DES MOINES - DHS Director Charles Krogmeier made an erroneous statement quoted in the Des Moines Register on Friday, August 28. Director Krogmeier was attributed with stating that Iowa is the only state in the country with a mix of county and state control of mental health systems. According to the National Association of County Behavioral Health and Developmental Disabilities Directors, counties administer mental health services in 22 states, representing 70% of the population of the United States.
Several county officials responded to the director's suggestion that it might be time to "get rid of county mental health systems and instead have one statewide system."
Jane Halliburton, Story County Supervisor and past chair of the State's MH/DD Commission, commented, "I think it's time to focus on the people rather than the system. In the adult mental health/developmental disabilities arena in Iowa, we've been on the state versus county merry-go-round for decades. Some progress has been made. When and where we've made progress, it's been when people worked together to increase prevention, provide options and produce better outcomes. There is not an either/or answer."
Angela Connolly, Polk County Supervisor, stated, "Counties are better equipped to handle mental health issues that reflect the nature of the local community. A "one size fits all" statewide mental health system would simply not work and would miserably fail to meet the needs of our most vulnerable citizens."
ISAC Executive Director Bill Peterson said in response to the comment that the county system leads to inconsistencies and wasted energy, "It is ironic that Director Krogmeier chose to criticize county employees for the work they do in this area, in an article lauding the work of overworked state employees. County employees have been making ends meet in the underfunded MH/DD service delivery system for years."
He went on, "The legislature has just convened another work group to make recommendations on improving the state's service delivery system. Counties look forward to seeing a viable proposal from the Department of Human Services to replace the more than $122 million in county property tax funding that would be necessary for there to be a wholly state funded and managed system."
The fact is that counties are facing a major funding crisis regarding county MH/DD services. Counties are mandated to provide certain services to certain groups of persons with disabilities. Unfortunately, as the costs for these services rise, counties cannot generate the funding needed at the local level through property taxes because of the cost-sharing agreement between the state and the counties that was reached in the mid-90's. The state agreed to pick up all of the growth in the system in order to decrease the disability service system's reliance on property taxes.
ISAC has aggressively pursued redesign of the Iowa's adult disabilities service system. This pursuit is an attempt to create a quality system for Iowans with disabilities by enhancing their quality of life and self-sufficiency.
To help facilitate this system redesign, ISAC adopted a proposal ten years ago that included several critical components. The proposal called for standardization of clinical and financial eligibility; a defined set of core community-based services; transition from funding based on the concept of legal settlement to one of residency; Increased utilization of federal funding for disability services; and creation of a funding formula that is directly linked to the individual receiving services.
While minor changes have occurred in the past decade, the Department of Human Services has shown little interest in working with the counties to implement the changes needed.
The Iowa State Association of Counties is a private, nonprofit corporation whose members are county officials from the 99 counties in Iowa. ISAC's mission is to promote effective and responsible county government for the people of Iowa. For further information visit www.iowacounties.org