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home : news : news Tuesday, April 15, 2014

1/30/2013 Email this articlePrint this article 
Redesign results in tight mental health budget

By Jeremy Huss
Staff writer

The impact of the legislature's redesign of mental health services in Iowa shows up in a big a way in Clinton County's proposed mental health budget for fiscal year 2014.

The budget includes a $565,999 drop in local property tax collections as a result of the legislature limiting the ability of counties to levy for mental health funding, and it shows multi-million dollar decreases resulting from the state takeover of Medicaid services and the elimination of four state funding mechanisms.

Overall, the budget projects revenue of $4.14 million, less than half of the $8.37 million estimated for fiscal year 2013. Expenses are estimated at $3.73 million, a decrease of $5.72 million from the current year.

Those figures include approximately $1.5 million in mental health dollars designated for case management services. Excluding the case management funding, Clinton County is estimated to receive $2.64 million in revenues for mental health programs from local property taxes, the state payment program and mental health cost recovery.

Clinton County's mental health director Becky Eskildsen said the decreases reflect the loss of state funding for property tax relief, local purchase services, community services and allowable growth.

Those funding mechanisms previously brought in revenue of approximately $3.5 million per year for the mental health department.

Since those funds were eliminated and the state took over the administration of Medicaid services, the county's mental health funding relies solely on local property tax dollars, Eskildsen explained.

"The other reason you're seeing the big decrease is the local property tax reduction," she said.

The legislature's reform bill equalized the rate of mental health property tax levies to $47.28 per person, requiring the county to reduce its levy, which was the equivalent of $58.71 per person, Eskildsen said.

The equalization reduced Clinton County's mental health levy from approximately $1.44 per $1,000 valuation to $1.10 and means the county will collect $2.31 million from the levy, down from $2.88 million in the current year.

As of July 1, 2012, the state took over administration of Medicaid services, which were previously funded by a federal/state/county split under which Clinton County paid about a third of the total cost.

"That's why you're seeing a large decrease this year from last year's budget," Eskildsen said.

The transfer of Medicaid services to state government is responsible for significant decreases in revenue and expenses for fund areas designated for persons with mental illness, chronic mental illness, mental retardation, developmental disabilities and brain injuries.

"A lot of those are just there's no Medicaid dollars anymore. It's just straight, 100-percent county-funded dollars," Eskildsen said.

Eskildsen presented the mental health budget proposal to the Clinton County Board of Supervisors Tuesday, Jan. 22.

No increases are planned to service providers, and the only services to receive 100 percent county funding will be sheltered workshop services, residential care facilities, costs related to a mental health commitment and outpatient mental health services, including prescription medications.

Eskildsen is recommending no waiting listing for services. Individuals will be required to access all Medicaid-funded services before they can access services funded with local tax dollars.

Clinton County has approximately $1.2 million in outstanding state bills, but no funds are assigned in the budget to cover the claims owed to the state on behalf of pervious Medicaid-funded services. Eskildsen said the plan is to slowly pay down the money owed beginning with the oldest claims.

The administration budget for the mental health office is estimated at $238,630, based on a 2 percent salary increase for Eskildsen and negotiated increases for a full-time social worker and full-time administrative assistant. General operating expenses are estimated at $12,740.

Case management budget

Eskildsen also discussed a proposal to transfer targeted case management services from the mental health budget to the general fund; however, the proposal was set aside due to cash flow concerns to cover staff costs.

Case management director Patti Robinson said last year's cost report that determines billing and reimbursement amounts for case management services wasn't approved by state officials until several months after it was submitted.

The county can't establish a billing rate or bill for services until after the cost report is approved, Robinson said, leading to concerns cash flow would be insufficient if it again takes months for the report to be approved.

"It's possible we could go several months without any money coming in," Robinson said.

Robinson is projecting revenues of $1,500,525.20 and expenses of $1,407,391.31 for fiscal year 2014.

The budget for the current year estimates revenues of $1,511,395 and expenses of $1,378,679.

Robinson said expenses have increased because the case management department now is fully staffed after running shorthanded during the first part of FY 2013.

Community assistance programs

The budget for community assistance programs is estimated at $344,114, with $277,727 coming from the general basic fund and $66,387 from the general supplemental fund.

This is an increase/decrease of $34,027 over the current year budget.

The biggest change proposed, according to program director Kim Ralston, is a $26,000 increase in the line item for rental assistance payments, from $44,000 to $70,000.

Ralston said the increase is needed due to a lack of funds at local social agencies for rental assistance for individuals.

The county's emergency food and shelter program has not received any funds since 2011, Ralston stated in a letter to the board of supervisors.

However, Ralston said she received notice after the budget presentation funding was approved for the program, which will give her department another place to refer individuals seeking rental assistance.

The budget includes an increase of $7,647 to salary and longevity line items due to a 40-cent hourly pay raise for two bargaining unit employees and a 2 percent increase for program director Kim Ralston.

The budget for substance abuse treatment is $84,964, an increase of $14,225, due to an increase in the per diem rate for primary treatment, an increase in the number of individuals being transported for substance abuse commitments and an increase in the number of people placed under a substance abuse commitment who need court-appointed legal representation.

The line item for diagnosis and evaluation of substance abuse problems increased slightly due to an $8 per day increase at the Center for Alcohol and Drug Services (CADS).

No changes are proposed for the juvenile court services budget, with total expenses estimated at $218,629.

The cost of the medical examiner budget is estimated at $121,885. County officials have discussed transferring responsibility for the medical examiner budget to the emergency management agency, but a decision will not be made until the emergency management commission sets the agency's budget in February.




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