CEDAR RAPIDS — Surrounded by health advocates, Gov. Kim Reynolds signed into law Wednesday her plan to restructure behavioral health care and disability services in Iowa.
On Wednesday, Iowa's Republican governor visited Foundation 2, a crisis mental health provider that opened its new headquarters in downtown Cedar Rapids last month, to sign House File 2673 into law.
The bill, one of Reynolds' top legislative priorities this year, aims to improve access to services for Iowans by breaking down administrative boundaries between mental health and substance use treatment in the state.
The new law also addresses disability services in Iowa, which is overseen by the local mental health regions and lacks "clear access points for Iowans with disabilities," Reynolds said. Instead, management of disability services will be shifted to the Iowa Department of Health and Human Services.
"By bringing services together in this way we will enable better coordination of care supporting the best possible outcomes for each individual," Reynolds said. "It's what every Iowan deserves, and that's what we intend to deliver."
Several behavioral health advocates and providers used the term "cautious optimism" to describe their outlook as the consolidation of mental health and substance use services begins, a step they believed was long overdue. Still, they worry about patients' wellbeing during the transition.
"Iowa Behavioral Health Association remains cautiously optimistic as anytime a system undergoes a massive overhaul of changes, we worry most about the people we are serving, our employees and the overall need to maintain the continuity of care to our clients," Executive Director Flora Schmidt said in a statement.
New law consolidates mental health, substance use disorder services.
Now that the bill has been signed into law, the clock is ticking for top officials at Iowa's human services agency to build up a new behavioral health system that's set to go online on July 1, 2025.
"For the first time, we will have an intentionally planned system that includes in statute, prevention, treatment and recovery. It's phenomenal," Iowa HHS Director Kelly Garcia said during Wednesday's press conference.
The law eliminates the state's 13 Mental Health and Disability Service regions and 19 Integrated Provider Networks that manage substance use disorder and problem gambling services.
Reynolds described the state's current system as "disconnected," even though more than one in four adult Iowans with serious mental health challenges also struggle with substance use.
In its place, the law establishes a new new Behavioral Health Service System comprised of seven districts to manage services for those with mental health conditions and substance use disorders. These districts would be charged with coordinating an array of services, including prevention services, early intervention and treatment, support services designed to avoid the need for acute care or law enforcement, and crisis services focused on de-escalation.
Funding for those services would also be merged into one behavioral health fund overseen by Iowa HHS.
Iowa HHS would also oversee the effort to hire an "administrative services organization," which can be a public entity or private nonprofit group, to manage each of the seven districts and its service array. That organization would be advised by a 10-person council of elected officials, local constituents, health professionals and law enforcement.
Iowa HHS Behavioral Health and Disability Services Director Marissa Eyanson told a state board Tuesday that an initial transition plan for the new system will be published on the agency's website by July 1.
The state will also finalize the map for the seven behavioral health districts by Aug. 1, and will select the entities to serve as administrative services organizations for each of the seven districts by Dec. 31, Eyanson told members of the Children's Behavioral Health System State Board.
Law shifts management of disability services to state agency
Disability services, which are folded into the state's 13 mental health regions, will be instead shifted into the state’s Aging and Disability Services division under Iowa HHS.
The agency plans to establish a system of aging and disability resource centers across the state, which would oversee long-term living or community support services for Iowans with disabilities. That includes those with chronic mental illness, intellectual disability, developmental disability or a brain injury.
Funding for disability services also will be separated from mental health services under the new law for the first time ever, Garcia told reporters after Wednesday's press conference. That shift will allow the agency to strengthen services for Iowans with disabilities, while still providing a clear connection with behavioral health services, she said.
"So this will not be disconnected. It will just be a reestablishment on equal footing," Garcia said.
Behavioral health providers share equal parts optimism, wariness of new systems
Some providers have applauded Reynolds' plan, saying it removes historic barriers separating mental health and substance use programs in the state.
"We believe this is a step in the right direction to ensure that every Iowan has access to comprehensive mental health and substance use support," said Emily Bloome, CEO of Foundation 2, during the press conference. "This legislation is an opportunity to make meaningful changes in the system, which translates to meaningful changes in the lives of Iowans."
Leslie Carpenter, co-founder of the advocacy group Iowa Mental Health Advocacy, said she believes integrating these systems could be “transformative" for Iowans.
Carpenter said she saw that separation between mental health and substance use services firsthand with her son, who was diagnosed with schizoaffective disorder in 2013. Carpenter declined to name her son publicly.
He received rehabilitation care for a substance use disorder several times starting as a teenager, but Carpenter said those facilities often failed to provide care for his serious mental health condition. In fact, she said they often provided education to families that was not helpful for individuals with co-existing diagnoses.
"In our opinion, looking back on it with what we know now, we feel like it increased some harm to our son early on in getting care from people who only understood one side of it," she said.
But even as top officials begin the effort to establish and implement the new behavioral health system, many details on the day-to-day functionality of the system still aren't known, as well as the anticipated impact on providers and patients.
While the bill garnered support of major groups like NAMI Iowa and the Iowa Hospital Association during the legislative session, many groups were registered undecided on the bill. Some behavioral health providers and other advocates said they still have lingering questions on the transition.
Schmidt, of the Iowa Behavioral Health Association, said members of her organization have concerns about the proposed one-year timeline to establish the system, adding that the one-year turnaround may be too fast to seamlessly integrate legacy programs and services into the new structure.
"We also want to make sure this is truly an integrated behavioral health system for not only mental health, but that also meets the unique needs of those with substance use disorders, including assurances there is adequate funding for existing programs as well as the specialized programs for women, children, and adolescents, as well as residential treatment and prevention services," she said.
Michaela Ramm covers health care for the Des Moines Register. She can be reached at mramm@registermedia.com, at (319) 339-7354 or on Twitter at @Michaela_Ramm.
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