Mental health services change

New expansions to Medicaid have changed how Webster County Community Services handles some payments and services, according to Administrator Ken Hays.

The department is seeing changes in who handles certain key services, he said, handing control of the Friendship Center over to the Hope Haven nonprofit, for example. But the biggest changes in the department come from a statewide mental health services redesign which began in 2012.

Many of Community Services’ clients are now eligible for expanded Medicaid under changes that went into effect Jan. 1.

“A lot of the folks that used to come to us for mental health funding, or for medication assistance for mental health and that kind of thing, most of those folks have transferred over into expanded Medicaid,” Hays said. “So part of our role at this point is just to help those folks understand that process, and help them to access those funds that are available.”

The changes can cause a lot of confusion among people seeking help, he said, so the department helps them connect with the right resources.

Shifting certain payments to the federal government instead of the county has advantages, he said.

“As taxpayers, we’ll pay for it one way or the other,” said Hays. “I honestly think it takes a burden off the county taxpayer to fund that medication and those outpatient services.

“The advantage to the person is that it opens up not only mental health services, and medication, but also general medical services that were very difficult for them to access in the past.”

These advantages go beyond what Community Services directly works with, he said.

The department will continue to work with people as it has in the past.

“We will not deny reimbursement for individuals who have failed to sign up or have not yet signed up for insurance,” he said. “As we’ve done in the past, we’ll refer, assist and support them in getting the coverage they need.”

Friendship Center under new management

In December, management of the Friendship Center changed over to Hope Haven, a non-profit organization based in Rock Valley.

The center is a place for people with chronic mental illness to go to meet with peers, join group therapy and use computers, said Doug Smit, director of Mental Health and Family Services for Hope Haven.

Before, Webster County was basically a service provider, said Hays. But over time the needs of people using the center evolved and put more and more demand on the county’s resources.

“We felt it was a very good fit for them,” Hays said of Hope Haven. “They were very excited about taking over that service.”

The county still pays for Hope to run the facility, Smit said.

“Down the road, the intent of it is to assist the county in lessening the amount of money they’re required to keep these services going,” he said. “Then we would move into more of a Medicaid-funded program as much as possible.

“That’s part of the mental health redesign that’s been happening across the state over last two or three years here,” he added.

Shortly after the change, the center moved to a new location, Smit said. It is now located where the county Public Health Department once was, the former Wahkonsa school, 330 Ave. N. The Health Department is now in the former Friendship Center, on the second floor of the Northwest Bank, 723 First Ave. S.

In the future, Hope Haven wants to bring more types of service to the Friendship Center.

“We would like bring in what’s called intensive psych rehab,” Smit said.

A group effort

Hope Haven joins a number of other local organizations the county works with to provide services, Hays said, including Opportunity Village, Lifeworks and the Berryhill Center at Trinity Regional Medical Center.

Community Services itself has seen a reduction in staff. Hays has been with the department since 2003; he became director in February 2013 when his predecessor retired.

“When my previous supervisor left, we did not replace me,” he said. “When I moved up to department director, my position was not filled.”

Hays is also paid less than his predecessor, who had worked there a long time. This reduction accounts for part of the decrease in the Webster County mental health budget.

The mental health budget for the 2013-2014 year is about $3.2 million, compared to an estimated $4.8 million spent for 2012-2013 and $5.4 million spent for 2011-2012.

A small portion of the department’s funding comes from the county Physical Health and Social Services budget, as well, according to County Auditor Carol Messerly.

Community Services takes care of mental health, but it also includes general assistance for the poor and case management, which monitors services provided to people with brain injuries or chronic mental illness.

Mental Health regions

The organization of all Iowa counties into mental health care regions will be completed in 2014, Hays said. This process began in mid-2012, when the state first mandated regionalization.

“In August 2012, we joined with the county social services region, which is a region covering – now there’s 22 counties,” Hays said. “It used to be every county was on its own.”

The focus is to provide more equally available services and funding throughout Iowa, in spite of differences in county population, he said.

Case management, especially, has changed under the new system. Before, Webster County Community Services was responsible for individuals outside the county as well.

“Some of those folks we used to work with in other parts of the state, and do case management for, are now covered by case management in the county in which they reside,” he said. “That’s one of the other advantages.”

In particular, rules on which county was responsible for a given individual changed in July 2013. Instead of a process called legal settlement, the rules are now based on residency.

Legal settlement was complicated, Hays said.

“For example, say I lived here in Webster County and I moved to Polk County sometime in the year after my 18th birthday. And I began to need mental health services or substance abuse services, or correctional services within that first year,” he said. “Polk County could say to Webster County, ‘This person does not have legal settlement, they did not live here for 12 consecutive months with no services.'”

Webster County could end up paying for that person indefinitely, he said.

Under the new rules, a person who moved to a new county would become the responsibility of that county, as long as he or she had once had a residence there outside of a group home.