The Eastern Iowa Mental Health Board approved over $1 million in budget cuts for fiscal year 2020 as a result of funding problems that officials blame on initial guidelines that accompanied the legislation.
The board approved a $1.2 million cut in services for fiscal year 2020 so the region would end the year with enough funds to get through the first three months of fiscal year 2021, Region CEO Lori Elam told Clinton County Supervisors Monday.
The Mental Health Region board approved cuts from the Robert Young Contract and eliminated the bridge appointments, a tele-health program.
“We felt that there are other ways we can make sure folks get medications,” Elam said. “The bridge appointment service was all done telehealth, and it was an expensive service.
“And we determined after about six months that the show rate, or the usage rate, was only about 66 percent,” Elam said.
The Mental Health board put a number of training sessions for providers in the region on hold, Elam said, and two agencies returned grant funds. The Department of Corrections didn’t spend all of its money for “mental health court” and returned $50,000 to the region, and Crossroads in Muscatine returned $161,000.
They did not move as fast as the region hoped with supported employment, Elam said, and the funds will be returned to the region’s fund balance.
The budget cut that caused the most angst with board members was a decrease of $250,000 for sheltered workshop services, Elam said. The Region budgeted $1.1 million for all five of its vocational providers. Sheltered workshops offer a supervised workplace for adults who have a physical or mental disability.
“We had had good interaction and feedback from all of the providers who attended our emergency board meeting last Monday,” Elam said. “And they are well aware that the federal government is changing (its) thoughts with sheltered workshop and not having that segregated employment. They feel people need to be in the community, supported community employment.
“The state of Iowa is moving in that direction as well,” Elam continued. “We were the only region who had been paying for sheltered workshop out of the entire state. We were kind of the last holdout for that.”
Elam said the region needs to dedicate funds that were going towards sheltered workshop services for supported employment.
Clinton County Auditor Eric Van Lancker said he knows there are people who take advantage of the sheltered employment, and asked if there are enough jobs and enough employers willing to participate with the supportive employment.
“That did come up at our meeting as a discussion,” Elam said. “And sometimes it’s a matter of just having to keep going out there and knocking on the doors and talking to the employers and getting them convinced to take a chance on our individuals.
“Statistics show the individual who has a disability, their attendance is much higher,” Elam said. “Their enthusiasm, their loyalty to a company is much higher than a given employee who may have been there 10 years.
“It’s just a matter of going and continually talking and knocking on their doors. Building that relationship. Making connections,” Elam said. “All five counties will be doing that. They’re all going to be facing very similar challenges.”
Elam said the region currently operates on the $30.78 cap, which is based on expenditures in fiscal year 2015. The per-capita rates need to be looked at, she said.
Elam asked CEOs of the mental health regions for expenditures for fiscal year 2018 and 2019 — when crisis services were developed across the state — and the population of the regions, she said.
Senate File 504 enacted in 2017 requires the state’s mental health regions reduce their fund balances to 20 percent. “Our region has done a very good job of that,” Elam said. “Fantastic. We’ve met our goal.
“But now we don’t have funding stability, and we can’t sustain some of our services,” Elam said. “Hence, that’s why we had to cut some. It had a double-edged sword, and we still need a fix.”
Iowa legislators approved House File 691 earlier this year, modifying provisions relating to the use of specified excess cash flow funds. The legislation mandates that, after July 1, 2023, a region’s cash flow amount, either reserved in the region’s combined account or among all separate county accounts, may not exceed 40 percent of the gross expenditures.
“We spent down to 20 percent as required by the law at the time,” Srp said. We’re still feeling the impact of a lower fund balance which disadvantages our ability to weather these storms.”
In fiscal year 2017, the region was spending $28.22 per capita, Elam said. In fiscal year 2018, it added crisis services and had expenditures of $32.23 per capita, and in fiscal year 2019, the region was at $42.83 per capita.
Supervisor Jim Irwin Jr. said the region spent $12.3 million last year, with about $1.3 million in one-time funding. Services cost the region $11 million, he said, with the tax levy cap only generating $9.3 million for the region.
“It’s simple math, honestly, that I think ... even our legislators can get at this point,” Van Lancker said. “We spent $12 million on doing what we’re supposed to do mandated, but we’re only bringing in nine. So, it’s got to be addressed.”
If funding does not change, the region will be looking at a budget of a little over $7 million, Elam said. The region can generate $9.2 million. The region could not have a budget higher than that because it would not have the fund balance to cover it. The region would lose services that it has built up over the last 2.5 to 3 years, Elam said.
“I’d hate to lose our community mental health centers and our other partners, because they’re depending on at least a portion of these resources,” Srp said.