Cedar Valley Legislators Consider Mental Health Funding

Editor’s Note: This is the last in a series of three articles in Iowa Patch’s look at the state’s mental health system, its deficiencies and whether a spate of mass shootings should change the conversation. 
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A prickly debate over Medicaid expansion as part of the Affordable Care Act could influence how Iowa’s mental health system overhaul is funded.

A bipartisan panel of legislators said last week that $20 million is needed to implement the redesigned mental health system, which is $18 million more than the Iowa Department of Human Services thinks is needed. Iowa is moving away from a system under which Iowa’s 99 counties each ran their own programs to a system of 15 regional authorities. 

The new system shifts responsibility for funding mental health care from county property taxpayers to Medicaid.

"The biggest problem is access and recognizing you have a condition," Rep. Bob Kressig, D-Cedar Falls, said of patients.

Local legislators, including Kressig, say mental health needs attention - and money - but they hesitate to say just how much should be committed.

Mental health-care advocates say that without Medicaid expansion, Iowa’s most vulnerable residents could encounter the same problems that prompted overhaul of the old mental health care delivery system – limited access. 

"I agree in the past that the Iowa Legislature might have a poor track record," Rep. Walt Rogers, R-Cedar Falls, said of providing consistent funding for mental health. "We don't want to underfund any of our core values."

Rogers said House Republicans are committed to funding it "appropriately and more than it has been." He and Kressig both stopped short of saying they support covering the full bill. Kressig said the true cost of the redesign is not yet known, so he can't predict if it will be fully funded.

One in six currently uninsured adults with incomes below 133 percent of poverty has a severe mental disorder, according to a 2011 study in the American Journal of Psychiatry on the effects of health-care reform on severely mentally ill adults.

Gov. Terry Branstad has said he’s reluctant to commit Iowa to the five-year Medicaid expansion outlined in the Affordable Care Act because he doesn’t think it’s sustainable. The federal government pledges to pay 100 percent of the cost of each state’s Medicaid expansion from 2014 to 2016. The federal share would be reduced to 90 percent by 2020.

Rep. Chris Hagenow, a Windsor Heights Republican, said Medicaid expansion should be approached cautiously. At this point, he said, lawmakers don’t know exactly what they’re committing to in terms of future resources.

“We have a federal government a lot of us think can't meet obligations for the Affordable Care Act,” Hagenow said last week at a public forum.

“We're not necessarily drawing lines in the sand,” said Hagenow, the majority whip in the Iowa House, “but we want to be careful.”

“I respect that,” said Sen. Matt McCoy, a Democrat representing Des Moines and West Des Moines, “but that said, we've had an election and that has consequences – the Affordable Care Act is the law and the state has the responsibility to follow that directive.”

The U.S. Supreme Court has given states more flexibility in implementing the Affordable Care Act and Branstad is one of a host of Republican governors asking that their states be allowed to “opt out” of Medicaid expansion.

McCoy said expanding Medicaid is imperative to make sure Iowa’s uninsured residents have access to health care, including mental health care.

Some studies show that Medicaid expansion could be less expensive than continuing coverage for uninsured Iowans under IowaCare, which provides medical coverage for Iowans who don’t qualify for Medicaid.

Read Part 1 of the series: 

Read Part 2 of this series: Legislators Say $20 Million in Mental Health Funding Needed; DHS Says Only $1.5 Million Required