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MH/DS Redesign Future Remains Up in the Air

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The legislature may be able to reach consensus soon on transition funding for the non-Medicaid services system, but there are still many other unresolved issues.  They include:

  • Target Populations.  Redesign only requires counties to serve people with an intellectual disability or mental illness. Those with other developmental disabilities and brain injuries are not included in this first wave of populations served, despite the fact that counties do pay for some services now.  Iowans with brain injuries can apply for services under the Medicaid Brain Injury Waiver, but the waiting list is very, very long.  There is no waiver for people with developmental disabilities, so there is simply no other option for publicly-funded services.  Some legislators would like to correct this, and require all counties serve all populations, to the extent funding is available.

  • Core & Core Plus Services.  Counties must provide all core services to the "target population" before they are allowed to serve others, and before they can move on to the list of "core plus" services.  Core plus services often save money in the system, and include things like mobile crisis, crisis intervention, jail diversion, and other justice-involved programs.  Because they save money, counties say this decision is penny wise, but pound foolish.  Since counties (and later regions) are only required to pay for core services "to the extent funding is available," some legislators would like to combine the core and core plus services into one single core services list.  They say if everything depends on funding, then just have one list and let regions decide which services are the most important.

  • Ongoing Funding.  Last year, legislators set up a new structure to "equalize" property taxes throughout the state.  Under their plan, counties would be able to collect and spend up to $47.28 per person living in that county.  Counties that currently collect less than that in property taxes would be given state money to make up the difference.  Counties collecting more than that would have to lower their taxes and just spend less.  Lawmakers hoped that as a region, some counties may gain, others may lose, but together it would even out.  Legislators predicted it would cost about $30 million to pay for this "equalization formula."  Some legislators want the state to live up to this commitment, and others want to distribute the money differently.  Some think counties need far less than the $30 million. 

    Counties, providers, advocates, and others are starting to express concern about ongoing funding. Counties need to know soon how much they will have to spend, because the new funding year starts on July 1, 2014 and their tax revenues don't start coming in until October.  Some legislators want to spend less. Some want to spend more. And some want to make sure that whatever level of funding is needed, that it gets to the counties that really need it.

There is currently no bill to address ongoing funding, changes to targeted populations, or merging the core/core plus service lists.  Keep watch for them on our Bill Tracker here.