Funding for Iowa MHDS Regions This Photo by Unknlicensed under CC BYown Author Funding for Iowa MHDS Regions
Regional Services Treatment Services Community Support Services Vocational Support Services Community Education Coordination Services Mandated Services Justice Involved Services Crisis Services The list of services we can provide is lengthy. For example there are 95 different line items in our budgets 35 core services, 4 mandated, 8 additional core and over 40 items listed as other services. Funding for these services is dependent on the levy ability of the counties within each region and also dependent on Medicaid and the MCOs meeting their obligations as well. A recent misconception is the majority of the cost of the new services will be covered through Medicaid funding. DHS recently gathered numbers from the Residential Crisis Stabilization Centers which showed around 43% of those served were Medicaid eligible. The balance would be regional funding. Regions fund those not eligible for Medicaid in addition to the services that are not Medicaid funding. That partnership is important but the lines of responsibility are sometimes blurred.
Medicaid is the largest source of funding for long term supports and services, including nursing care center and personal care services. The majority of Medicaid dollars is spent on services for the elderly and persons with disabilities The Medicaid program is jointly funded by the federal government and states. The federal government pays states for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP) . States must ensure they can fund their share of Medicaid expenditures for the care. The current FMAP is around 60%. Example: If Medicaid pays a providers $100 for a service -- $60 of that paid by the federal government. Regional funding for the same services would all come from property tax dollars. Regions cannot access the Federal Funds. These are the same local property taxes that are supposed to be earmarked for people without insurance. The notion that Regions can subsidizing Medicaid rates is fiscally irresponsible. Mental Health Funding Counties can not afford to subsidize Medicaid and meet the mandates set in legislation for complex crisis services. Iowa pays for mental health services for people with Medicaid through managed care companies. Currently, if Medicaid or managed care companies do not pay for a service on the list, then county property taxes are expected to pay for that service. We believe that the Medicaid program with federal requirements and federal funds should be utilized first, because there is no predetermined limit on these funds. Since the federal government also pays part of Iowa’s Medicaid costs by guaranteeing matching funds to states for qualifying Medicaid expenditures; states are guaranteed at least $1 in federal funds for every $1 in state spending on the program. This open-ended financing structure allows federal funds to flow to states based on actual costs and needs as economic circumstances change. In Iowa, the federal government actually pays almost $60 out of every $100 spent for Medicaid services. As I mentioned earlier for people and services not covered by Medicaid, the State legislature outlines the core services that regions must pay for out of property taxes. Property taxes pay all of the costs for the people without insurance with no help from the federal government. Iowa needs to ensure that property taxes and local funding are utilized last and only when people have no other resources. However the state Medicaid agency sometimes sets the Medicaid behavioral health rates lower than the providers’ costs. They have suggested that providers seek a subsidy from the local governments property taxes. Now understand that the subsidy isn’t matched by the federal government. That would mean that Iowa would replace federal funds for approved Medicaid services with property tax funding. For example (Slide example) This fiscal practice doesn’t make sense. Counties can not afford to subsidize Medicaid and meet the mandates set in legislation for complex crisis services.
Funding for Regional Services 2017 legislation altered the funding rules Regional totals remained the same (FY 16 cap) Redistributed the county levy authority maximum to move to a regional per capita All counties within a region have the same per capita levy cap Each Region has a different per capita levy cap Funding for Regional Services This Photo by Unknown Author is licensed under CC BY-NC-ND
Maximum Regional per capita
2017 Legislation also required Regions to deplete fund balances Carryover exceeding 20% or 25% would offset future years tax revenue Funding concerns Rapid property tax swings Fund Balance This Photo by Unknown Author is licensed under CC BY-ND
Eliminate Remove Eliminate MH/DS Levy Caps This Photo by Unknown Author is licensed under CC BY-SA Remove Remove Carry Forward Balance Restrictions Remove the carry forward balance restrictions of 20% or 25% to provide counties/regions resources for new and existing programs without dramatic changes in property taxes. Addressed in HF548 (later amended) Eliminate Eliminate MH/DS Levy Caps Eliminate the regional mental health levy caps that were established in SF 504 and allow for counties to levy what is necessary to meet their regional budgetary needs.
Questions This Photo by Unknown Author is licensed under CC BA