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Questions Loom After Mental-Health Supplemental Funds Advance

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DES MOINES, Iowa Senators grudgingly agreed Tuesday to provide $11.6 million in transition funds for counties struggling to meet mental-health cost obligations, but vowed to press for more state funding in fiscal 2014 and beyond to ensure a smooth shift to a regional delivery system.

A Senate subcommittee voted to advance a supplemental funding bill for counties for the current fiscal year that ends June 30, but acknowledged the state must do more financially in redesigning Iowa's mental-health system to avoid waiting lists and service cuts that already are being contemplated.

Advocates for service providers and counties Tuesday favored for a $20 million recommendation made by an interim legislative study group, but Sen. Bob Dvorsky, D-Coralville, chairman of the Senate Appropriations Committee, said the $11.6 million was the most funding that could be agreed to with the House, which already approved House File 160 last week.

"Is this a perfect bill? No. Can we get more out of the House? No," said Dvorsky, who advocated for moving the bill to Gov. Terry Branstad's desk to get the supplemental funds to counties before they have to certify their fiscal 2014 budgets next month. "This is a good start," he said.

However, several senators questioned whether it was legal as the House had proposed to use money from the Children Health Insurance Program (CHIP) to distribute among the 26 counties having trouble meeting their Medicaid obligations at Iowa moves to a regional mental-health service delivery system. Branstad also has expressed concern about the transition funding source. CHIP is administered by states, but is jointly funded by the federal government and states.

Sen. Mark Segebart, R-Vail, said it appeared that using state surplus funds might be a preferred source given that the transition needs are a one-time problem that would be appropriate to address with one-time state money.

The representatives for mental-health providers and counties who addressed the subcommittee said waiting lists and service interruptions already were being contemplated through the first quarter of fiscal 2014 given that local property tax proceeds wouldn't arrive until October.

Sen. Joe Bolkcom, D-Iowa City, the subcommittee's leader, said the change-over from a county-based to a regional system for equalized mental-health services will require a multi-year funding solution that should help counties build up reserves to cover funding fluctuations "so things don't unravel" in fiscal 2015 when the regional approach has been fully implemented.