
"They want to do away with work activity,"?noted Supervisor Ron Graettinger. "For so many of those people, that's what they look forward to every day - something to keep them busy. With the re-design, we won't have the funding for work activity and I?really think that is going to be a big problem. We need to have a place for them to work and stay active."
"When I?left Des Moines at the end of the session last
Spring, we lawmakers knew there would be some counties that would need financial help with the re-design,"?Johnson said. "At that time, it was thought that $80 million would get counties through the process. But now, that number is down to $1.2 million, and I'm told Scott County will get the majority of it, close to $1 million."
Johnson continued, "The intent of the re-design was to provide equal access all across the state for people to get mental health assistance. There were a lot of inequalities in levels of service because some counties were doing a better job with their mental health services than others. That's why the Department of Human Services came up with the idea for this re-design."
Under the re-design, counties are to form "regions" to pool their mental health dollars to provide equal services for all residents. Questions about how the pooling of dollars remain unanswered, another concern of the supervisors.
"The big question about pooling money is not a slam dunk,"?Johnson agreed when the subject was broached. "The legality of moving property tax dollars across county borders has to be addressed on that subject."
"I take some offense that the state felt there is no equality of services,"?Sandberg said. "Back when House File 69 was implemented requiring management plans and all that,counties were mandated to provide certain services by DHS. If there was inequality, why didn't the Legislature act back then. I?don't think all that paperwork and such was even being reviewed back then."
"Why even go to regions?" asked Supervisor Ed Noonan. "Why not just tell counties what has to be done? What are they taking the local control away? All that's happening is that they are creating another layer of government."
"They could end up with one region providing less services than other regions,"?Sandberg said.
Johnson agreed the re-design was a work in progress, noting he had been attending meetings on the topic for some nine years. "Not all of this is set in stone."
"Have you met anyone in your district who likes the re-design?"?Noonan asked Johnson, and got a "No" in reply.
"This is a very intricate issue and frankly, people just don't get it,"?Megan Hess observed. "People complained that something had to be done, and the Legislature tried to do something but left it awfully open."
Both lawmakers agreed they would keep in touch with the local board on the issue during the upcoming Legislative session.
"Well, I still believe that the more local you keep it, the better the service," Ed Noonan said.