County MHDD Funding

1. County MHDD Funding What is happening with the funding of Mental Health and Developmental Disabilities Services in Iowa and Fayette County. Julie Jetter, DHS, Community System Consultant July 2, 2008

2. Historical Review • Process started with HF2430 in 1994 and has continued to evolve through today • 1995 legislative session created SF69 and counties had to choose a base year for their MHDD expenditures (actual 1994 or projected 1996) • The State of Iowa provided Property Tax Relief to counties based on a formula created using expenditures, valuation and population numbers. • The State agreed to provide for growth in the system using a Growth Allocation Formula

3. Historical Review (cont.) • In FY97 counties created a new fund from which service funding shall be expended (based on the ‘base year’ they chose). • Counties could not (and still cannot) levy above the dollar amount limit for the new services fund (MHDD or Fund 10). • All service funding for persons with disabilities shall be made from the MHDD fund. • Counties had to employ an individual to oversee the funding of services. (The Central Point of Coordination Administer: CPC)

4. Historical Review (cont.) • Counties had to develop management plans with input from their constituents. Which included: • Eligibility criteria (diagnostic and financial) • Services to be provided • Service Providers • Waiting list criteria • Etc., etc., etc.,

5. Historical Review (cont.) • Subsequent legislation has done little to ‘change’ the original intent of HF2430 and SF69. • Some services have been added to the Home and Community Based Waivers and to the State Medical Assistance plan to relieve some of the pressure on the MHDD fund. • By adding these services to the above systems, the federal government pays 62% of the cost.

6. What is different about the MHDD fund? • Most funds are capped by a levy rate. • General Basic Levy Rate cannot be any higher than $3.50/$1000 valuation • Rural Basic Levy Rate cannot be any higher than $3.95/$1000 valuation. • Fayette County MHDD fund is capped by a dollar amount and cannot raise anymore than $773,024.

7. MHDD FUND • Valuation x levy/1000 = dollar cap limit • $200,000,000 x X/1000 = $700,000 X = $3.50 = levy • $250,000,000 x X/1000 = $700,000 X = $2.40 = levy • $150,000,000 x X/1000 = $700,000 X = $4.66….= levy The levy changes to the level needed to raise the dollars. Increases or decreases in valuation only serve to raise or lower the levy, it does not change the amount of revenues raised.

8. Code Sections and Administrative Rules County Management Plan Information may be found in Iowa Code: • 331.338, 331.339, 331.440 • 426B And in Iowa Administrative Code: • Chapter 25 (Specifically Division II)

9. What does that mean for Fayette County? • Counties have been restricted by the amount of money they may raise to pay for MHDD services. • Counties are not allowed to overspend from their MHDD fund (cash basis). • When a county’s MHDD fund becomes fully encumbered, the county must start a process of waiting lists and/or service cuts.

10. What else does Fayette County have to think about? • The MHDD fund is the only place where the county may pay for services for individuals with Mental Illness, Chronic Mental Illness, Mental Retardation and Developmental Disabilities. • CPC administrative costs may be included here.

11. What services can not be controlled by the county? The services that are funded in part by the federal government cannot be cut, nor can people be placed on a waiting list for these services (other than Home and Community Based Waiver) • We call these “Mandated” Services

12. Mandated Services… • Home and Community Based Waiver Services, including (not an exclusive list): • Supported Community Living • Prevocational Work Services • Supported Employment • Day Care Services • Day Habilitation Services

13. Other Mandated Services: • Intermediate Care Facility for the Mentally Retarded • Habilitation Services for the Chronically Mentally Ill • Targeted Case Management Services • Involuntary Mental Commitments to the Mental Health Institutes and private hospitals, including transportation, legal costs, advocate costs and diagnoses and evaluation costs.

14. What is happening statewide? • There are many counties within the state that are experiencing budget issues. • Linn County • Polk County • Scott County • Johnson County • Black Hawk County

15. Adair Audubon Benton Boone Buchanan Butler Calhoun Clarke Clayton Fayette Guthrie Harrison Jackson Lee Madison Polk Sac Tama Taylor Union There are numerous counties that have a negative fund balance (as of June 30, 2007):

16. What can a county do to prevent or remedy negative fund balances? • A county can reduce the amount of services being provided to individuals with disabilities. • ONLY the NON-MANDATED (100% county funded) services can be reduced or ‘wait listed’: • Mental Health Services • Work Services • Community Support Services • Transportation • Residential Services

17. What can a county do to prevent or remedy negative fund balances? (cont.) • Institute a waiting list for new individuals with disabilities or for individuals currently in the system requesting more services. • A county may only put people on a waiting list if the services they are requesting are 100% county funded. • Home and Community Based Waiver services may have a waiting list based on availability of slots.

18. What can a county do to prevent or remedy negative fund balances? (cont.) • Reduce the services the county will fund (either overall or by diagnostic group). • The county can remove any non-mandated service from their service list. • Individuals who are developmentally disabled but NOT mentally retarded have very few mandated services. • Individuals who are mentally ill or chronically mentally ill have very few mandated services.

19. What has the state done to help? • Growth Allocations: • FY2008=$71,281,437 (added an extra $12 million) • FY2007=$36,461,148 (added an extra $3.1 million) • FY2006=$26,507,362 • FY2005=$21,642,972 • FY2004=$17,073,638 • FY2003=$13,681,000 • FY2002=$8,554,056 (removed $16 million) • FY2001=$19,773,470 • FY2000=$16,097,060

20. What has the state done to help? (cont.) • Changed the Growth Allocation formulas in 2002 to ensure that maximum funding went to counties that needed it the most. • Allowed more services to be covered by Medicaid dollars • ARO Services – Now replaced with Habilitative Services • HCBS/SCL services in Residential Care Facilities • Day Habilitation Services • Day Care Services • Pre-Vocational Services

21. Fayette County Levies, Expenditures and Fund Balances Year Levy Expenditures Fund Balance FY01 $608,234 $1,604,755 $874,707 FY02 $392,018 $1,719,744 $232,852 FY03 $773,024 $1,736,304 $107,905 FY04 $773.024 $2,003,318 $252,826 FY05 $773,024 $2,078,875 $383,844 FY06 $773,024 $2,052,923 $431,003 FY07 $773,024 $2,672,999 $(25,440) FY08 $773,024 (Levy FY09 773,024) **Max levy amount is $ 773,024

22. Fayette County Ending Fund Balances

23. Fayette Gross Expenditures

24. Fund Balance Percentage (as a percentage of Gross Expenditures:

25. Levy Amounts (Max Levy=$773,024)

26. Levy Percentages

27. Growth, Targeted Growth & Leadership allocation • All three of these allocations are based on a county’s population as a percentage of all the eligible counties populations. • Growth: All counties are eligible if they submitted all their reports by December 1. • Targeted growth is shared by those counties that have a fund balance of less than 25% (last year) and a levy of 100% (current year). • Leadership is shared by those counties that had a fund balance of less than 15% (last year) and a levy of 100% (current year) plus Wapello and Carroll counties. • These three allocations, end up being one by the end of the calculations!

28. Growth Allocation

29. Community Services Allocation • This ‘pot of money’ is divided into two portions. • ½ of the money is allocated based on the percentage of the total population. • ½ is based on the percentage of the total poverty population. • If a county does not get all of it’s reports into the state by December 1 of each year, the amount they would have been eligible for is shared by the eligible counties. • This is the ‘other’ allocation sent to counties.

30. Community Services Dollars

31. Local Purchase Allocation • These are federal pass through dollars allocated to the county. Each county receives this allocation each year. • The ‘pot’ is divided into two equal portions. A county gets ½ of it’s portion based on what it received last year. The other ½ is allocated based on the number of people living in the county who are below the poverty level.

32. Local Purchase Dollars (Federal Pass Through Money)

33. Where the revenues come from:

34. Other revenues: A county may have other revenues that may include: • Client Co-payments, reimbursements, repayments, etc. • Medicaid Revenue for Case Management • State Payment Program Revenue

35. County, State & Federal Revenue by Fiscal Year:

36. Fayette Expenditures vs. Revenues

37. Population Changes 2000-2007

38. What does the future hold? • What types of services will be available? • Who will be eligible to receive those services? • What other funding sources are available? • ??????????????