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Linn, Johnson counties ask regional board to fully fund mental health access centers

Gazette - 2/24/2023

Feb. 24—HIAWATHA — The mental health access centers in Linn and Johnson counties would again be funded below their requests under a proposed budget for fiscal 2024, which county officials and providers warn will result in reduced services — if not closure of the facilities that help meet critical mental health needs.

Several county supervisors said they would not support a budget that underfunds the access centers while the nine-county district that manages locally provided mental health services sits on a roughly $5.83 million surplus — at least the second year in a row it has sat above $5 million.

Linn County requested $1.875 million and Johnson County asked for $1.4 million, but both currently would receive only $1.25 million each, according to the budget reviewed Thursday at the regional board's meeting at the Kirkwood Regional Center.

Linn County Supervisor Ben Rogers and Johnson County Supervisor Rod Sullivan, who represent their respective counties on the regional governance board, said they want the facilities to run on the "firehouse model," where they have the same level of staffing and services whether they're used by one or 20 people at a time.

"That's the whole point of access centers is the access," Rogers said.

Since the two centers receive funding from the East Central Mental Health Region, they are open to individuals from nine counties: Benton, Bremer, Buchanan, Delaware, Dubuque, Iowa, Johnson, Jones and Linn.

The Linn and Johnson facilities, which both opened in 2021, are the only two state-designated access centers in the region.

The Linn County Mental Health Access Center is located at 501 13th St. NW in Cedar Rapids. Johnson County's GuideLink Center, managed by Abbe Mental Health Center, is located at 300 Southgate Ave. in Iowa City. The facilities offer crisis triage, crisis stabilization and sobering services, among others. They take walk-ins, but also get referrals from law enforcement — providing a place other than jail or a hospital emergency room to take people who are experiencing a crisis.

Iowa lawmakers in 2021 passed a bill to fully shift mental health funding from local property taxes to the state by fiscal 2023, so counties no longer get to raise the tax levy rate to meet mental health needs.

The region's Finance Coordinator Deborah Seymour-Guard said funding allocations reflect what's been billed, though providers and county officials pushed back and said that's not enough to keep the centers in operation.

County officials who spoke at the meeting were united in arguing that access centers have not been funded at levels that align with true costs despite growing needs. They said regional funding and low Medicaid reimbursement rates don't cover the cost of services, and in Linn County's case are a barrier to the center expanding to 24/7 hours.

For instance, Diane Brecht, the adult provider representative, said board members were seeking a mechanism to fund empty beds, as there's the cost of staffing and operations even while services are not being provided.

Regional Chief Executive Officer Mae Hingtgen said the state Health and Human Services Department wants consistency across Iowa's access centers, but there's a regional committee working on developing a formula to manage such funding.

Sullivan said counties have invested a lot into these centers, and if directors and providers are saying they need more funding to make it work without reducing services, they should be funded at their full request.

He said Johnson County shouldn't have had to use its share of federal American Rescue Plan Act dollars to support a center that people from around the region use.

"You've got the systems and providers that we spent years building up, and now we finally in the last couple of years are providing service. People seem really happy with the service and it seems to be cutting-edge service," Sullivan said, noting a visit to the center from Gov. Kim Reynolds and Human Services Director Kelly Garcia in 2021.

"It just doesn't make basic sense that if we've got providers — we're asking them to provide a service — and they're saying, 'If we don't get more money, we may have to make choices like reducing hours,' or something like that. The exact opposite of what we want, and we have extra money. Why would we not spend the extra money to do that?" he asked.

Several, including Rogers, opposed building out new systems while existing ones like the centers are underfunded. The region currently is allowed to keep a 20 percent fund balance, but as of next year that balance is set to decrease to 5 or possibly 10 percent — meaning the district won't be able to keep as much money in reserves.

Unspent surplus dollars are given back to the state, so the region typically ends up making decisions late in the budget year on how to spend these dollars. Sullivan said that's all the more reason to sufficiently fund the centers upfront.

Some were skeptical of possibilities Hingtgen proposed, such as a new residential treatment facility where people could seek treatment for both substance use disorders and mental health issues, as access centers provide similar services and already are struggling to achieve financial sustainability. Another idea was purchasing computer tablets to give to people experiencing a mental health crisis to provide mobile service access or appointment reminders.

Dubuque County Supervisor Ann McDonough said the board should study why the access centers are having barriers to financial sustainability. McDonough suggested the region form a budget committee with Rogers and others — or hire an impartial consultant — to "have greater transparency inside building the budget."

"These are likely the best interventions, the best treatment that we can think of, and if they were properly funded, they probably would work for all of our citizens — all of us regionwide," McDonough said.

Hingtgen will return to the group in March with a modified proposal.

Comments: (319) 398-8494; marissa.payne@thegazette.com

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