Iowa officials preview plan to overhaul behavioral health care

DES MOINES — Iowa health officials called Tuesday for an overhaul of the state’s mental health and substance use treatment systems, presenting lawmakers with a plan to merge several programs into a unified behavioral health system.

Marissa Eyanson, director of behavioral health at the Iowa Department of Health and Human Services, previewed the plan for lawmakers, saying it would help streamline services offered to Iowans, align the goals of existing systems and eliminate redundancies in mental health and addiction treatment programs.

“We have to reduce system redundancies,” Eyanson said during an Iowa House Health and Human Services Committee meeting. “We’re wasting money when we have a better system, and we’re making it more confusing for people to access what they need.”

Gov. Kim Reynolds last week called for the merging of Iowa’s disparate behavioral health networks in her Condition of the State address. Health and Human Services officials said her proposed bill would be made public soon.

According to the preview, the proposal would dissolve Iowa’s 13 Mental Health and Disability Service areas and 19 Integrated Provider Network areas, replacing them with seven behavioral health regions. Those regions would provide services and care for Iowans with mental health needs and substance use disorders.

Some disability services provided by the state’s Mental Health and Disability Service network would be shifted to the state’s Aging and Disability Services.

“Our state is filled with capable professionals who care about getting Iowans the support they need,” Reynolds said last week. “But their talent and dedication are short changed by a fractured system that makes coordination almost impossible.”

The recommendations for the overhaul came in a report by Health Management Associates, which the state hired to review the merger of the Iowa Department of Public Health and the Department of Human Services.

The restructure would not lead to hiring any new state employees, officials said.

New system would transform funding

Iowa Health and Human Services Director Kelly Garcia, who called the realignment a “once-in-a-generation opportunity,” said the proposal would strike sections of state law dealing with addiction and mental health services and replace them with a comprehensive behavioral health system.

“It will lay out the functions that are the state functions in that system, and then lay out the functions that ultimately are charged to local administrations at a district level,” Garcia said.

The state would contract with local administrative service organizations, Garcia said, to carry out their services in each of the seven behavioral health districts.

Funding for the administrators would be similar to a “block grant,” Eyanson said. The goal of the new system would be to target funding to measurable outcomes rather than services, she said.

“We tend to fund a lot of things, we don’t tend to fund a lot of functions,” she said. “So what we want to do is move into a future state that says we’re going to tie our funding to measurable outcomes.”

Lawmakers react

Republican Rep. Ann Meyer of Fort Dodge, the chair of the House Health and Human Services Committee, said the disparate health systems add difficulty.

“It is a huge issue for every one of our districts, and we’ve been hearing about it from all of us for so long,” she told the state officials. “So thank you for the hard work addressing it.”

Rep. Beth Wessel Kroeschell, a Democrat from Ames, said she recognizes there are problems that need to be addressed when it comes to accessing behavioral health services in Iowa. She said she would be disappointed, though, if the proposed bill does not include any extra money going toward the state’s system to address the gaps in services.

“We need to be serious about this, and you can’t just shuffle the deck and expect new results if you don’t fund it,” she said.