MHDS Redesign: How Did We Get Here? Where Are We Going?

1. MHDS Redesign: How Did We Get Here? Where Are We Going? Robert Bacon, MA Director, Iowa’s University Center for Excellence on Disabilities, Center for Disabilities and Development Psychiatry Postgraduate Conference & Meeting of the Iowa Psychiatric Society October 11, 2013

2. Mental Health and Disability Services (MHDS) Redesign • A time of unprecedented change • Challenges can be opportunities • Together we can

3. Improving the Quality of Life of Iowans with Intellectual Disabilities:Three Things You Can Do • Follow redesign planning and contribute your expertise to implementation. • Advocate for sufficient funding for Iowa’s MHDS system to comply with Olmstead. • Help build the capacity of the new regions to assist individuals with co-occurring disabilities.

4. So How Did We Get Here? • Iowa’s MHDS system was at the breaking point three years ago • Service system inequity—the services an individual received depended too much on where he or she lived • Disproportionate reliance on county property taxes for MHDS service funding—including for the state match required to drawn down federal Medicaid funding • Long term underfunding of the system by the state coupled with a state-imposed dollar cap on county funding at 1996 levels • Over-reliance on high cost institutional services in violation of the 1999 Olmstead Supreme Court decision • Whatever challenges redesign now presents, something had to done

5. Legislative Action • SF 525 (signed July 26, 2011) http://www.dhs.state.ia.us/docs/MHSummarySF525Workgroups.pdf • SF 2315 (signed May 25, 2012) http://www.dhs.state.ia.us/docs/MHDSRedesignLegislationOverviewJuly242012_080312.pdf • 2013 session: SF 452, SF 446, HF 198 http://www.infonetiowa.org/news/newsletters/may-news-issue-8/ • http://www.infonetiowa.org/news/newsletters/july-news-2013/

6. Implementation Progress To Date • The state assumed responsibility for the entire match for Medicaid as of 7/1/12. • The regions have formed ahead of the 12/31/13 deadline: http://www.dhs.state.ia.us/uploads/Map-of-Approved-MHDS-Regions.pdf • “Core services” have been defined in administrative rules (but not “Core Plus”). • Administrative rules have been drafted for regional operations. • Some regions have begun developing their initial Regional Plan due to DHS by 4/1/14. • Full implementation to begin 7/1/14 (but some regions will probably begin early).

7. Follow the Money • The state taking over match for Medicaid-funded MHDS services is huge. • However, counties/regions are still responsible for non-Medicaid eligible individuals. • The new $47.28 per capita levy rate—is it enough? • How will the Iowa Health and Wellness Plan contribute—or will it? • When will there be enough money to require the regions to offer “Core Plus” services like robust crisis prevention and response services? • The reduction in the federal share of Iowa’s Medicaid program is very problematic (i.e. 2% reduction in FMAP in FY 13 cost Iowa $80 million).

8. So Where Are We Heading? • The new regional system has promise if it is funded adequately. • But until then, only Iowans with mental illness and/or intellectual disabilities will be eligible for services. • Iowans with developmental disabilities or brain injury currently receiving services are grandfathered into the system, but others must wait until resources are available. • The Legislature’s Mental Health and Disability Services Redesign Fiscal Viability Study Committee meets October 22.

9. Improving the Quality of Life of Iowans with Intellectual Disabilities:Three Things You Can Do • Follow redesign planning and contribute your expertise to implementation. • Advocate for sufficient funding for Iowa’s MHDS system to comply with Olmstead. • Help build the capacity of the new regions to assist individuals with co-occurring disabilities.

10. Thank you for all you do—and will do! robert-bacon@uiowa.edu