OTTUMWA — While Wapello County’s mental health services are stable at the moment, that could all change in just a couple of years.

Wapello County Central Point of Coordination Administrator Jennifer Vitko said according to Senate File 2315, which was passed into law last year, it would be up to regions of counties whether they want to pool their money and how many counties they want to include in their region.

“However, what we’re hearing from [Iowa Department of Human Services Director Charles Palmer] in a meeting with other providers is that he is wanting apparently to apply some stricter principles that go above and beyond what the legislation actually says,” Vitko said. “I don’t know that this will get done, however, there’s always a concern.”

At a legislative forum Friday morning, Vitko said county officials got the chance to air their concerns about mental health with area legislators, including state Rep. Mary Gaskill, D-Ottumwa.

“We really need to look at the levy,  and hopefully I can be of some influence up there and convince other legislators that we really need to address that,” Gaskill said.

Currently, Wapello County is able to levy $2.4 million per year, but because of the new per capita requirements that will lower the levy to 47.28, the county will lose $773,000 per year.

While there will not be an effect on mental health services in the county right now due to a fund balance carryover, in the future this could be a huge problem.

“Wapello County has always chosen to provide above and beyond services,” Vitko said. “We support the Promise Center, the Southern Iowa Mental Health Center through a block grant plus a sliding scale fee. Those services will remain intact along with prescription medications.”

So as long as the county continues to provide “above and beyond” services, their expenditures will continue to grow. Right now, Wapello County is fortunate to have that fund balance, Vitko said, but eventually that will run out.

“We’ll have to pull back to the mandated services,” she said. “At this point and time, we’re going to continue to offer expanded services, and the region we’re looking at going with, if we’re approved, also supports that philosophy. However, when the money begins to narrow and tighten, services will begin to narrow and tighten.”

Wapello County will join together with Appanoose and Davis counties to form a region, and their letter of intent is due to DHS by April 1. If and when that is accepted, the counties will move forward with their 28E agreement.

“Here’s the problem: We don’t know what the letter of intent is supposed to say because they never told us,” Vitko said. “Legislation doesn’t tell you what the letter of intent is supposed to say verbatim or verbage-wise. We just know it’s supposed to say who we intend to regionalize with.

“When we ask questions of DHS to give us some directive or help us in understanding, we’re not able to get that information. They indicate it’s as legislation says, no surprises, no surprises. However there have been two other regions that have submitted their letters of intent and have received no response.”

Gaskill said she didn’t realize there was so much confusion following the legislation.

“I think there has been [a disconnect] because that is the way they really want it to be, but we didn’t pass the legislation like that,” Gaskill said. “The Legislature wanted it one way, and obviously the administration probably wanted it the other way.”

That’s a reoccurring problem in Des Moines, Gaskill said.

“We have to deal with that continually with administrative rule in that the administrative office will interpret them one way and the legislative intent will be different,” she said. “It’s something we have to watch.”

Medication is not part of the core, mandated services.

“I’m concerned,” Gaskill said. “I knew that there were probably things going on I wasn’t aware of that I would eventually find out was happening. If the goal is to have services across the state of Iowa that are equal, I don’t believe that so far I see that that’s going to be happening.

“I don’t know how you can diagnose someone with a mental illness, know they need medication and then not provide it. If they can’t afford the medication, they have no way of getting the medication, then they just go without and get in trouble, disrupt families. If they had a broken leg or another physical problem, somebody would help them, so why don’t we help them with mental problems?”

Funding, or lack thereof, has been the problem all along, she said.

“If we don’t fund it adequately, then all of this drama and all of this changing has been for not,” she said.

And the unknowns surrounding the levy makes planning each county’s budget difficult.

“There are counties who are going to take a hit, like us, but there are also counties they promised to backfill,” Vitko said. “However, there was no money appropriated for that backfill.

“There’s a feeling of distrust with DHS. We as counties are trying to do exactly what the legislation says and have tried to have a very open conversation with DHS, but we’re redirected on a regular basis that there will be no surprises. But then, of course, we have very good provider relationships. When we talk to other providers, we’re hearing a more restrictive philosophy from DHS.”

Wapello County Supervisor Jerry Parker said the problem is that the rules established after a law is passed have not been written yet

“[Palmer] is, in my opinion, undermining the legislative intent of the law,” he said.

One problem that could arise once funding starts to dwindle is waiting lists.

“That means a new client may be told, ‘I’m sorry, we don’t have the funding.’ And they’ll have to wait until someone moves away, gets better and is off the program or passes away,” Parker said. “That’s a terrible way to manage mental health.”

Wapello County currently serves around 800 clients, Parker said.

“While mental health organizations around the state have closed, ours have been open because our county is financially able to support them,” he said. “If we in the future are not able to fund them, that would mean Southern Iowa Mental Health would not be in existence.”

Without medication, more mental health clients might offend or break the law, Parker said.

“If we don’t provide medications, they’ll be incarcerated or put in institutions and the costs there are considerably more,” he said. “What do we do now? We don’t know. All this time, clients out there are getting extremely nervous.”