January News 2013 (Issue #1)

Legislators returned to Des Moines to begin their work on January 14, 2013.  Top on their "to do" lists are:

1. Passing a new two-year budget.
2. Reforming the state's education system.
3. Lowering property taxes.
4. Implementing the Affordable Care Act 
5. Addressing Iowa's skilled workforce shortage
6. Lowering other taxes on Iowans

What are your priorities for 2013?  Your legislators want to hear from you, so let them know what you think they should be spending their time on at the State Capitol.  You can contact your legislator through our Grassroots Action Center.

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Governor Terry Branstad presented a new two-year budget to lawmakers on Tuesday, January 15, during his annual "Condition of the State" speech.  Governor Branstad outlined his top priorities for the next two years - property tax relief  and education reform.   "We still have much work to do.  In particular...our on-going efforts to reduce property taxes and to adopt a truly transformational educational system."

There is also a lot of work yet to be done on the mental health and disability services system, including decisions on how to fund it.  The Governor made no mention of this in his speech, and his budget does not include funding for the new regional Mental Health & Disability Services system.  The following statement is from a review of the Governor's budget done by the non-partisan Legislative Services Agency,

"This fall the General Assembly had a Mental Health and Disability Services Redesign Fiscal Viability Study Committee that met twice and made various recommendations including providing $20.0 million for the Mental Health Transition Fund for FY 2013. The purpose of the Transition fund is to provide a bridge to counties until the per capita levy equalization payment of $29.8 million that begins in FY 2014. The Governor recommended $3.8 million for the Transition Fund in FY 2013 and made no recommendation for the $29.8 million equalization payment.  

In short, the Governor recommends no funding for local non-Medicaid services, and only 19% of the funds counties think they need to get through the next six months without service disruption.  In addition, the Medicaid budget is funded at the lowest estimate, not allowing much room for growth.  The Governor does not expand Medicaid to cover additional low-income Iowans as allowed by the new Affordable Care Act (federal health care reform).  Under such an expansion, the federal government would pay 100% of the costs of this expansion for the first three years and no more than 90% after that time.

You can read all of the Governor's remarks and read the details in his budget at www.governor.iowa.gov.

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• Property tax reform. Supporters of tax reform say that commercial and industrial property taxes in Iowa are among the highest in the nation and are a barrier to economic growth. Others say they are concerned that cutting property taxes for businesses leaves local governments without tax dollars they use to pay for roads, public transportation, public health programs, libraries, parks, jails, etc. The Governor's plan gives city and county governments state funding to replace the lost property tax dollars, but local governments want to make sure that the Legislature lives up to its promise in future years. 
  
  Why is this important to you? Your property taxes could go down, business may be able to hire more people, or your cities and counties may need to cut services if the state doesn't live up to its promise to reimburse them for lost funds.
  
  
• Mental Health & Disability Services Reform (Part 2). Legislators passed the reform bill last year, but didn't fund the new system. On the list of topics for discussion - funding for the Transition Fund (to help counties get through this "transition year"), and funding for the Property Tax Equalization Fund (the fund that allows counties to budget $47.28/person). Other legislators want to make changes to the law passed last year to make sure Iowans with developmental disabilities continue to have access to services, and that core plus services be moved into the list of core services so counties are not forced to drop them if funds are not sufficient.
  
  Why is this important to you? Access to the new list of core services depends on funding. Depending on how much money is available, your county may have to cut services or may not be able to make progress in adding core services. 
   
• Medicaid Expansion. The federal government is encouraging states to expand their Medicaid programs to cover all persons earning under 133% of the federal poverty level. Right now to get Medicaid, you must have a disability, be elderly, or have a child that qualifies for Medicaid. There are special Medicaid programs that allow other populations, but this new expansion would allow anyone earning up to 133% of the federal poverty level to become eligible for Medicaid. The federal government has agreed to pay for all of the costs of expanding Medicaid to this new population in 2014-2016, and then will pay for 95% of the costs in 2017, 94% in 2018, 93% in 2019, and 90% in 2020 and beyond. Governor Branstad doesn't want to expand Medicaid without making sure it will really make Iowans healthier and that the federal government will live up to its funding commitment. 
  
  Why is this important to you? Expanding Medicaid makes sure more low income Iowans have access to health care, and it also helps counties/regions because some of those newly eligible people would no longer need to be served by the county-funded non-Medicaid services system. 

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Senator Rob Hogg (D-Cedar Rapids) has had enough talk.  He wants to see the Iowa Legislature take action this year to make sure Iowa's jails, prisons, and courts do not become the state's largest providers of mental health services.  As one sheriff present at a recent legislative hearing said, "Unfortunately, throughout the country, county jails are now the largest providers of mental health services."

For years, the state has looked for ways to keep people with mental illness out of the state's jails and prisons, but without much luck.  Everything proposed needs to be driven locally, involves very complicated legal issues, and ultimately comes down to the need for more money.  But Senator Hogg says that it's time, and the public support for change is overwhelming.

To get the ball rolling, Sen. Hogg called a special meeting of the Senate Judiciary Committee to look at ways the state can address the needs of those with mental illness that end up in our jails or get the attention of law enforcement.   This meeting was the first in a series, and the packed committee room (people had to sit in the aisles on the floor) seems to show the "overwhelming public support" that Senator Hogg referred to in his opening comments. 

Sheriff Tony Thompson of Black Hawk County was the first to speak.  He presented a ten-page document describing the jail diversion program in Black Hawk County.  "People hold Black Hawk County up as a model on what to do to address the mental health need, but we still have a lot of work left to do," said Sheriff Thompson.  He described their jail diversion program, the goal of which is to keep those that need treatment out of jail, and get them into a treatment program that meets their needs.  Black Hawk County has hired a jail diversion coordinator to assess people that law enforcement think may be in need of mental health services.  The coordinator is able to work with the judges, prosecutors, and law enforcement to get the person probation (instead of jail time) and find a place for that person to get appropriate treatment.  While this works well, Sheriff Thompson said they still have trouble with those that do not want treatment, will not cooperate, or are more violent.  He said there are very limited options for this part of these individuals, who have very complex mental health needs and are very difficult to manage.  "There just are not enough options for these individuals," said Sheriff Thompson.

Sheriff Paul Fitzgerald of Story County spoke next about the Story County Crisis Intervention Team, which was modeled after the Black Hawk County program.  Their team includes county supervisors, ISU, city and county staff, county attorney, public defenders, prosecutors, NAMI, law enforcement, mental health professionals and providers.  "No one agency is big enough to have a single person available 24x7 to respond to a person in crisis, so we pooled our resources," said Sheriff Fitzgerald.  The program trains law enforcement officers on responding appropriately to a person with mental illness that is in crisis, so that they have coverage all the time.   The training program was developed by an Iowa State University clinical psychologist and has been very successful, but they face ever-decreasing funding (grants).  He also indicated that new gun laws passed two years ago by the Iowa Legislature take away the county sheriff's ability to deny gun permits to people they know have a history of mental illness.  He said that even though he is told someone has "suicidal tendencies" he can no longer deny a gun permit, he must issue it, and that is troubling for his department.

Captain David Knight of the Polk County Sheriff's Office spoke next about Polk County's metro-wide Mobile Crisis Intervention Team.  When an officer finds someone in crisis, they call in the mobile crisis unit.  This team of trained experts can then talk to the person, get them stabilized, and then take them to an appropriate treatment facility that may be able to get them on medication.  "This allows our officers to get back on the street, and get properly trained people assessing the situation and getting (the individuals) where they need to be," said Captain Knight.  He also acknowledged that sometimes a uniform makes things work, so getting people that are not law enforcement to work with the individual makes a big difference. "It's all about getting people the help they need without taking them to jail, and keeping our officers on the street," said Captain Knight. 

Barb Gay of Foundation 2 – was the final speaker.  Foundation 2 manages the Cedar Rapids Crisis Program as well as manages a statewide suicide hotline.  What makes the Cedar Rapids program different is that anyone can refer someone to the crisis program - not just law enforcement but also family, friends, coworkers and others.  The Cedar Rapids crisis response team is usually onsite within 20 minutes, but they are allowed up to an hour.  This year, their suicide hotline has taken 12,000 calls in first six months, and those calls are increasing (Iowa has 400 suicides per year – they receive 160 calls per month from Iowans in all 99 counties).  Funding is also their biggest challenge - they have only one year of funding and never know if they'll find enough money to continue.  "Services need to be stable, so funding needs to be stable too," said Gay.

Senator Daryll Beall of Fort Dodge asked if there were options for rural areas that may not have the resources or hospital beds to do their own crisis program.  He said its an issue everywhere, "and we are now losing more veterans to suicide than combat injuries."   The panel of sheriffs seemed to all agree that everyone has different resources, and funding is scarce, so programs have to be developed locally to meet the needs of the community within the resources they have available.

Sen. Steve Sodders of State Center said that mental health should not be the job of jails.  Sen. Sodders, who is a Deputy Sheriff in Marshall County, said this needs to be part of a much larger discussion on mental health reform.  "Subacute care is needed so the jails are not the de facto providers," said Sen. Sodders.  Last year, the Mental Health and DIsability Services Redesign bill included a pilot for 50 subacute beds, since there were none of these "step-down" programs in the state.  Subacute is something between hospitalization and community-based services, and many think this level of treatment may be helpful in making sure people don't end up cycling back through the system (reducing the number of people that repeatedly end up in trouble with the law and not getting the treatment support they need).

In closing, Senator Herman Quirmbach urged Iowa's Legislature to take strong action. He said the Legislature must:

1. Fund the mental health transition fund – so counties have enough money to make it through this year.
2. Increase mental health capacity (more professionals to serve the needs).
3. Accept the federal governorment’s offer to expand Medicaid, including new coverage for mental health services.

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Is this a topic you care about? Are you ready to take action?  Use our Grassroots Action Center to contact your State Senator, State Representative, and the Governor.  Click here to get started.

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Following the Senate Judiciary Committee hearing on mental health, Senator Rob Hogg of Cedar Rapids challenged others in the Legislature to take action.  He outlined is plan for moving forward on the issue (the comments on each item are his).

1. Fully Fund the MH/DD Re-Design Transition Fund - The state must provide an adequate transition fund – $20 million or more – to ensure that people do not lose services or face waiting lists for services during the MH/DS re-design.  The scenarios identified by the DHS did not account for all needs or for every county.
    
2. Fully Fund the MHDS Regional Services Fund – The minimum funding needed for regional services fund is $13.4 million for FY14 to provide block grants to counties for non-Medicaid funded services.
    
3. Fully Fund the MHDS Equalization Fund – The minimum funding needed to equalize counties that have been capped on property taxes below the specified per capita amount is $29.8 million.  The per capita level may also be too low.
    
4. Expand Medicaid – The federal Affordable Care Act gives states the ability to expand Medicaid to provide health insurance for low-income adults in addition to low-income children, seniors, and disabled.  Expanded Medicaid would provide health care including mental health for an estimated 200,000 Iowans (net savings to the state).
    
5. Fund and Expand 24/7 Emergency Services And Outreach – The state could fund the 24/7 crisis hot line to improve awareness and expand services (estimated cost: $600,000) and mobile crisis units for each region statewide (estimated cost: $3 million).
    
6. Fund Regional Residential Care Facilities – The state funds state mental health institutes, but not regional residential care facilities.  The state should fund residential care facilities for commitments and other services to maintain and improve services and to avoid higher-cost alternatives (estimated cost: $15 million).
    
7. Pre-Commitment Screening – Some counties have used pre-commitment screening to find alternatives to judicial commitment through the courts.  The state should provide all applicants for judicial commitment with pre-commitment screening to identify more appropriate and potentially less costly alternatives (estimated cost: $3.6 million).
    
8. Expand Core Services To Include Development Disabilities and Brain Injuries – MH/DS re-design left developmental disabilities and brain injuries out of the initial core services contingent on sufficient funding.  The state should provide sufficient funding to include development disabilities and brain injuries (cost estimate needed).
    
9. Fund and Operate the ANCHOR Center – The ANCHOR Center was built by the state several years ago to provide outpatient and inpatient services for people under correctional supervision who have mental health conditions.  Although the facility has been opened partially on an outpatient basis, it has never been funded and operated as originally intended (estimated cost:  $2.6 million).
    
10. Sheltered Workshops – Sheltered workshops have been cut because they are not considered mental health treatment.  The state should provide funding for our sheltered workshop workforce to avoid higher-cost treatment options (estimated cost: $5 million).

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infoNET and ID Action do not endorse policies, plans, or bills. We report on them, provide the tools and opportunities to help our readers take action, and encourage people to take action on things they feel are important to them.  So while the Senate Democrats have been the first to outline a plan of action on mental health reform, we will report on other legislator's plans to address the needs of Iowans served by the mental health and disability services system.

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Last year, the Iowa Legislature passed a massive redesign of the Mental Health & Disability Services System.  The changes go into affect over several years, but there was one big issue the Legislature didn't tackle last year.  Funding for the newly redesigned system.

Sixteen communities have hosted "Community Conversations on Mental Health & Disability Services Redesign" wih the ID Action/infoNET team - Ames, Cedar Rapids, Cherokee, Clinton, Des Moines (twice!), Decorah, Dubuque, Estherville, Iowa City, Iowa Falls, Sac City, Spencer, Spirit Lake, Washington, and Waukon.  Nearly 800 Iowans have participated in these events.

Community Conversations open with a presentation by ID Action/infoNET explaining how the system changed, and end with a discussion about what advocates and community leaders can do next to make sure the system redesign is successful and meets the needs of all Iowans with disabilities.  

• Click here for the powerpoint presentation.
• Click here for our Guide to MH/DS Redesign.
• Click here for our Quick Review of the MH/DS Redesign (two-pager).

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Local advocacy is the best advocacy. Your legislators come home to their legislative districts on Fridays-Sundays during the legislative district, and many hold open public forums during that time. They call them by many names - public forums, town hall meetings, listening posts, Eggs & Issues, Pizza & Politics, legislative breakfasts, legislative forums.   But they all give legislators a chance to talk to the people they represent, answer their questions, and hear their concerns.  They are great and highly effective ways to advocate.

To find a forum near you, click here.  
For tips on going to a forum, click here.

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You can find bills of interest to Iowans affected by disability here.  We update our bill list daily, adding new bills and changing them as they move through the process.  Check back often as this changes daily.

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