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Lori Elam

Lori Elam, CEO of the Eastern Iowa Mental Health and Disabilities Service Region, asks Muscatine County Board of Supervisors to support proposed changes to mental health tax levy.

MUSCATINE — The Eastern Iowa Mental Health and Disabilities Service Region needs the support of Muscatine County Board of Supervisors to tell the state its requirements for the region aren't working.

Lori Elam, CEO of the region, gave her quarterly update before the board Monday morning about the condition of the levy, services, and future provided by the five-county region that includes Scott, Cedar, Jackson and Clinton.

Giving background, she said the legislature passed a bill in 2017 that "altered the levy authority and also created fund balance requirements" for counties in the region.

Now the legislature, she said, may this week consider changing the fund balance spending requirement for the region from 20-25 percent to 30 percent, and give the region five years to spend the fund balance beyond the 30 percent, rather than three years.

"But that doesn't help matters," she said. "The bottom line is, our cap, that $30.78 (per capita), just doesn't work," referring to the mental health tax levy.

To add to the pressure, last year the House File 2456 moved additional mental health services into core services, mandating the regions provide them. The state would require regions to have access centers, ACT (Assertive Community Treatment) teams and intensive residential service homes beginning July 2021.

Elam said she told Department of Health and Human Services that the region will not start planning discussions or moving toward development of the new services because of the funding cap.

"We are not going to add any new services," she said. "It doesn't matter if they're mandated or not. We don't have enough money to pay for what we have now. It doesn't make sense to take on additional services that we can't pay for. It's not good for our citizens and it's not good for our providers to start something new and then have to end it in a year when we don't have any money."

Elam said two of the required services are already offered through the region. Vera French in Davenport is already providing ACT team services to 34 clients, three of them from Muscatine County, and care coordinators in the county are already providing services such as those offered at access centers. She said the program at Vera French is working to expand to serve 100 clients.

"(The state is) trying to address folks with complex needs who frequent our jails, emergency rooms and homeless shelters," she said, "and so the ACT team is one service that can help us address that."

The region already contracts with the nonprofit because it is the only ACT team provider in the region and has budgeted about $250,000 for clients not on Medicaid. Using Medicaid dollars before county dollars is how the region wants to spend its budget.

"My wish for DHS and state legislature was to leave us alone for a couple years and let us do good things," she said. "And let us get our feet on the ground and moving forward with some good services, and see what our rates are in terms of hospitalization and commitment and in the jail and homeless shelter.

Elam said between $40-45 per person would be "sufficient to do the services we need in our region as long as they don't make any other changes legislatively."

With the current tax levy, the region is depleting the fund balance but not replenishing it.

If all counties in the region levy at $30.78, "we can only generate $9.2 million," she said, "but yet with all the core services the crisis services we end up with a budget at about $13-14 million."

Supervisor Jeff Sorensen suggested the board rally other counties to put pressure on legislative groups to allow the counties to make changes based on regional need, as was the intent of the regionalization.

"Because enough is enough," he said of the state. "It's just ridiculous. They continue to do the same stuff. They got us into the problem in the first place, mandating services we have no funding streams for and they won't let us fix our own problems and we're not even asking them for state dollars. These are local tax dollars we're talking about. Just take the shackles off us and let us do our jobs."

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