Perspectives in Policy - Mental Health & Disability Services Redesign

Issue 4, 12/27/2012

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Mental Health & Disability Services Redesign

Earlier this year, the Iowa Legislature passed a bill that made big changes in the state’s adult mental health and disability services system. The legislation (Senate File 2315) changed the way the system is funded and managed, shifting greater responsibility to the state and away from the 99-county system.
In addition, this redesign required counties to work together as regions to deliver non-Medicaid services and set a new menu of “core services” that must be available to Iowans with disabilities no matter where they live.
However, there were also a number of issues that were not addressed in this redesign, leaving those decisions to the 2013 Legislature. Nine work groups have been meeting for the last seven months to address these remaining issues, the biggest of which are funding and eligibility limits that are intended to control costs. 
Funding is the biggest unknown in this new system, and the most important factor in the success of this redesign. Funding will determine who gets services, and the types of services available.
The redesign has created a lot of uncertainty and anxiety among counties, providers, families and those receiving (or waiting for) services. With the passage of the Mental Health and Disability Services Redesign of 2012, Iowans with disabilities are left with more questions than answers.
That is why we are focusing this issue of Perspectives in Policy on the redesign. We asked stakeholders what they think about the changes made to the system, the challenges and opportunities that lie ahead, and the priorities that should be addressed when the 2013 Legislature reconvenes on January 14.

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Ben's Perspective

Ben Taber is a young Polk County resident who is living and working with Asperger Syndrome. In a recent meeting about the Mental Health and Disability Redesign legislation passed last year, Ben spoke out about his thoughts on the redesigned system and the supports that he needs to continue working and living independently.

“I am learning that to do a good job in the workplace, I need to do things that allow me to feel better when off the job. Supported Community Living Services will teach me critical living skills.

I live in my own condo and take pride in hard work well done. Born with a highly functioning form of autism, I am fortunate to have a unique set of skills that are rewarded with a paycheck in the adult work world. I pay taxes on these wages – state, county, city, schools, and public hospital. I want to become an independent, fully contributing member of our society.

But the fact is that I need some help to retain my job. Please help me and others with even greater challenges to learn to deal with and overcome obstacles that are facing us. Keep the Developmental Disabilities funding intact- and we will all reap the rewards. “

You can read Ben’s statement in its entirety HERE.

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Dennis & Tina's Perspective

Tina Terrell and Dennis Bahr are nervous about their futures. They are experienced, capable and valued members of the workforce at Cherokee Work Services and in the community of Cherokee, Iowa. The passage, last year, of SF 2315 has left a lot of uncertainty for them with many questions about the funding of Iowa’s redesigned mental health and disability services left unanswered. As a result, Tina and Dennis worry that they may lose access to the services, including work services that they need to live independent and productive lives. In the current system, funding has been available to places like Cherokee Work Services to allow persons with disabilities to work. The experience gained there also helps many of those employed to develop the skills they need to work in the community.

That’s exactly what Dennis Bahr did. Dennis began working at Cherokee Work Services and then transitioned to work on the assembly line of a local business. During that time, Dennis was able to buy his own home and become an active, taxpaying member of the Cherokee community. Eventually, the company where Dennis worked closed their doors, forcing Dennis back to Cherokee Work Services where he currently works now. Without programs like Cherokee Work Services, Dennis worries about the availability of work for people with disabilities. “I like to come to work; I think of the people I work with as family,” Dennis said. “If the work program is cut, what do we have to look forward to? Ending up in a nursing home? A nursing home will be less cost effective.” Dennis has a developmental disability but sees himself as far from disabled. He rode 40 miles on RAGBRAI this past year and is a well known and respected member of the Cherokee community.

His friend, Tina, who has a brain injury, is concerned because SF 2315 did not fully include people with brain injuries or developmental disabilities in the redesign legislation. This is a key policy piece that concerns not only Tina, but the staff who work with Tina and Dennis. Calvin Carver, Director of Cherokee Work Services notes that in the redesigned system, “Funding will depend on where you live and what kind of disability a person has. In the end, funding for programs like these are essential to keep the doors open and it’s important those doors stay open for people with all kinds of disability.”

Tina is a passionate advocate for people with all types of disabilities and strongly believes the exclusion of funding for people with brain injuries and developmental disabilities demonstrates a lack of understanding about the potential those individuals bring to the table. “I had a head injury because I was in an accident but that does not mean I’m not capable of having a job.” Moreover, Tina talks passionately about her desire to live independently and the importance of work to her independence. One priority Tina has for Iowa legislators is to ensure that Iowans with brain injuries and developmental disabilities are treated equally and have the same access to the services they need. She calls on lawmakers to revisit the “target populations” they established in SF 2315 and address the need to fund services for those left out of last year’s effort.

Tina and Dennis have taken notice of the issues that put them at risk and now they are taking action. They are working at an individual level to contact their legislators and local elected officials and Tina is leading an effort to organize others served by Cherokee Community Services to raise a collective voice of the group’s concerns. They hope that by organizing, they will have a more powerful voice; one that that will put a face to the critical decisions that will be made to move the redesign of the disability services system forward.

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A Provider's Perspective - Marilyn Althoff, Hills & Dales Executive Director, Dubuque, Iowa

As we are all preparing to celebrate the new year, we must also be planning for the next important political process to begin. The 85th General Assembly of the Iowa legislature is set to convene on January 14, 2013 with many new faces attempting to navigate this new process and system in representing their constituents. One critical job of this legislature is the implementation of the Mental Health Disability System Redesign. An equally important priority for this legislative agenda is a fully funded MHDS services system, and anything less would be detrimental to the well-being of vulnerable Iowans who depend on the services they are receiving. The prior legislative actions did not include all of the funding necessary to transition. Thus, we must remind them of this shortfall. Individuals, families, advocates and providers, collectively supporting funding as a priority will set the direction for the success of this monumental redesign.

Contact your representatives and stay in contact regularly. One email may make a difference, however in Des Moines “the squeaky wheel” does get attention! A continuous loop of contacts assures that the redesign does “No Harm”, which could occur if funding does not follow the new system.

Speak with your legislators at their local town hall meetings, or even make a visit to the capitol. It is an enlightening and wonderful experience to see your government in action! Stay informed, action and outcomes can occur quickly so keep up-to-date with the process. DHS and the General Assembly web pages are all great resources to use. Use the “Keep it Simple” principle in your conversations. In my experience Legislators want to know how their actions in legislation will affect the individuals who need the service.

I am certain an unfunded or underfunded service system was not a desirable redesign plan outcome for any of the House or Senate representatives. Budget appropriation issues are an ongoing challenge, however through educating and informing legislators we will be supporting them as they perform their duties this session.

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A County Perspective - Sarah Kaufman, Henry County CPC & IA Community Services Association President

When the 2013 legislative session begins there is a need to continue to make mental health and disability service financing a priority. Counties contribute to the MH/DS system through a property tax levy established in 1996. This levy has never been adjusted upward to meet the changes in county demographics and service needs that have occurred over the last 17 years. Beginning in July 2013 the levy structure will be modified to capture property taxes on a $47.28 per capita basis. This still leaves a property tax inequity among counties and removes ten million dollars from revenues needed to fund non-Medicaid core services.

Budgeting for outcomes addresses limited finances, conscientious use of revenues and funding in an approach that strategic goals are attained. An adequate resource pool, regardless of the rural or urban issue, is a must for a regional structure to budget for outcomes and better succeed at implementing service delivery envisioned by redesign.

The message from all stakeholders should be to insist the legislature develop a financing structure that provides adequate resources to maintain current services and to recognize the new core and expanded core services will require more resources than are currently available. There are 32 counties in financial difficulty. It will be vital that transition funds be awarded in January and in a manner that augments the perplexing funding decisions these counties must make.

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