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Lori Elam

Lori Elam, director of the Eastern Iowa Mental Health/Disability Services Region, has been trying to adjust budgets and long-term planning after new legislation added to the services her region would need to provide.

Mental health providers in eastern Iowa say they may run out money because of requirements set by the state legislature.

They shared that warning Monday afternoon during a meeting of the Eastern Iowa Mental Health/Disability Services Governing Board, a five-county organization that provides regional support and links residents with services.

In 2017, the legislature passed Senate File 504, which limits the maximum tax levy for mental health to $30.78 per capita and mandates that counties and regions spend down their health fund balance to 20 percent of their mental health expenditures.

But providers say that maximum tax levy is insufficient to continue providing services, and they're scrambling to figure out what will come next.

"I think it's important that (the legislature) realizes we will not make it through FY 20 at the rate we're currently going," said Lori Elam, CEO of Eastern Iowa Mental Health/Disability Services.

And while this year has brought myriad challenges for mental health providers, next year will bring even more, Elam said. Providers will then be required to spend down their mental health fund balance, from 20 percent in 2019 to 40 percent in 2020.

In the meantime, they're asked to provide more and more services. 

"Our levy cap is extremely low, but then we're forcing counties to spend down money or levy less just so we're all to the point of 40 percent," Elam said. "We keep spending more, and yet there's less revenue coming in."

Elam noted the expenditures per capita at the county level averages $33.81. "This shows that $30.78 doesn't work, though you know that," Elam said, noting that the 2019 fiscal year is not over yet.

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In preparation for next year, Elam said the legislature needs to see the current levy doesn't work. "They need to see that $30.78 is not working and it will force cuts in services. … They need to make a change, and they need to make it now."

"It's like we're facing a famine in a couple of years, but we're not allowed to put more acres into production," said board member Nathan Mather. "Part of the perversity of the whole legislative scheme is that not only do we have enough money, but because of the strictures of the cap, some of our member counties are effectively disallowed from even levying what they might be able to.

As of April 30, revenue is down sharply in FY 19. Revenues sit at $4.46 million, compared with $7.8 million during FY 2018 and $9.6 million the year prior. Expenditures are up to $10.1 million this year, compared with $9.6 million in FY 18 and $8.4 million the year prior.

A plan for mental health cuts will need to be ready to go by the November meeting, in preparation for sending that list to the legislative body as evidence that the cap doesn't work.

FY 20 is estimated to have an expenditure of $12 million before including children's services, access centers or intensive residential services, Elam said.

"These are the services that would need to be eliminated, these are the number of people that would be affected, the dollar savings and the projected other costs because when you cut services in one place it has an increased cost somewhere else," she said. 

While there are things that can be done, Elam said, it's important that the legislature sees $30.78 is not working and will force cuts.

Board Chair Jack Willey struck a pessimistic tone in response to that. "We've been saying that for years, and they haven't listened." 

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